The health crisis has been a trial run for the medical consultations online, but this trend going to last? The French have been convinced by the telemedicine consultations as video-conference or by phone? The challenges to sustain the use and spread of telemedicine are many, and his usefulness, to absorb the medical deserts, for example, remains to be seen. Then, the telemedicine will she survive? The debate is launched.
Remote consultations, more useful than ever before
During the containment, telemedicine has made it possible for many persons confined to consult a health professional at a distance, and this has had a fundamental role in the fight against the spread of the virus. On one side, this type of consultation has helped to relieve pressure on hospital services by exercising a first sorting between false alerts and potential patients who, to treat people infected with the coronavirus, which did not require hospitalization; on the other hand, it was possible to avoid physical contacts, protecting the caregiver and the elderly or people with chronic diseases.
What brakes to the implementation of telemedicine?
During the health crisis, the regulatory constraints that limit the use of tele-consultations have been lifted. The decree of 10 march allowed the reimbursement of the patient from the first consultation with a doctor, whether the doctor or not.
A consequence, while between September 2018 and December 2019 only 138 000 tele-consultation have been refunded, between 6 and 12 April 2020, the health Insurance has refunded more than one million tele-consultation medical.
However, professionals were not necessarily equipped with video conference tools and medical devices-connected to provide tele-consultation quality. In addition to the facilities, the doctors are not trained in methods of a virtual consultation.
According to a survey published in 2019 , 90 % of medical students were not trained in telemedicine in the first year (called PACES, which is common to all students in health), and only 20 % of interns were trained in this new form of practice of medicine.
The explosion of telemedicine will not necessarily solve the problem of medical deserts
The doctors have been able to get consultations, either by telephone to the public the less connected, either by using messaging services such as Whatsapp or Skype, but it’s the service Doctolib, the leading actor of tele-consultation in France.
Before the outbreak of Covid-19, Doctolib equipped 3 500 practitioners of his service, tele-consultation, including a majority of general practitioners. For the containment (between January 2019 and march 2020), 180000 tele-consultation have been carried out via Doctolib and taken care of by the Insurance.
At the global level in France, the video consultations have therefore been multiplied by 100, with 100000 tele-consultation conducted by day. To follow this exponential development, the platform has put its tool video access free. The use of the platform has, however, been very unevenly distributed on the territory. One-third of the doctors registered on Doctolib and equipped for their solution vidéoconsultation were based in the Île-de-France. And half of the tele-consultation via Doctolib since the beginning of the epidemic, have been made since the Île-de-France and Auvergne-Rhône-Alpes, while these two regions do not gather that 30% of the French.
For some regions, the tele-consultation is not going to solve the problem of desertification a medical, in particular because there is a need medical assistants to carry out the consultations.
John Billard, mayor of Favril and vice-president of the Association of mayors of rural France, which has launched a cabin teleconsultation to fight against the medical deserts, the health crisis has, however, “liberalized the practice and changed the look on telemedicine”.
In addition to the teleconsultation, digital health at the service of the medical care provides other uses: the appropriation by the patient of the medical data, the chatbots that work as coaches of health, the robots (which take the temperature or make levies), making an appointment online but not yet e-prescribing, which is now limited to a scanned image of the hardcopy sent by the pharmacists.
According to a recent report from the Montaigne Institute, the crisis of the Coronavirus may be an opportunity to move to a model much more innovative in supporting innovative businesses in the health and directing the purchasing policy to the innovation), to make France a leader in e-health .