Has telemedicine come to fruition? Parents' and pediatricians' perceptions and preferences regarding telemedicine.

BACKGROUND: Telemedicine has increasingly become a viable option for patient care and may increase access to care. The aim of our study was to evaluate both parent and pediatrician perceptions, preferences, and acceptability regarding the use of different telemedicine modalities. METHODS: We conducted a cross-sectional survey of both parents and pediatricians in Geneva, Switzerland in 2021. The questionnaire focused on digital literacy, preferences, acceptability, advantages, and disadvantages regarding telemedicine (phone, email, video, and instant message). Descriptive statistics and comparisons of preferences and perceptions (Pearson Chi2 and logistic regression) were performed. RESULTS: Two hundred and twenty-two parents and 45 pediatricians participated. After face-to-face consultations, parents and pediatricians preferred the phone for simple medical advice, discussion of parameters, acute or chronic problems, and psychological support. Email was preferred for communication of results and prescription renewal. Main reasons for using telemedicine were avoiding travel and saving time. Disadvantages were lack of physical examination, technical problems, and unsuitability of the reason for consultation. CONCLUSIONS: Understanding the factors that influence acceptance and satisfaction with telemedicine is vital for its successful implementation. Convenience, quality of care, trust, strong pediatrician-parent relationships, technical reliability, user-friendliness, and privacy considerations play significant roles in shaping parent and pediatrician attitudes toward telemedicine. IMPACT: The COVID-19 pandemic spurred the expansion of the use of telemedicine in pediatric care. Few studies have addressed parent and pediatrician perceptions and preferences regarding telemedicine. Both parents and pediatricians consider certain telemedicine modalities (phone, email, video, and instant message) pertinent in only specific clinical situations. Advantages of telemedicine outweigh disadvantages with parents and pediatricians appreciating the increased access to care, time savings, and avoiding transport. However, the lack of a physical examination remains a significant disadvantage. Convenience, quality of care, trust, strong pediatrician-parent relationship, technical reliability, user-friendliness, and privacy considerations play significant roles in shaping attitudes towards telemedicine.

Assisted teleconsultation in an outpatient pharmacy: Results of a pilot study in Geneva, Switzerland.

INTRODUCTION: Assisted teleconsultation (ATC) is the act of telemedicine involving on one side a patient in the presence of a healthcare professional, and an expert on the other side. ATC in outpatient pharmacies may be an alternative to the emergency room for patients with a semi-urgent medical problem. This project aimed at pilot testing the ATC in an outpatient pharmacy to assess its feasibility and to collect initial real-world data. METHODS: After initial evaluation and triage by the pharmacist, ATC was proposed to patients consulting at one outpatient pharmacy for semi-urgent medical problems. Prospective data on patients, consultation reasons, teleconsultation duration, patient's orientation and pharmacist' satisfaction were prospectively collected. RESULTS: Between December 2020 and June 2021, 39 consultations took place, 12 with video and 27 with telephone. Patients' median age was 37 years (IQR 26-50), 59% were women. Near half of the consultations (19) happened during the weekend. Mean ATC duration was 22 min (IC95% 18.6-26.1). Twenty-nine (74%) consultations ended with a prescription, 8 (21%) with medical recommendations and 2 (5%) with an emergency care referral. Without teleconsultation, 34 (87%) patients would have consulted a physician for their problem, and 24 (62%) would have been to the emergency room (self-reported). Fourteen (36%) consultations involved ENT, ophthalmologic and dermatologic complaints. CONCLUSION: A young population with semi-urgent medical problems can be managed in the pharmacy using ATC with a primary care physician. Financial, technical and training aspects should be developed and optimized in the future.

Perceptions of and Preferences for Telemedicine Use Since the Early Stages of the COVID-19 Pandemic: Cross-Sectional Survey of Patients and Physicians.

