Supported by Health Insurance since September 2018, medical teleconsultation was struggling to become more democratic and to become anchored in the habits of general practitioners and specialists. Containment, introduced in mid-March to fight the Covid-19 pandemic, has exploded the use of this practice, with 1 million teleconsultations recorded by the CNAM for the week of March 30 alone.
According to Doctor Jean-Paul Ortiz, President of the Confederation of French Medical Syndicates (CSMF), this crisis will accelerate the adoption of teleconsultation, and, more broadly, of telemedicine.
Why did doctors not seize the opportunity to resort to teleconsultation before being forced to do so by the pandemic?
Dr Ortiz. – The health crisis played the role of an accelerator, making it possible to cross in a few days the stages which usually mark out the cycle of adoption of an innovation. It was necessary to reduce the exposure of professionals and their patients to the virus. And the call by the authorities to consult only in emergencies was so well heard that general practitioners, and medical specialists, in particular, saw their offices deserted overnight. They logically worried about the follow-up of their patients, in particular those with chronic diseases (diabetes, heart failure, etc.), whose risks are increased in the context of Covid-19. Subscription to online platforms allowing appointments to be made, video calling and the secure exchange of documents was not very common among doctors until then. Thanks to the crisis, most market players have granted advantageous pricing conditions (including temporary free access), which has made it possible to democratize the use of their solutions. Finally, during the state of a health emergency, the authorities relaxed the rules for teleconsultation coverage by Health Insurance and decreed 100% coverage of teleconsultation acts for all. the patients1. From 40,000 teleconsultation acts in February, we went to one million for the week of March 30 alone! 85% of these teleconsultations were also carried out between a patient and a doctor who knew each other, therefore respecting the course of care, according to the CNAM.
What are the advantages of teleconsultation, beyond those linked to the current context?
Dr Ortiz.- In the “ My health 2022 ” plan, teleconsultation is presented in particular as a means of fighting against geographical inequalities in access to care. However, this is not obvious, because the medical deserts partially cover the white areas, that is to say, poorly covered by telecommunications networks. And it is also in these areas, mainly rural, that we find the people least familiar with new technologies. The assistance of a health professional (nurse, pharmacist, etc.) can nevertheless be requested to enable teleconsultations in these cases.
Today, the populations who practice teleconsultation the most are city dwellers, rather young and belonging to the CSP +. To which are added grandparents who have started to use smartphones and tablets to keep in touch with their children and grandchildren.
The advantage of teleconsultation, alternating with consultation in the office, is to simplify the monitoring of chronic pathologies, this by limiting patient travel. This also makes it possible to speed up the time taken to take charge of treatment in the event of an emergency, a one-off acute pathology (winter illnesses for example) or requiring the assistance of an unusual speciality. Finally, teleconsultation responds to a major trend in the medicine of tomorrow: the patient is, more and more, an actor in his health.
Isn’t the clinical examination too superficial during a teleconsultation?
Dr Ortiz.- For a doctor who knows his patient, seeing his face helps to understand his general condition. For a dermatological problem, the examination can be performed by video. And, more and more, patients are equipped to record some of their physiological constants: temperature, blood pressure, glucose levels for diabetics, etc. Spaces dedicated to teleconsultation, which are being developed in pharmacies, are also equipped to allow, from a distance, a more in-depth clinical examination. That said, the video is indeed a cold medium: it is impossible to palpate, auscultate, gauge the gait, the attitude or even the personal hygiene of a patient. For these reasons, teleconsultation is not intended to replace consultation, which must remain a privileged mode of access to care.
Once the epidemic has passed, will the teleconsultation boom end?
Dr Ortiz.-While deconfinement will start soon, it may still be difficult to imagine today, but nothing will ever be the same again. An epidemic ends when 60% of the population has developed antibodies, either by contracting the disease or by vaccination. The Covid-19 vaccine does not yet exist, so it is likely that social distancing will be the norm for several more months.
There will undoubtedly be a slight drop in the number of teleconsultations, but I am convinced that practice has become firmly established in the habits of doctors and patients. It responds to a real need: to facilitate access to care. As of April 7, the CNAM listed 30,000 doctors now practising teleconsultation on a regular basis. It will gradually be necessary to train all the doctors and future doctors there. Ultimately, this does not mean fewer consultations, but better patient care, and therefore better efficiency of our health system.
