Motivations of French Physicians to Perform Teleconsultations During COVID-19: A Mixed-Method Study

International audienc

Considering the Artifact Ecology when Supporting the Evolution of Practices - Analyzing the Parallel Journeys of Two Teleconsultation Software in a General Hospital

International audienceThe growing use of teleconsultation, especially since the start of the Covid-19 pandemic, changes physicians' work at the hospital. In this paper, we set out to study how physicians have integrated teleconsultation into their healthcare practices. Moreover, we are interested in how teleconsultation software contributes to developing new medical practices and how the design of teleconsultation software can better support them. Based on 16 months of fieldwork in a general hospital that offers two different teleconsultation software, we have investigated teleconsultation practices through interviews and observations involving ten physicians doing teleconsultation and a telemedicine secretary. Unlike the existing informal remote care by phone, we observe that teleconsultation supports new formal healthcare practices, particularly for patient care management and inter-organizational cooperation. While analyzing the integration of teleconsultation in physicians' practices, we highlight that both pieces of software do not support those practices on equal terms according to their design. We argue that teleconsultation software design can limit the spread of these new healthcare practices and that the artifact ecology of physicians should be considered during the design process

Telemedicine in nursing homes during the COVID ‐19 outbreak: A star is born (again)

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How the local domestication of a teleconsultation solution is influenced by the adoption of a national policy?

International audienceTelemedicine is presented by the French government and regional authorities in France as key to guaranteeing equal access to healthcare. Research on telemedicine has highlighted how it impacts the work practices of healthcare professionals and how its adoption is challenging. In this context, we are interested in understanding how the discourses and policy on equal access to healthcare are implemented and how they impact the deployment of telemedicine solutions in practice. We are currently studying the deployment of a teleconsultation solution for nursing homes inside a group of hospitals in Northeast France. On the basis of on-site visits at four nursing homes and interviews with the different stakeholders, we analyzed the domestication of the teleconsultation solution. Our first results highlight that the defined policy is useful to support the deployment of the technology but does not appear as sufficient for its incorporation into regular work practices. Our hypothesis to understand this obstacle is that nursing homes would need to endorse a new role to engage in further incorporation and later stage of domestication, which may be prevented by their existing ecosystem

: Behind the scenes of operational activity. Crossed perspectives on contemporary transformations in surgery

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Experience of Primary Care Physicians in the Aube Department, France, Regarding the COVID-19 Crisis

Background: General practitioners (GPs) played a decisive role during the COVID-19 epidemic, particularly in the identification and care of patients at home. This study aimed to describe the primary care physicians’ perceptions of the COVID-19 crisis and to guide future decisions regarding measures to prolong, abrogate, or improve upon methods for crisis management. Methods: This is a cross-sectional study based on a 30-item questionnaire aiming to investigate how primary care physicians (GPs) working in the rural Aube Department experienced the COVID-19 crisis. Results: Among the 152 respondents, 60.5% were not satisfied with the level of information from authorities during the crisis. By multivariate analysis, a feeling of having been adequately informed (OR 21.87, 95%CI 4.14–115.53) and a feeling that non-COVID-19-related diseases were adequately managed (OR 6.42, 95%CI 1.07–38.51) were both significantly associated with an overall satisfaction with the management of the crisis. Conclusion: This study about rural primary care physicians in Eastern France highlights some of the weaknesses of the French healthcare system in terms of the provision of primary care during the epidemic. A leading cause of dissatisfaction was that the information relayed by the health authorities about the disease and its management largely overlooked the primary care providers, many of whom had to rely on traditional media to obtain information

Gaps to Best Practices for Teleconsultations Performed by General Practitioners: A Descriptive Cross-Sectional Study

The COVID-19 pandemic led to large increases in telemedicine activity worldwide. This rapid growth, however, may have impacted the quality of care where compliance with guidelines and best practices are concerned. The aim of this study was to describe the recent practices of a telemedicine activity (teleconsultations) and the breaches of best practice guidelines committed by general practitioners (GPs) in the Greater Eastern Region of France. A cross-sectional study was conducted using a 33-item questionnaire and was provided to the Regional Association of Healthcare Professionals, Union Régionale des Professionnels de Santé (URPS) to be shared amongst the GPs. Between April and June 2021, a total of 233 responses were received, showing that (i) by practicing telemedicine in an urban area, (ii) performing a teleconsultation at the patient’s initiative, and (iii) carrying out more than five teleconsultations per week were factors associated with a significantly higher level of best practices in telemedicine. All in all, roughly a quarter of GPs (25.3%, n = 59) had a self-declared good telemedicine practice, and the rules of good practice are of heterogeneous application. Despite the benefits of learning on the job for teleconsultation implementation during the COVID-19 lockdowns, there may be a clear need to develop structured and adapted telemedicine training programs for private practice GPs