BACKGROUND: While the use of telemedicine (TLM) increased worldwide during the early phases of the COVID-19 pandemic, little is known about the use and acceptance of TLM post the COVID-19 pandemic. OBJECTIVE: This study aims to evaluate patients' and physicians' self-reported use, preferences, and acceptability of different types of TLM after the initial phases of the COVID-19 pandemic. METHODS: We conducted a cross-sectional survey among patients and physicians in Geneva, Switzerland, between September 2021 and January 2022. Patients in waiting rooms of both private and public medical centers and emergency services were invited to answer a web-based questionnaire. Physicians working in private and public settings were invited by email to answer a similar questionnaire. The questionnaires assessed participants' sociodemographics and digital literacy; self-reported use of TLM; as well as preferences and acceptability of TLM for different clinical situations. RESULTS: A total of 567 patients (309/567, 55% women) and 448 physicians (230/448, 51% women and 225/448, 50% in private practice) responded to the questionnaire. Patients (263/567, 46.5%) and physicians (247/448, 55.2%) generally preferred the phone over other TLM formats and considered it to be acceptable for most medical situations. Email (417/567, 73.6% and 308/448, 68.8%) was acceptable for communicating exam results, and medical certificates (327/567, 67.7% and 297/448, 66.2%) and video (302/567, 53.2% and 288/448, 64.3%) was considered acceptable for psychological support by patients and physicians, respectively. Older age was associated with lower acceptability of video for both patients and physicians (odds ratio [OR] 0.03, 95% CI 0.00-0.33 and OR 0.23, 95% CI 0.08-0.66) while previous use of video was positively associated with video acceptability (OR 3.16, 95% CI 1.84-5.43 and OR 3.34, 95% CI 2.91-5.54). Psychiatrists and hospital physicians were more likely to consider video to be acceptable (OR 10.79, 95% CI 3.96-29.30 and OR 3.97, 95% CI 2.23-7.60). CONCLUSIONS: Despite the development of video, the acceptability of video remains lower than that of the phone for most health issues or patient requests. There is a need to better define for which patients and in which medical situations video can become safe and efficient.

Patients preferences for communication during video consultations.

Objective The aim of our simulation-based study was to explore patient preferences for physician behaviours in video consultations METHODS: We conducted an exploratory study in outpatient setting in Geneva, Switzerland.Patients were invited to watch two variations videos of six simulated physician communication behaviours (camera framing, gaze orientation, initial talk at the opening phase, privacy reminder, pauses, empathy)and to indicate which one they preferred RESULTS: 417 patients watched three different video-recorded encounters. Most patients preferred framing with both face and bust (50.7 %) versus face alone (21.8 %). They valued eye gazing towards the camera (42.9 %) versus eye gazing shifting between screen and camera (13 %). The social talk related to the connection quality was appreciated (43.1 % vs 17.1 %) as well as the privacy reminder (80.8 % vs 6.5 %). Patients preferred short rather than long pauses after physician's statements (63.9 vs 14.9 %) as well as expressive rather than neutral nonverbal behaviour (46.7 % vs 17.6 %). CONCLUSION: Our results confirm that patients prefer the use of video specific communication behaviours recommended by experts except for shifting eye gaze and long pauses after physician's statements. PRACTICE IMPLICATIONS: Given the increasing use of video consultations, video communication "best practices"should be systematically addressed in physician training.

Centre de santé de soins primaires : à quoi ressemblera-t-il dans le futur ?

Poussé par les besoins croissants des patient·e·s et l'augmentation des différents professionnel·le·s de la santé, le lieu de travail du monde ambulatoire doit évoluer. La pandémie a montré que la digitalisation des pratiques, avec toutes les questions que cette transformation soulève, est l'un des aspects du futur qui s'ouvre. Mais elle n'est de loin pas le seul enjeu du centre de santé de demain. Prévention et promotion de la santé, santé intégrative, social, économie, architecture, durabilité : les défis sont multiples. Pour les matérialiser, la Revue Médicale Suisse, en partenariat avec Unisanté, organise un concours avec une vingtaine de jeunes médecins et professionnel·le·s de la santé entourés de douze tuteur·trice·s pour imaginer le centre de santé de demain. Le résultat sera présenté dans un show-room de 200 m2 aux Assises de la médecine romande le 4 novembre 2021.

[Telemedicine in the era of COVID-19: a revolution†? The experience of the University Hospitals of Geneva]. / Télémédecine à l'ère du COVID-19†: une révolution†? Expérience des hôpitaux universitaires de Genève.

The COVID-19 pandemic has imposed a reorganization of our health care system leading to an unhoped-for boom in telemedicine, particularly in Geneva. The deployment of HUG@home at the Geneva University Hospitals and of docteur@home in the doctors' offices has allowed health professionals to come together around a single solution thus ensuring continuity of care for patients with chronic diseases but also the triage and follow-up of patients with COVID-19 in compliance with security and confidentiality rules. The ease of use of remote consultation tools is essential for the sustainable anchoring of telemedicine in practice. The supervision of practices, training and the financial valorization of telemedicine are also necessary for the development of quality care.

