Panorama of teleconsultation in France Ehealth innovation

January 07, 2020

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Telemedicine took off in 2018 with the medical insurance coverage of teleconsultation procedures for all patients and throughout the country since September 15. Decryption of teleconsultation in France.

To fully understand the challenges of deploying teleconsultation in France, it is necessary to start with a simple definition of this act of telemedicine and the associated objectives.

For Health Insurance, " teleconsultation is a consultation carried out remotely of a patient by a doctor (general practitioner or any other medical specialty), the patient being able to be assisted or not, on this occasion, by another health professional (ex: doctor, nurse, pharmacist…) ".

Teleconsultation provides new solutions to facilitate user access to healthcare throughout the country, including in areas with medical desertification. In particular, it allows:

  • improve patient care, by avoiding renouncing specialized opinions or excessively long care times

  • simplify patient monitoring

  • avoid unnecessary travel or emergency room visits for patients.

  • coordinated care between health professionals.

Teleconsultation concretely how does it work?

The application decree clearly defines the methods for putting teleconsultation into practice.

" Any doctor can use teleconsultation, whatever: their specialty, their sector of practice (sector 1, sector 2) and their place of practice, in town or in a health establishment (city office, multiprofessional health center) , health center, nursing health home, hospital, clinic, etc.). It is achievable everywhere in mainland France and in the overseas departments and regions. "

All medical situations can give rise to teleconsultation, but the implementation is the sole decision of the doctor (treating doctor, doctor with direct access or corresponding doctor, as the case may be) who must judge the relevance of treatment. medical work remotely rather than face to face.

There are prerequisites for teleconsultation:

  • The "teleconsultant" doctor must know the patient: he must have had at least one physical consultation with him during the last 12 months preceding the teleconsultation

  • The course of care must be respected: the teleconsultation is part of the respect for the coordinated course of care so the patient must be referred by his attending physician to a teleconsulting doctor (if he is not the teleconsulting doctor).

Teleconsultation procedures are billed by the teleconsultant doctor at the same price as a face-to-face consultation. The reimbursement procedures are the same as for a standard consultation.

Opening of teleconsultations in pharmacies

To allow access to teleconsultations for the entire population and to benefit from the territorial network of pharmacies, it was decided to open teleconsultations in pharmacies.

Provided by the conventional amendment n ° 11, the teleconsultation is now specified in the amendment n ° 15, signed on December 6, 2018 by the Health Insurance. This conventional advance provides a concrete solution for the elderly and frail people who may encounter difficulties accessing healthcare. It allows these patients to access their doctor or the hospital via the equipment of the local pharmacy, thus limiting their movement.

Teleconsultations must be carried out in accordance with the patient's coordinated care plan with an attending physician or a physician known to the patient. In their absence, teleconsultation will be implemented within the framework of a coordinated territorial organization (professional community of health territory or primary care team).

All pharmacies can offer teleconsultation. They must have a confidentiality space and various equipment such as a videoconference, a smart health connected stethoscope, a smart health connected otoscope, an oximeter and a blood pressure monitoring.

Teleconsultation players in France

To exercise teleconsultation in France, it is necessary to obtain approval from the ARS (Regional Health Agency). Obtaining this approval is subject to various conditions: secure hosting of health data, equal treatment of patients, securing care paths, etc.

During the implementation of the teleconsultation application decree, the government announced forecasts: 500,000 teleconsultation acts in 2019, 1 million in 2020 then 1.3 million in 2021. These forecasts attract new players to conquer this market.

A number of start-ups have emerged and obtained their approval: Medaviz, Mesdocteurs, Qare, Feelae, Medicitus, Zava, etc. They apply the procedures defined by proposing citizens to follow an online consultation in writing, by telephone or ehealth, with a professional. health.

These new players are added to historical players in teleconsultation such as Médecin Direct. Other players are entering this market, such as Doctolib, which launched its teleconsultation service in early 2019.

As part of the procedures for setting up teleconsultation, teleconsultations can be carried out and billed as part of “external consultations” by health establishments under the same conditions as face-to-face consultations. Teleconsultation services are legally assimilated to external acts and consultations and thus meet the same legal frameworks and the same billing conditions.

Focus on chronic diseases: where are they used?

Thinking ahead of time about renewing your medication, waiting two months for an appointment with your specialist, making an emergency appointment with your general practitioner, etc. Having a chronic illness changes your daily life and often requires close medical follow-up, forcing you to plan your schedule, which can be very restrictive. Teleconsultation may appear to be one of the solutions reducing the multiple constraints encountered by people with a chronic illness and promoting the flow of care.

However, the survey conducted with the Chronic Panel of B3TSI shows that:

  • Only 8% of people affected by a chronic disease have already used teleconsultation in the past 12 months.

  • 92% have not yet experienced it:

On average, people who have used teleconsultation consult their doctor 5.4 times a year compared to 4.6 for those who have not teleconsulted in the last 12 months.

In the same logic, those who teleconsult used specialists on average 3.5 times in the year against 1.9 for the others.

The same goes for people who have used emergency services in a hospital or clinic: 30% of those who have already teleconsulted, compared to 22% of people who have never used teleconsultation.

Teleconsult today: who, how, why?

B3TSI looked more specifically at the reasons why 8% of respondents used teleconsultation in the past 12 months.

  • 66% consulted a general practitioner and 30% a specialist doctor,

  • 75% carried out this teleconsultation from their health home,

  • 49% of respondents say that teleconsultation was the only way to access the doctor in question,

  • 39% that it was an emergency,

  • 37% that the physical appointment was too far away,

  • 20% that their attending physician was unavailable.

Moreover :

  • in 71% of cases, the patients carried out a teleconsultation to avoid moving,

  • 36% to avoid stress,

  • 30% to avoid traveling by VSL (light medical vehicle) or by ambulance.

Teleconsulting, is it as good as consulting?

Teleconsultation is not only limited, as one might think, to tele-counseling and today is really part of the field of care for chronically ill people who have used it.

Finally, in terms of patient satisfaction, 10% are more satisfied by teleconsultation than by conventional consultation and 63% believe that the two systems are just as satisfactory.

Teleconsultation, towards more frequent uses?

Teleconsultation therefore facilitates the daily life of certain chronic patients. The system avoids the displacement and stress provided by a restrictive organization and above all allows easier access to care and much more simplified medical follow-up. However, the device is still very little used by the chronically ill, the main people concerned with the organization of the health system.

And tomorrow what will it be? For Alexis Bonis Charancle, associate director of B3TSI: "The real answer will be known in early June, with the publication of the results of the second edition of this survey. 8 months after the implementation of the teleconsultation reimbursement, we will be able to see if the uses are really developing. To be continued… ".

Survey conducted on the basis of the B3TSI Chronic Panel, from November 14 to 22, 2018, with a representative national sample of 1,427 chronically ill respondents.

Sources: Health Insurance, B3TSI

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