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Teleconsultation, which was commonplace during the lockdown, is becoming part of healthcare practices

Published on 24 June 2020
Update on 26 September 2022
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Summary

Since 2018, teleconsultation is part of the common law of medical practices. However, this practice remains quite marginal (25,000 in December 2019, 40,000 in February 2020), compared to making an appointment with doctors, practiced by 40% of French people, according to the survey Capuni.

At the time of the confinement, thanks to a relaxation of the regulatory framework, on March 10th, teleconsultation was very quickly and widely adopted by professionals and by a very large number of patients. In addition to the traditional telemedicine platforms already in place, consultations could be done through any device, be it Skype, WhatsApp... A simple consultation by phone was even possible for people living in white zones.

Teleconsultation essential in the fight against the coronavirus epidemic

On March 23 (13 days after the decree), the think-tank Montaigne Institute pointed out the importance of teleconsultation.

" In an epidemic situation like the one we are currently experiencing, the main challenge for the health system is to be able to cope with the overload in hospitals, caused by COVID-19 and to ensure continuity of care. In case of symptoms, the guidelines of the Ministry of Health are very clear: "do not go to your doctor or to the emergency room, to avoid any potential contamination".

Therefore, teleconsultation seems to be the most appropriate way to relieve the hospital services by making a first sorting between false alarms and potential patients, to treat at a distance by allowing to take care of the persons infected by the coronavirus but whose state does not require a hospitalization and finally to avoid the physical contacts by protecting the most vulnerable (old people, persons suffering from chronic diseases) but also by protecting the caregivers, in order to minimize the infection risk. In addition to teleconsultation, there is also remote monitoring, which allows the less serious cases of coronavirus to be followed up at home, and tele-expertise, which offers healthcare professionals the possibility of seeking a second medical opinion.

Référence :

Over 4.5 million teleconsultations recorded in April

Between February and March, the number of teleconsultations increased 30-fold, notes Cnam, which has tallied nearly 5.8 million cumulative teleconsultations since September 2018, including 5.5 million performed between March and April 2020 alone, when the number quadrupled again.

Almost all teleconsultations performed since September 2018 have been billed by private physicians (96%), ahead of health centers (2%) and outpatient consultations (2%) at institutions.

The number of teleconsulting physicians reached 36,000 in March, before increasing to 56,000 in April (there were 3,000 at the end of 2019)

Since September 2018, Ile-de-France has concentrated the largest number of teleconsultations performed (1.09 million, including 320,000 in Paris) ahead of Auvergne-Rhône-Alpes (741,000), Occitanie (560.000), New Aquitaine (541,000), Provence-Alpes-Côte d'Azur (533,000), Eastern France (532,000), Hauts-de-France (437,000), Pays de la Loire (296,000), Brittany (248,000), Normandy (231,000), Burgundy-Franche-Comté (229,000) and Centre-Val de Loire (171,000).

Since September 2018, more than 57,000 healthcare professionals have billed an average of 100 teleconsultations each.

According to the CNAM, 26% of teleconsultations were carried out for patients with long-term illnesses (ALD) and 80% were billed through third-party payment.

Référence :

"Boosted by the crisis, teleconsultation will not solve medical deserts"

Alexandre Lechenet and the Gazette des Communes have had access to data from Doctolib, a platform used by many doctors to facilitate the booking of appointments and which allows remote consultations. According to Doctolib data, the use is very unevenly distributed over the territory.

For example, one third of doctors registered on Doctolib and equipped with their video-consultation solution practice in the Île-de-France region. And half of the teleconsultations via Doctolib since the beginning of the epidemic have been made from the Île-de-France and Auvergne-Rhône-Alpes regions, even though these two regions account for only 30% of the French population.

"The use of teleconsultation has thus become more democratic, but it is not the effective remedy against medical desertification, agree to say different elected officials concerned contacted; especially if the tool is considered alone," observes the Gazette des Communes."Teleconsultation must not be the tree that hides the forest, but a key to entry among others," explains Gilles Noë, the mayor of Varzy (Nièvre). "We can't just wait for telemedicine to save the day," he continues, "we need to attract health professionals, and not just doctors, to the area. He cites, for example, the possibility for caregivers to perform consultations next to the elderly people they care for. "The real solution, however,is to put doctors in the territories", pleads André Accary, president of the department of Saône-et-Loire, who is very skeptical about the teleconsultation booths in town halls.

Internet access is another major obstacle; moreover, the map of medical deserts covers the areas with the lowest digital bandwidth.

Even once connected, the obstacle course isn't over. "We realize that there are barriers to using telemedicine," notes Caroline Span, co-director of MedNum. " The oldest have significant support needs: need for an email address to register, identification of the teleconsultation service where to find the doctor among the dozens that exist"...

