Reflection following the possibility of teleconsultation (TC) in pharmacy following the publication of amendment 15 of Article 54 of the LFSS 2018 in the framework of the national convention of 4 April 2012 organizing the relationship between pharmacists holders of pharmacies and health insurance.
Following the reading of new regulatory decisions, we find ourselves faced with a complicated construction coming from the governance, may not be really articulated with the reality of the field. With the same fantasy that is to create new provisions supposed to overcome the shortage of health professionals (primary care specialists but also in some medical deserts Pharmacists).
I believe that in their subconscious the public authorities and the various guardians have integrated that they were unable to act favorably on the lack of primary care doctors, so they never speak seriously about it. (Read the problem of the Numerus clausus https://bit.ly/2Tuzxeb )
There is a leap forward in giving the NICTs a magic power on the one hand, and stigmatizing the professionals in place on the other hand, accusing them of all the ills if it does not work "is that they do not want to organize for the public good and settle in the under-equipped areas … "
Here are the components of the new gas plant listed in the new provisions:
-The health centers and multiprofessional health homes (MSP), (They already lack doctors and nothing indicates that because of this they can ramp up)
-the territorial occupational health communities (CPTS)!
-the primary care teams or any territorial organization proposing to organize a response in telemedicine!
-the local joint committees (CPL) or regional medical committees (CPR) entered to validate the proposed organization!
-Territorial support platforms (PTA)
Not to mention the organizational problems that require the pharmacist to organize this TC under his responsibility …
These are my thoughts;
The networking of the national territory by the pharmacies still suffers from the closure of medical offices, and the scarcity of the number of doctors installed (in number in many health centers and MSP). As a corollary, therefore, there are currently pharmacy closures in medical deserts.
It is therefore not sure that the device presented by this new regulation is based on a solid foundation perennial (the Officine).
The key to the problem is that there is therefore a medical density (Primary Care Physicians) under which one should not go down. The risk would then be great of a collapse of the whole system, and in practice a deterioration of our system of care first affecting the most vulnerable economically and geographically.
We can not leave alone FDI, caregivers, physio … in territories deserted by doctors and sometimes by pharmacists.
The government failed in this mission to provide a sufficient number of primary care doctors who had done studies that should have allowed them to react in time and hours (The Ministry of Employment (DREES) having published in February 2002 projections of medical density rising from 329 per 100,000 inhabitants to 250 in 2023…)
The public authorities are still in error today, they think that NICT and new organizations such as that of the installation of TC in pharmacies will suffice to overcome the lack of generalist.
While teleconsultation from the pharmacy is an excellent idea. Indeed more and more patients are moving to the pharmacy to have an opinion and a treatment most often for benign pathologies. But they do it most often because their doctor is less and less available. There is of course a place for an appropriate response when he "consults" at the pharmacy but if medical advice is needed by TC, the snake is biting its tail.
Or you must have the honesty to talk about self-medication medieval or favored by the Pharmacist.
Certainly the pharmacist is the expert of the drug but not indications (see in this season the number of pharmaceutical specialties recommended by television commercials and offered to the pharmacy without prescription to treat the ENT diseases "benign"! an excellent example of overconsumption of products that are often very active in very bad indications. How to manage a cold epidemic by integrating AI and TC.
The conflict of interest is obvious for the pharmacist to whom the public comes to seek advice … This should be studied by conducting studies on this type of self-medication hijacked.
But self-medication based on a real education of patients, and relayed by serious media and patient associations is an excellent thing. This is another very broad subject.
In addition, the public should not be encouraged to move to the pharmacy, but rather to favor teleconsultation from the patient's home. It is therefore necessary to encourage the use of NICTs at home and thus to eliminate the white areas and to equip the last homes without a smartphone. The interest is that the patient consults if possible his usual doctor, and as I think it is necessary to integrate the CT in the daily practice of the medical office it is necessary that the guardians invest massively in the training of the doctors and the equipment of the medical practices for TC.
The teleconsultation can look like a face-to-face consultation, it only takes a good transmission of sound and image and a little preparation of the health professional putting his patient in trust. In my experience there is even an advantage of the TC on the CS especially during the presence of a caregiver, a caregiver, or even an IDE to the patient at home. There is a real exchange on a lot of problems such as the follow-up of a chronic wound, a chronic disease … The home-based patient may also apply to a TC platform operating either as part of the conventional care path or as part of a service provided by a mutual insurance company, an employer or a health insurance provider. another community, these platforms are flourishing everywhere today, they will have an important place in the near future.
The teleconsultation at the pharmacy remains a very interesting additional possibility for the patient who could not easily integrate into one of the preceding situations.
I therefore insist on the fact that we should not institutionalize a system that creates an additional layer schematized by
-The patient's move to the pharmacy, the use of a TC room, with the mobilization of the pharmacist who is responsible for the teleconsultation.
-The call and the mobilization of a remote doctor who carries out the CT, which prescribes or redirects the patient is in his office or in a heavier structure.
Regarding older patients and disabled, it seems even more interesting to favor teleconsultation from home and not to impose a displacement that would not be justified elsewhere. I am also thinking of people in nursing homes, again the intervention of carers and health professionals (IDE) should be promoted.
The conclusion is that there is not a single connected health device that can keep our primary care system afloat, but an addition of a lot of devices. And we must not forget about the role of general practitioners, whose work must actually evolve and focus on the diagnosis and coordination of care, but they must remain in sufficient numbers.
The main criticism of these new arrangements with teleconsultation at the pharmacy, which I also approve of the concept, is the effective mobilization of an additional player, the Pharmacist, who may be missing. And the need to resort all the same to a doctor (during the teleconsultation) when precisely the patient addresses the pharmacy in part because his doctor is not very accessible.
Finally, to date, general practitioners are absolutely not technically and culturally ready to integrate teleconsultation into their daily practice. It is also on this wheel that we must act with determination quickly and massively.