La pandémie de Coronavirus Disease 2019 (COVID-19) a imposé une réorganisation de notre système de soins conduisant à un essor inespéré de la télémédecine, en particulier à Genève. Le déploiement d'HUG@home aux HUG et de docteur@home dans les cabinets a permis la réunion des professionnels de la santé autour d'une solution unique assurant ainsi une continuité des soins de patients atteints de maladies chroniques, mais également le tri et le suivi de ceux atteints du COVID-19 dans le respect des règles de sécurité et de confidentialité. La simplicité d'utilisation des outils de consultation à distance est essentielle à un ancrage durable de la télémédecine dans la pratique. L'encadrement des pratiques, la formation ainsi que la valorisation des actes de télémédecine sont également nécessaires pour le développement de soins de qualité.

[Telemedicine at the heart of management of the COVID-19 crisis]. / Télémédecine au cœur des dispositifs de gestion de la crise COVID-19.

During the COVID-19 crisis, telemedicine was at the center of the health management systems in the canton of Geneva. Telemedicine contributed to the triage and follow-up of patients with a suspected or confirmed diagnosis of COVID-19, as well as to the coordination of different healthcare actors in the patient's trajectory. New partnerships and reinforcement of coordination in the Geneva healthcare and social care networks with an unprecedented use of telemedicine tools were able to ensure patient care while preserving frontline healthcare providers. Telemedicine has benefited during this time from a temporary relaxation of measures and regulations governing its practice, encouraging its deployment in a crisis situation. However, for these tools to be effective, they need to become an integral part of our healthcare systems.

Durant la crise Coronavirus Disease 2019 (COVID-19), la télémédecine a été au cœur des dispositifs de gestion de la crise sanitaire dans le canton de Genève en contribuant au tri et au suivi des patients suspects de COVID-19 et à une meilleure coordination du parcours des patients. Une collaboration inédite entre les différents acteurs du réseau de soins genevois et un recours sans précédent aux outils de télémédecine ont permis ainsi d'assurer une prise en charge des patients, notamment les plus vulnérables, tout en préservant les soignants de première ligne. La télémédecine a bénéficié d'un assouplissement temporaire des réglementations encadrant sa pratique, favorisant son déploiement durant cette crise. Cependant, celle-ci devrait faire partie intégrante de nos systèmes de soins.

[Legal aspects of teleconsultation]. / Aspects juridiques de la téléconsultation.

There is no specific legal framework in Switzerland for the practice of telemedicine. The doctor carrying out a teleconsultation must therefore respect the general principles of medical practice : provide care online with professional recommendations, provide his patient with clear, appropriate and complete information, and also respect medical confidentiality. The doctor, due in particular to the limitation of the senses and the absence of direct physical examination, must maintain a degree of caution in the practice of remote consultations. He also remains responsible for the medical data exchanged and it is up to him to use a telemedicine solution adapted to the data security and confidentiality standards.

Il n'existe pas en Suisse de cadre légal spécifique à l'exercice de la télémédecine. Le médecin réalisant une téléconsultation doit ainsi respecter les principes généraux de l'exercice médical : apporter des soins en adéquation avec les recommandations professionnelles, délivrer à son patient une information claire, adaptée et complète, mais aussi respecter le secret médical. Le médecin, du fait notamment de la limitation des sens et de l'absence d'examen physique direct, doit garder un degré de prudence dans la pratique de consultations à distance. Il reste également responsable des données médicales échangées et il lui appartient d'utiliser une solution de télémédecine adaptée aux normes de sécurité et de confidentialité des données en vigueur.

[Teleconsultation in practice]. / Téléconsultation en pratique.

Teleconsultation is subject to the same rules as face-to-face consultation. However, doctors who wish to integrate it into their activity must be aware of a certain number of requirements linked to this practice such as the need to adapt their working environment, to comply with security rules, to ensure the continuity of medical information or to be aware of good practices and billing possibilities. In this article, we try to answer the frequently asked questions of health professionals who wish to carry out remote consultations in good conditions.

La téléconsultation est soumise aux mêmes règles que celles de la consultation en présentiel. Le médecin souhaitant l'intégrer à son activité doit cependant être sensibilisé à un certain nombre d'exigences liées à cette pratique comme la nécessité d'adapter son environnement de travail, satisfaire aux règles de sécurité, s'assurer de la continuité de l'information médicale ou encore connaître les bonnes pratiques et les possibilités de facturation. Dans cet article, nous tentons de répondre aux questions fréquentes des professionnels de la santé qui souhaitent réaliser des consultations à distance dans de bonnes conditions.