Référence :

Limitations of teleconsultation

On May 19, in a note dedicated to the Urban medicine and the epidemicpublished by the think tank Terra-Nova, general practitioners pointed out the limits of teleconsultation.
  • "The absence of a clinical examination that is inseparable from a consultation with a doctor that allows the diagnosis and, above all, the evaluation of the severity is not possible, which may introduce a bias in the evaluation of the patient's situation.
  • Some prescriptions are impossible to make at a distance: a clinical re-evaluation is sometimes indispensable, especially for certain renewals of chronic treatments in elderly or vulnerable patients.
  • The digital divide: lack of internet or smartphone connection, lack of familiarity with new technologies, language barriers, can lead to breakdowns in care for vulnerable, elderly or precarious people.

    • Référence :

Telemedicine, beyond the extreme case of Covid19 .

The interest of these tools for remote monitoring of patients is not limited to the extreme case of a pandemic, observes the Institut Montaigne. "Caregivers are getting equipped and many patients will become familiar with teleconsultation, which will undoubtedly increase access to care (...) Teleconsultation will undoubtedly allow France to begin the shift to prevention-based medicine. Indeed, in a context of an aging population and an explosion of chronic diseases, the French healthcare system will have to focus its strategy more and more on disease prevention and regular support for patients.

To perpetuate this practice, Doctolib makes five recommendations:

  • allow professions authorized to perform reimbursed video consultations during the epidemic to continue after the epidemic (in particular nurses, midwives, masseurs-physiotherapists and speech therapists)
  • Create a greater financial incentive to encourage health professionals to use video consultation
  • encourage the use of secure video consultation solutions and put an end to the reimbursement of procedures carried out via non-medical video or telephone consultation solutions, decided on an exceptional basis during the epidemic
  • facilitate patients' access to video consultation with their general practitioner and specialist
  • produce good practice guidelines for healthcare professionals and patients to guide them in adopting this new usage.
For Marie-Laure Saillard (MesDocteurs), interviewed by the specialized site TIC-Santé, "this crisis has considerably shortened the distances and broken down the partitions between the actors of health... It is now a question of transforming the test. Telemedicine must not remain a medicine of war".

An order published on June 18 extended the 100% reimbursement of telemedicine procedures by the health insurance "until a date specified by decree, and no later than December 31, 2020.

 

 

 

Référence :

Sources

Teleconsultation, which was commonplace during the lockdown, is becoming part of healthcare practices

Since 2018, teleconsultation is part of the common law of medical practices. However, this practice remains quite marginal (25,000 in December 2019, 40,000 in February 2020), compared to making an appointment with doctors, practiced by 40% of French people, according to the survey Capuni.

At the time of the confinement, thanks to a relaxation of the regulatory framework, on March 10th, teleconsultation was very quickly and widely adopted by professionals and by a very large number of patients. In addition to the traditional telemedicine platforms already in place, consultations could be done through any device, be it Skype, WhatsApp... A simple consultation by phone was even possible for people living in white zones.

Teleconsultation essential in the fight against the coronavirus epidemic

On March 23 (13 days after the decree), the think-tank Montaigne Institute pointed out the importance of teleconsultation.

" In an epidemic situation like the one we are currently experiencing, the main challenge for the health system is to be able to cope with the overload in hospitals, caused by COVID-19 and to ensure continuity of care. In case of symptoms, the guidelines of the Ministry of Health are very clear: "do not go to your doctor or to the emergency room, to avoid any potential contamination".

Therefore, teleconsultation seems to be the most appropriate way to relieve the hospital services by making a first sorting between false alarms and potential patients, to treat at a distance by allowing to take care of the persons infected by the coronavirus but whose state does not require a hospitalization and finally to avoid the physical contacts by protecting the most vulnerable (old people, persons suffering from chronic diseases) but also by protecting the caregivers, in order to minimize the infection risk. In addition to teleconsultation, there is also remote monitoring, which allows the less serious cases of coronavirus to be followed up at home, and tele-expertise, which offers healthcare professionals the possibility of seeking a second medical opinion.

Référence :

Over 4.5 million teleconsultations recorded in April

Between February and March, the number of teleconsultations increased 30-fold, notes Cnam, which has tallied nearly 5.8 million cumulative teleconsultations since September 2018, including 5.5 million performed between March and April 2020 alone, when the number quadrupled again.

Almost all teleconsultations performed since September 2018 have been billed by private physicians (96%), ahead of health centers (2%) and outpatient consultations (2%) at institutions.