Perception of the use of a telephone interpreting service during primary care consultations: A qualitative study with allophone migrants

International audienceObjectives The language barrier prevents allophone migrant patients from accessing healthcare when arriving in a country, and interpreters are often needed to help them to be understood. This study aimed to understand perceptions and experiences of allophone migrant patients who used a telephone-interpreting service during primary care consultations. Study design A qualitative study using semi-structured interviews was undertaken between September 2019 and January 2020. Interviews were transcribed and analysed using thematic analysis framework. Setting Allophone migrant patients from an accommodation centre for asylum-seekers who used a telephone-interpreting service during primary care consultations with a general practitioner. Participants A purposive sample of allophone migrant patients (n = 10). Results From the semi-structured interviews, we identified three themes: (1) multi-level difficulties of being an allophone migrant in the primary care pathway (i.e., before, during, and after the consultation); (2) the key role of the interpreter in the doctor-patient relationship, participating in improving the patient’s management by establishing a climate of trust between the two; and (3) advantages and limitations of the TIS. However, even if a telephone-interpreting service is very helpful, allowing quick access to interpreters speaking the allophone patient’s native language, certain situations would require the interpreter to see the patient to better guide the doctor during the consultation. Conclusion Telephone-interpreting services enable improving communication and comprehension between allophone migrant patients and doctors. Nevertheless, the interpreter may sometimes need to physically see the patient to better guide the doctor. To do so, interpreting services using videoconferencing deserve wider development

Telepsychiatry to Provide Mental Health Support to Healthcare Professionals during the COVID-19 Crisis: A Cross-Sectional Survey among 321 Healthcare Professionals in France

Pandemics are difficult times for the mental health of healthcare professionals, who are more likely to present with PTSD-like symptoms. In the context of a highly contagious communicable disease, telemedicine is a useful alternative to usual care, and should be considered as a means to support healthcare professionals’ mental health. This is a multicenter (n = 19), cross-sectional study, based on a 27-item questionnaire, aiming to investigate the acceptability to healthcare workers of a telepsychiatry service as a means of providing mental health support during the COVID-19 pandemic. Between October and December 2020, 321 responses were received, showing that women, caregiving staff, and those directly involved in the care of COVID-19 patients are less favorable to the idea of receiving remote support. In our population, barriers were related to the clinical setting or ethics, and most of the respondents would not accept a drug prescription by telepsychiatry. Although telepsychiatry should be a part of the armamentarium of mental health management, it is not suitable as a stand-alone approach, and should be combined with conventional face-to-face consultations

Perceptions of general practitioners towards the services provided by advanced practice nurses: a cross-sectional survey in France

Abstract Background New healthcare professions are emerging due to scarce medical resources. The appearance of a new healthcare profession, advanced practice nurses (APNs), has raised questions about how general practitioners interrelate with them as primary care providers. The objective of this study was to explore the perceptions general practitioners have towards the services rendered by APNs to patients, to general practice and the role they play in the healthcare system. Methods A survey-based, cross-sectional study was conducted throughout the Grand Est region of France which covers 57,333km2 and has a population of approximately 5,562,651. The survey was compiled using pre-existing questionnaires and was carried out from July to September 2022 via email. Variables collected were rate of acceptability and socio-demographic characteristics. Results In total, 251 responses were included. The mean age of general practitioners was 41.7 years, most were women (58.2%) and worked in rural areas of the region (53.8%). Over 80% of respondents practiced in group structures (defined as either multi-professional health centers (n = 61) or in group practices (n = 143)). Most respondents (94.0%) were familiar with the APN profession and did not consider that APNs improved access to care (55.8%, percent of responders with score ≤ 3/10). Moreover, most did not believe that APNs were useful as a primary care provider for patients (61.8%). However, being a member of a territorialized healthcare community, known as Communautés Professionnelles Territoriales de Santé (CPTS), was associated with a positive appraisal of APNs’ services (OR = 2.116, 95%CI: 1.223 to 3.712; p = 0.007). Conclusions Encouraging shared and networked practice within a healthcare community may promote a positive perception of new actors. Further studies need to be conducted to show whether the integration of APNs into healthcare networks improves quality of care