Eighteen paramedical professions now have the possibility of practicing tele-care, remote care.
A recent experiment was set up in Lorraine and has proven to be positive, according to the professionals concerned.
But does not generalizing such a device risk, in the long term, dehumanizing these care and bonding professions?
How could a physiotherapist relieve your tendonitis without touching you?
How about a nurse checking a wound without visiting you?
The very recent establishment of tele-care and remote consultations for paramedics may leave room for doubt.
Because after the boom in teleconsultations linked to the Covid-19 pandemic, does this new stage in the deployment of telemedicine represent a really positive development for patients?
What is remote care?
Tele-care, a target set by Ma Santé 2022, was implemented in a derogatory fashion during the health crisis. In February 2021, the Haute Autorité de santé published the criteria and recommendations for its proper use. And since the decree and decrees, published in early June, this remote practice has been perpetuated. Eighteen professions can offer this option, including dieticians, occupational therapists, nurses, physiotherapists, speech therapists, orthoptists, chiropodists, psychomotor therapists and pharmacists.
Concretely, these paramedics can offer certain patients a remote appointment, provided they obtain their agreement and enter the report in their patient file and their shared medical file (DMP). "This will only happen with a dialogue between patient and caregiver and according to needs," warns Gérard Raymond, president of France Assos Santé. The nurse must first check that the patient is equipped (box, smartphone, blood pressure monitor, blood glucose meter, etc.) and that he has sufficient cognitive capacities to perform this remote care. Or that he does not suffer from illectronism. "It therefore depends on the judgment of the professional and the consent of the patient, and this autonomy is appreciated by the paramedics", assures Alexandre Mathieu-Fritz, professor of sociology at the University Gustave-Eiffel (Marne-La-Vallée),and who has been working on medical teleconsultations for ten years.
But if a teleconsultation with a psychologist may seem obvious, this is less the case for a nurse who bandages, sews up, vaccinates… "Our job is clinical, we need to reach people, recognizes Patrick Chamboredon, president of the Order. nurses.
The objective is not to replace the care, but to complete it.
In some cases, digital allows for a faster link.
He sees this novelty as a breakthrough, if it is offered between two home consultations to reassure a patient already followed, to renew a prescription, to provide therapeutic education ...
An experiment in Lorraine
And patients benefit from it. In any case, this is the conclusion of a recent experiment set up by mesdocteurs.com and the Mutualité française de Lorraine, which enabled 15 caregivers to perform 29 tele-care (only). With an original concept: the coordinating nurse is behind her screen, but a nursing assistant comes to the home. The objective: to verify that the remote care really meets a need, and in which case.
Maklouf Idri, regional director of the autonomy pole of the French mutual insurance company of Lorraine, sees many advantages in it: “the exchanges are traced, secured on the platform of my doctors whereas before, it was a bit like the D system. saving time and efficiency for healthcare teams, who no longer have to travel every time. Most French people hope to age at home. In the future, with remote care, it will be possible to have a multidisciplinary team around the screen: attending physician, nurse, nursing assistant, nutritionist… ”
According to Marion Joigny, the nurse coordinator of the experiment, "this helps to ensure a more regular link, to be more in" alert "mode ... and not only in times of heatwave or health crisis!
»Under what conditions?
“The only exclusion criterion is the quality of the network.
For most patients, the screen is of no concern as they use it to talk to their loved ones.
"
Variable benefits depending on the patient profile
But depending on the age of the patients, their pathology, the stage of their disease, their knowledge, this remote care turns out to be more or less interesting.
For Alexandre Mathieu-Fritz, two elements are added to the equation: the location of the remote care, therefore its equipment.
And the fact of knowing if it is done thanks to a third person (caregiver, nursing home professional, caregiver ...) who can check the installation, refer, advise ...
For a chronic patient who is young, connected and wants to go on vacation, this new flexibility can be an advantage.
But for an elderly patient with Alzheimer's, isolated, without a caregiver, the nurse's visit remains essential.
This is why this turning point, if the tele-care becomes systematic, seems to divert the mission of these caregivers.
"This can improve access to healthcare, especially in medical deserts"
"We are far from dystopias where all care is done remotely, even if some may have asked questions during confinement, recognizes Alexandre Mathieu-Fritz, also co-director of the Technical Laboratories, Territories and Societies (Latts). In reality, we observe alternate and reasoned uses. Paramedics must be allowed time to define for which uses remote practices appear to be the most suitable. "" This is a favorable development that can improve access to healthcare, especially in medical deserts, welcomes the president of France Assos Santé. The acceleration of telemedicine, with the boom in teleconsultations, the establishment of telemonitoring, telesoin, the opening of My health space, is wanted by the government and we are supporting it.But always by pointing out this vigilance: it is necessary to strengthen the information and support of all citizens, patients and caregivers, to better master these tools. Otherwise we will go to failure. "
But by keeping care and connection professions at a distance, are we not heading towards dehumanizing practices?
“The devices are not dehumanizing, everything depends on the uses and their contexts, corrects the sociologist.
Face to face, some practitioners incomprehensibly discuss the patient in the third person, while he is present.
As in Dr House!
"And the president of France Assos Santé concluded:" digital technology is a path that is opening up and seems relevant.
It's up to us to make it the best and not the worst.
"
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