The number of teleconsulting physicians reached 36,000 in March, before increasing to 56,000 in April (there were 3,000 at the end of 2019)

Since September 2018, Ile-de-France has concentrated the largest number of teleconsultations performed (1.09 million, including 320,000 in Paris) ahead of Auvergne-Rhône-Alpes (741,000), Occitanie (560.000), New Aquitaine (541,000), Provence-Alpes-Côte d'Azur (533,000), Eastern France (532,000), Hauts-de-France (437,000), Pays de la Loire (296,000), Brittany (248,000), Normandy (231,000), Burgundy-Franche-Comté (229,000) and Centre-Val de Loire (171,000).

Since September 2018, more than 57,000 healthcare professionals have billed an average of 100 teleconsultations each.

According to the CNAM, 26% of teleconsultations were carried out for patients with long-term illnesses (ALD) and 80% were billed through third-party payment.

Référence :

"Boosted by the crisis, teleconsultation will not solve medical deserts"

Alexandre Lechenet and the Gazette des Communes have had access to data from Doctolib, a platform used by many doctors to facilitate the booking of appointments and which allows remote consultations. According to Doctolib data, the use is very unevenly distributed over the territory.

For example, one third of doctors registered on Doctolib and equipped with their video-consultation solution practice in the Île-de-France region. And half of the teleconsultations via Doctolib since the beginning of the epidemic have been made from the Île-de-France and Auvergne-Rhône-Alpes regions, even though these two regions account for only 30% of the French population.

"The use of teleconsultation has thus become more democratic, but it is not the effective remedy against medical desertification, agree to say different elected officials concerned contacted; especially if the tool is considered alone," observes the Gazette des Communes."Teleconsultation must not be the tree that hides the forest, but a key to entry among others," explains Gilles Noë, the mayor of Varzy (Nièvre). "We can't just wait for telemedicine to save the day," he continues, "we need to attract health professionals, and not just doctors, to the area. He cites, for example, the possibility for caregivers to perform consultations next to the elderly people they care for. "The real solution, however,is to put doctors in the territories", pleads André Accary, president of the department of Saône-et-Loire, who is very skeptical about the teleconsultation booths in town halls.

Internet access is another major obstacle; moreover, the map of medical deserts covers the areas with the lowest digital bandwidth.

Even once connected, the obstacle course isn't over. "We realize that there are barriers to using telemedicine," notes Caroline Span, co-director of MedNum. " The oldest have significant support needs: need for an email address to register, identification of the teleconsultation service where to find the doctor among the dozens that exist"...

Référence :

Limitations of teleconsultation

On May 19, in a note dedicated to the Urban medicine and the epidemicpublished by the think tank Terra-Nova, general practitioners pointed out the limits of teleconsultation.
  • "The absence of a clinical examination that is inseparable from a consultation with a doctor that allows the diagnosis and, above all, the evaluation of the severity is not possible, which may introduce a bias in the evaluation of the patient's situation.
  • Some prescriptions are impossible to make at a distance: a clinical re-evaluation is sometimes indispensable, especially for certain renewals of chronic treatments in elderly or vulnerable patients.
  • The digital divide: lack of internet or smartphone connection, lack of familiarity with new technologies, language barriers, can lead to breakdowns in care for vulnerable, elderly or precarious people.

    • Référence :

Telemedicine, beyond the extreme case of Covid19 .

The interest of these tools for remote monitoring of patients is not limited to the extreme case of a pandemic, observes the Institut Montaigne. "Caregivers are getting equipped and many patients will become familiar with teleconsultation, which will undoubtedly increase access to care (...) Teleconsultation will undoubtedly allow France to begin the shift to prevention-based medicine. Indeed, in a context of an aging population and an explosion of chronic diseases, the French healthcare system will have to focus its strategy more and more on disease prevention and regular support for patients.

To perpetuate this practice, Doctolib makes five recommendations:

  • allow professions authorized to perform reimbursed video consultations during the epidemic to continue after the epidemic (in particular nurses, midwives, masseurs-physiotherapists and speech therapists)
  • Create a greater financial incentive to encourage health professionals to use video consultation
  • encourage the use of secure video consultation solutions and put an end to the reimbursement of procedures carried out via non-medical video or telephone consultation solutions, decided on an exceptional basis during the epidemic
  • facilitate patients' access to video consultation with their general practitioner and specialist
  • produce good practice guidelines for healthcare professionals and patients to guide them in adopting this new usage.
For Marie-Laure Saillard (MesDocteurs), interviewed by the specialized site TIC-Santé, "this crisis has considerably shortened the distances and broken down the partitions between the actors of health... It is now a question of transforming the test. Telemedicine must not remain a medicine of war".

An order published on June 18 extended the 100% reimbursement of telemedicine procedures by the health insurance "until a date specified by decree, and no later than December 31, 2020.

 

 

 

Référence :

Sources

Labo Société Numérique

Labo République Française Agence nationale de cohésion des territoires
Teleconsultation, which was commonplace during the lockdown, is becoming part of healthcare practices