The sustainability of telemedicine should make it possible to improve respiratory health (patient association)

Usually hosted by the Senate, this conference took place on October 16 by videoconference due to the resumption of the Covid-19 epidemic. “The health crisis has also favored accessibility to organizational or technological innovations such as telemedicine, thanks to exemptions”, recalled the president of the association, Dr Frédéric Le Guillou.

“This trend is in line with our proposals made in 2019 to design and test new tools integrated into the patient care pathway,” he observed. “A dynamic is underway. We must now maintain a high level of telehealth practice in towns and hospitals, and promote a territorialized implementation favoring access to care.”

“It is important and urgent to rethink access to respiratory health whether through teleconsultation, tele-expertise, remote monitoring and other connected objects”, added the vice-president of Respiratory health France, Vincent Daffourd , respiratory patient.

He recalled that during confinement, according to the results of a survey of some 600 patients, 42% said they had canceled or postponed a scheduled consultation with the pulmonologist and 24% tested the teleconsultation on this occasion.

It can be “a guarantee of continuity of the course of care for all, on condition of being financed by the health insurance without remainder of charge for the patient”. “The multiplication of physical teleconsultation points (connected booths, for example) is another way to avoid disruption of care, especially in medical deserts. Hospitals and city medicine have no other choice than to go digital and adopt solutions for a better quality of follow-up of their chronically ill patients. “

During a round table, Grégory Tempremant, pharmacist and president of the regional union of health professionals (URPS) pharmacists of Hauts-de-France, confirmed that it was possible in particular to provide tele-care at the pharmacy for a shared medication review or pharmaceutical interview. It is also possible to bring in a home nurse to assist the patient in a teleconsultation if he is not used to it.

“Not all patients are geeks and for them, we have further developed telephone consultations,” observed Dr Bruno Stach, president of the Respiratory System Union. He also considered that teleconsultation by video or telephone as well as primary consultation should be authorized for all health professionals, with traceability.

Head of the department of services and chronic diseases at the National Health Insurance Fund (Cnam), Stéphanie Schramm also considered that “barriers had fallen among health professionals but [que] the digital divide remained strong among patients. “” It is important to maintain a face-to-face offer, in times of crisis or in poorly covered areas. “

Regarding telemonitoring, Dr Stach recalled that for the moment it only applies to patients with COPD under non-invasive ventilation as part of the Stages program (Telemedicine experiments for the improvement of health care pathways), ” the results of which are expected soon “. The wish is to extend it to a larger number of patients, in particular those with COPD.

“Any proposal for an experience will be welcomed by the regional health agencies for chronically insufficient patients with a severe medico-economic connotation”, he continues in the press kit. For this, connected objects will allow personalized follow-up in patients’ homes or in lean structures.

In addition to teleconsultation, telesurveillance and tele-expertise (“conventional riders will be signed soon”, indicated Dr Stach), the association is also asking to urgently develop respiratory rehabilitation (in particular tele-rehabilitation). It is a “pillar” of the management of chronic respiratory failure which only benefits less than 10% of patients, while its effectiveness has been demonstrated.

Here again, the Covid-19 epidemic and containment have highlighted the needs for respiratory rehabilitation and physical activity adapted to the patients’ homes, coordinated remotely by physiotherapists.

In its press kit, the association reports the experience of FormAction Santé, a mobile team offering respiratory rehabilitation at home in the Nord and Pas-de-Calais. With the closure of almost all outpatient respiratory rehabilitation centers to reserve them for patients with severe forms of the infection, “the health crisis has highlighted the importance of the home and telerehabilitation as useful and effective alternatives”, comments Dr Jean-Marie Grosbois, manager of FormAction Santé.

“The pandemic has considerably accelerated the development of the home and rehabilitation by all means to get in touch with patients: telephone, video by smartphone or computer. Of the 64 courses in progress on March 17, 58 were completed during confinement, 6 patients having preferred to postpone it after deconfinement. During confinement, 63 educational diagnoses were made, 47 internships started and 16 patients preferred to wait until the end of confinement to put it in place. of non-Covid chronic respiratory patients. “

The intervention consisted of one or two contacts per week, from about fifteen minutes to one hour depending on the needs, devoted to therapeutic education and to a motivational and behavioral approach. Videos of adapted physical activities were available on the website and two people from the team visited the patients’ homes, once or twice during the internship, in order to drop off educational material and tools, and to ensure that the internship was properly followed.

A significant portion of patients did not have the Internet or applications such as WhatsApp, requiring adaptations, specifies Dr Grosbois. For Respiratory Health France, tele-rehabilitation is useful but must be associated with face-to-face, whether at home or in a full-time or part-time hospital structure.

During the Covid-19 crisis, the general direction of healthcare provision (DGOS) encouraged the dissemination of tele-rehabilitation. “Feedback is being analyzed, which will undoubtedly lead to proposals for this type of care for typologies of patients to be defined, as well as for home rehabilitation”, so as to propose responses adapted to the needs, within the framework of the course of care “, continues the association.

Beyond telemedicine, the association pleads for better management of respiratory health, recalling the importance of early detection of patients, the environment and pollutants, especially on exacerbations, as well as prevention.

“We must find new solutions with the doctor and the patient on known elements of the course, such as screening, hospitalizations or respiratory rehabilitation, in order to improve the care and quality of life of patients,” said the head of the department of services and chronic diseases at the CNAM.

“One of the levers among health professionals is to strengthen coordination within a conventional framework, within new structures such as multi-professional health centers or territorial professional health communities (CPTS), or the development of new professions” , she added.

Another association, “Josiane Salone, all united against COPD”, also launched a call for systematic screening for COPD on October 15 in a press release, ahead of the World Day for the fight against this disease, which is being held. November 21. A large proportion of patients remain underdiagnosed.

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