Telecare: role and responsibilities of the advanced practice nurse (APN)

2023-09-20 13:49:09

In June 2021, the French Society for Digital Health (SFSD) published a white paper entitled “Telecare at the heart of health care innovation – Recommendations and testimonials for carrying out your project”. This collaborative work demonstrates the challenges of deploying telecare in France and highlights recommendations for good practice for all health professions concerned. A supplement is now necessary to clarify the role and responsibilities of the advanced practice nurse (APN), the new cornerstone of the coordinated/alternating care pathway..

Associé à la télémédecine dans le cadre du parcours coordonné-alterné qui elle est réservée aux professionnels médicaux, le télésoin se définit comme « une forme de pratique de soins à distance utilisant les technologies de l’information et de la communication. Il met en rapport à distance un patient avec un ou plusieurs pharmaciens ou auxiliaires médicaux dans l’exercice de leurs compétences prévues au présent code »

This addendum to the White Paper on telecare aims to support the growth of the practice of telecare by APNs by applying good clinical practices recommended by the HAS. This time the spotlight is on APNs working in hospitals or in private practice in all regions of France. Each person shares, through verbatim statements from telephone interviews, their main thoughts around the implementation of a telecare project and its benefits for caregivers, those receiving care and the health system in general.

As part of the coordinated-alternating pathway, certain IPAs, both hospitalists and liberals, did not wait for the texts to evolve to begin practicing telecare since their decrees allowed them to do so. Especially during the COVID pandemic. These pioneering initiatives have encouraged the spread and multiplication of telecare.

The multiple testimonies from IPA confirm the interest in integrating telecare into their practice, alternating with face-to-face care. Telecare is experienced as an experience with real added value for patients and APNs.

For the IPA, telecare is an act of care as relevant as face-to-face care in patient follow-up. It makes it possible to strengthen support facilitating therapeutic education, compliance, and development of self-care skills, while ensuring that the quality of care is maintained.
For the patient, adherence will be all the more effective when complete information has been provided (real effective preparation time for both parties) and consent has been obtained. Caregivers are also key players in the success of telecare. Even more so if they were involved in carrying out the care plan. The relationship of trust established reassures the patient and the personalized support improves their quality of life on a daily basis.
However, the following should be mentioned:
– the essential preparation during the eligibility visit to avoid telecare being time-consuming and risking being monopolized by patients.
– the need for a minimum active queue for liberals subscribing to non-mandatory paid solutions.
– the IT and sometimes logistical limits encountered in the hospital.
Telecare is changing professional practices which for some are obstacles in the face of individual, technological, logistical and financial limits. But once resistance to change has been overcome by identifying or anticipating them, it is synonymous with improved quality of life… for the stakeholders concerned.

The French Digital Health Society would like this addendum to highlight the potential of telecare for APNs, new players in the coordinated care pathway, with a key activity of patient monitoring. By adopting the practice of remote care and digital tools, APNs are diversifying and enriching their practice while strengthening
the care of their patients in a coordinated-alternating pathway. An evolution of the still “young” profession in France to rely on examples by turning its eyes towards the international and in particular towards Canada, which demonstrates by example the diversity and scope of nursing practice in advanced practice , both remotely and in person. A model to draw inspiration from, at a time when the Rist law now allows first-time prescriptions for APNs working as part of a coordinated exercise in hospitals, in medico-social establishments or in homes or health centers and primary and specialist care teams

The three recommendations of the SFSD for IPAs for remote practice:
– Think “remote” from the initiation package;
– Formalize the telecare act with a report;
– Validate the effectiveness of telecare.

• Telecare at the heart of health care pathways. Recommendations and testimonials to successfully complete your project. ADDENDUM: advanced practice nurses (APNs) at the heart of telecare. May 2023.
• “Telecare at the heart of innovation in health care pathways – Recommendations and testimonials to successfully complete your project”. June 2021.