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Usually hosted by the Senate, this conference was held on October 16 via videoconference due to the resumption of the Covid-19 epidemic. “The health crisis has also favored the accessibility to organizational or technological innovations such as telemedicine, thanks to the 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 journey,” he noted. “A dynamic is taking place. We now need to maintain a high level of telemedicine practice in cities and hospitals, and promote a territorialized implementation that favors access to care.”
“It is important and urgent to rethink access to respiratory health through both teleconsultation, tele-expertise, remote monitoring and other related objects,” added Respiratory health France vice president Vincent Daffourd, respiratory patient.
He recalled that during childbirth, according to the results of a survey of about 600 patients, 42% said they had canceled or postponed a scheduled consultation with the pulmonologist and 24% tested teleconsultation on this occasion.
It can be “a guarantee of continuity of the care pathway for all, provided that it is financed by health insurance without any remaining costs 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 choice but to go digital and adopt solutions for better quality of follow-up of their chronic patients “.
During a panel discussion, Grégory Tempremant, pharmacist and president of the regional union of health professionals (URPS) pharmacists of Hauts-de-France, confirmed that it was notably possible to provide remote pharmacy assistance for a shared drug review or pharmaceutical interview. . It is also possible to bring a home nurse to assist the patient in a teleconsultation if he is not used to it.
“Not all patients are geeks and we have further developed telephone consultations for them,” noted Dr Bruno Stach, president of the Respiratory System Union. It also believes that teleconsultation via video or telephone as well as primary consultation must be authorized for all health professionals, with traceability.
Stéphanie Schramm, head of the department of services and chronic diseases of the National Health Insurance Fund (CNAM), also felt that “the barriers have fallen among health workers but [que] the digital divide remained strong among patients “.” It is important to keep an offer face to face, in times of crisis or in poorly covered areas. “
Regarding telemonitoring, Dr. Stach recalled that for the moment it applies only to COPD patients on non-invasive ventilation as part of the Stages program (telemedicine experiments for the improvement of health pathways) “, the results of which are expected to short “. The desire is to extend it to more patients, especially those with COPD.
“Any proposed experience will be accepted by the regional health authorities for chronically insufficient patients with a strong medical-economic connotation”, continues in the press kit. For this, the connected objects will allow a personalized follow-up in patients’ homes or in lean structures.
Develop rehabilitation, at a distance or not
In addition to teleconsultation, tele-surveillance and tele-expertise (“soon to sign conventional knights”, indicated Dr. Stach), the association also asks for the urgent development of 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 proven.
Here too the Covid-19 epidemic and confinement have highlighted the need for respiratory rehabilitation and physical activity adapted to patients’ homes, coordinated remotely by physiotherapists.
In the press kit, the association reports the experience of FormAction Santé, a mobile team that offers respiratory rehabilitation at home in the North and Pas-de-Calais. With the closure of almost all outpatient respiratory rehabilitation centers to reserve them for patients with severe forms of infection, “the health crisis has highlighted the importance of home and tele-rehabilitation as useful and effective alternatives”, comments Dr. Jean-Marie Grosbois , manager of FormAction Santé.
“The pandemic has significantly accelerated the development of the home and rehabilitation by all means to connect with patients: telephone, video via smartphone or computer. Of the 64 courses underway on March 17, 58 were completed during childbirth, 6 patients who preferred to postpone it after hospitalization, 63 educational diagnoses were carried out during childbirth, 47 internships were initiated and 16 patients preferred to wait for the end of childbirth to implement it. Of non-Covid chronic respiratory patients. “
The intervention consisted of one or two weekly contacts, from fifteen minutes to one hour depending on the needs, dedicated to therapeutic education and 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, to deliver educational materials and tools and to ensure that the internship was properly followed.
A significant portion of the patients did not have the Internet or applications such as WhatsApp, which require adaptations, Dr. Grosbois specifies. 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.
During the Covid-19 crisis, the Directorate General for Healthcare Services (DGOS) encouraged the spread of tele-rehabilitation. “The feedback is being analyzed, which will undoubtedly lead to proposals for this type of treatment for types of patients to be defined, as well as for home rehabilitation”, so as to propose adequate responses to the needs, within the scope of the treatment “, continues the ‘Association.
In addition to telemedicine, the association calls for better management of respiratory health, recalling the importance of early diagnosis of patients, the environment and pollutants, especially in exacerbations, as well as prevention.
“We have to 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 of 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 unite against COPD”, also launched an appeal for systematic screening for COPD on October 15 in a press release, ahead of the ongoing World Day to fight COPD. . November 21. A large percentage of patients remain underdiagnosed.
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