2023-06-18 07:00:00
It sits at the back of the pharmacy, between the big brand beauty products and the shelves of hydroalcoholic gels. Since December, a teleconsultation booth has been installed in Stanislas Kamba’s pharmacy, in Bussy-Saint-Georges, in Seine-et-Marne. In this town of around 30,000 inhabitants, where young Ile-de-France executives and retirees mingle with hordes of tourists who have come to visit Disneyland Paris, it has become difficult to get an appointment with a doctor. “Despite the twenty general practitioners who practice here, you have to wait at least a week to obtain a consultation. Many patients are in disarray”, testifies the pharmacist, who regrets the sudden closure of two large practices in the post-urban city center. Covid.
Its one square meter “box”, delivered by the company Medadom, leader in the sector, is equipped with a tensiometer, an otoscope allowing to inspect the auditory canal, a stethoscope, an oximeter to to measure heart rate and blood oxygen levels, and a dermatoscope to examine certain skin lesions. Without forgetting, of course, a camera and a microphone, supposed to connect the patient to a doctor by videoconference. Via this system, “about 150 patients” would consult a general practitioner in Stanislas Kamba’s pharmacy each month, with or without an appointment and for the price of a classic consultation, to which an additional four euros can be added “in the event of non-issuance of prescription”. “This avoids medical overconsumption, but also builds patient loyalty, who then obtains the drugs directly from us,” admits the pharmacist.
Long shunned by patients, teleconsultation ended up seducing a part of the French, especially during the Covid: according to a study of the Research, Studies, Evaluation and Statistics Department (DREES) published in December 2022, 13.5 million video appointments were thus made by private general practitioners in 2020, and 9, 4 million in 2021 – against only 80,000 in 2019. These remote appointments have often become, for the 30% of French people living in a medical desert, the only way to obtain a quick consultation. The market to conquer is huge.
“Sustained growth”
Town halls, universities, pharmacies, nursing homes, and even supermarkets… In less than five years, these futuristic little boxes have flourished all over the territory, installed by a handful of specialized companies. If the Health Insurance assures L’Express “not to have exhaustive data on the entire care offer in this area”, Nathaniel Bern, co-founder of Medadom, estimates that “more than 4000 devices” would currently be available In France. Since 2018, his company alone has been responsible for setting up 3,500 terminals and cabins located “in medical deserts, but also in semi-rural or urban areas”, for more than 1, 8 million teleconsultations carried out. “Each year, we triple the number of patients cared for. For us, as for all the other players in the sector, growth is sustained,” he says.
At Medadom, 95% of devices were installed in pharmacies. For “219 to 400 euros monthly” and a commitment contract over several months, the latter can benefit from the delivery and installation of these terminals. Public services are also starting to equip themselves. According to information from the Letter A, the SNCF has just launched a call for tenders to equip 1,735 stations, while last April, the Yvelines department, for example, announced the deployment of around fifty remote consultation devices and a “health bus “itinerant on its territory, for a budget of 10 million euros. “In the department, half of the liberal doctors are over 60 years old, we have lost 20% of general practitioners in ten years, and 15% of the inhabitants do not benefit from a general practitioner. We must fill these holes in the racket, and these cabins can meet part of the need”, comments Sandra Laventureux, Deputy Director General for Children, Family and Health within the department.
“To cope with the shortage of doctors, many municipalities have no other choice”, abounds John Billard, mayor of Favril, in Eure-et-Loir. In 2019, he was the first elected to invest in a teleconsultation booth for his town hall, installed by the specialized company HD4 for an investment of 100,000 euros – three quarters of which were financed by the department and the Center Val region. of Loire. Since then, more than 300 patients have passed through the doors of the facility, thereby avoiding the “seven to fifteen days of waiting” to obtain an appointment with a general practitioner. According to a report carried out by the municipality that L’Express was able to consult, nearly 40% of the users treated between October 2019 and September 2021 were over 60 years old, and 70% had recourse to teleconsultation due to the unavailability of their attending physician.
“We know that it will never replace a doctor, but it’s better than nothing”, summarizes the mayor, before warning: according to him, such an installation can only work with “real support”, and “a real knowledge of the needs of the inhabitants”. A town hall secretary has been trained to welcome patients.
“consumer good”
These cabins and their massive deployment worry the unions of doctors, who denounce a “commodification” of medicine, even “serious and shameful excesses” concerning the medical care of certain users. “When it comes to listening to a lung or a heart, the quality will never be as good as it is in real life. There is a whole finesse to the practice of medicine, which is paramount, and cannot have place at a distance”, deplores Dr Jean-Luc Leymarie, deputy secretary general of the URPS Médecin Île-de-France.
“These are ‘one-shot’ appointments, during which the doctors do not know the patient’s history, and absolve themselves of all responsibility. There is a risk of bad prescriptions or excessive prescriptions, while transforming the care into a new consumer good”, accuses Agnès Gianotti, president of the MG France union. A few months ago, the installation of around ten devices in supermarkets by the company Tessan – which has around 700 booths and terminals throughout the country, for 200,000 teleconsultations in 2022 – particularly upset the medical world. . “They don’t give a damn about ethics and deontology. It’s a medicine low cost, a hitch solution to try to retain its customers”, plague Jérôme Marty, president of the French Union for a free medicine. The general practitioner goes even further, fearing a “loss of chance” for certain patients in the event of bad examinations. made.
For Amandine Rauly, lecturer in economics at the University of Reims and author of several studies on the subject, the very location of these cabins poses a problem. “They are not only flourishing in medical deserts, but wherever there is a minimum of demand. The target group is no longer precarious, isolated and sick patients, but the younger, connected and well-to-do who come to consult at at all costs, immediately and now”, she summarizes. An observation noted by the DREES in its general study on teleconsultation: according to the organization, the latter are indeed “not particularly carried out with patients residing in the areas least endowed with general practitioners”: 23.3% of these Appointments are thus made by the 20% of the population with the best general practitioners.
However, Amandine Rauly does not condemn all the cabins, insisting on the various local impacts of the device: “You will have rural territories where they develop very well, as in Brittany where more and more young executives have settled And places like the tip of the Ardennes, where the aging population will never be comfortable with these technologies.”
At the Bussy-Saint-Georges pharmacy, patients, delighted to get a quick appointment, are also aware of the limits of the device. On this hot Friday morning in June, a father who has just tested the experiment on his young son says he is “disappointed”. The blood pressure and temperature of the child, who had returned from school the day before with severe stomach aches and fever, were not checked by the GP in video. The latter simply diagnosed “a heat stroke”, prescribed paracetamol and wrote a certificate to justify her absence from school. “There may be another problem, and if so, it will not have been detected. It helps out, of course, but it’s really expeditious”, blows the user. On the other side of the pharmacy, a second patient shades. “For me, it definitely saved me one day when I had an allergy flare-up,” says Laurie, who was able to get a prescription for antihistamines within minutes. “Of course, it will never replace the face-to-face exchange. But I can tell you that that day, I was very happy to have it”. His primary care physician was not available for four weeks.
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