[Cross glances on the videoconsultation]. / Regards croisés sur la vidéoconsultation.

The covid-19 outbreak prompted many health care providers to use video consultation for the first time. While it is particularly useful in times of pandemic, a number of patients wish to continue using video consultation as it allows easy access to their physician. However, many physicians may be uncomfortable communicating with new technologies and without performing a traditional physical examination. Training in communication and virtual physical examination in telemedicine appears to be necessary, making it possible to make videoconsultation sustainable into daily practice while guaranteeing quality of care.

La crise liée au Covid-19 a poussé de nombreux soignants à utiliser pour la première fois la vidéoconsultation. Si celle-ci est particulièrement utile en temps de pandémie, elle est également sollicitée au quotidien par certains patients, leur permettant un contact facilité avec leur médecin. Pourtant, ce dernier est parfois peu à l'aise pour communiquer avec les nouvelles technologies et du fait de l'absence d'examen physique traditionnel. Une formation à la communication et à l'examen physique virtuel en vidéoconsultation apparaît nécessaire, permettant d'inscrire la télémédecine dans la pratique quotidienne tout en garantissant une prise en charge de qualité.

[Assisted teleconsultation†: a new medical practice with many stakes]. / Téléconsultation assistée: une nouvelle pratique aux nombreux enjeux.

Assisted teleconsultation, one of the components of telemedicine, is a form of medical practice set to further develop in the coming years. Interprofessional relationships are being adapted, and the triad patient-care provider-physician is experiencing new challenges. In this article we focus on the competencies and skills required and suggest some clinical practice guidelines for this new form of medical practice based on the pilot phase of our project.

La téléconsultation assistée, une des composantes de la télémédecine, est un type de pratique médicale amené à se développer dans les prochaines années. Dans cette nouvelle forme de relation interprofessionnelle, la triade patient-soignant-médecin connaît de nouveaux enjeux. À travers cet article, nous nous intéressons aux compétences requises pour cette nouvelle pratique et tentons de proposer quelques bonnes pratiques à partir de notre expérience pilote.

A Speech-Enabled Fixed-Phrase Translator for Emergency Settings: Crossover Study.

BACKGROUND: In the context of the current refugee crisis, emergency services often have to deal with patients who have no language in common with the staff. As interpreters are not always available, especially in emergency settings, medical personnel rely on alternative solutions such as machine translation, which raises reliability and data confidentiality issues, or medical fixed-phrase translators, which sometimes lack usability. A collaboration between Geneva University Hospitals and Geneva University led to the development of BabelDr, a new type of speech-enabled fixed-phrase translator. Similar to other fixed-phrase translators (such as Medibabble or UniversalDoctor), it relies on a predefined list of pretranslated sentences, but instead of searching for sentences in this list, doctors can freely ask questions. OBJECTIVE: This study aimed to assess if a translation tool, such as BabelDr, can be used by doctors to perform diagnostic interviews under emergency conditions and to reach a correct diagnosis. In addition, we aimed to observe how doctors interact with the system using text and speech and to investigate if speech is a useful modality in this context. METHODS: We conducted a crossover study in December 2017 at Geneva University Hospitals with 12 French-speaking doctors (6 doctors working at the outpatient emergency service and 6 general practitioners who also regularly work in this service). They were asked to use the BabelDr tool to diagnose two standardized Arabic-speaking patients (one male and one female). The patients received a priori list of symptoms for the condition they presented with and were instructed to provide a negative or noncommittal answer for all other symptoms during the diagnostic interview. The male patient was standardized for nephritic colic and the female, for cystitis. Doctors used BabelDr as the only means of communication with the patient and were asked to make their diagnosis at the end of the dialogue. The doctors also completed a satisfaction questionnaire. RESULTS: All doctors were able to reach the correct diagnosis based on the information collected using BabelDr. They all agreed that the system helped them reach a conclusion, even if one-half felt constrained by the tool and some considered that they could not ask enough questions to reach a diagnosis. Overall, participants used more speech than text, thus confirming that speech is an important functionality in this type of tool. There was a negative association (P=.02) between the percentage of successful speech interactions (spoken sentences sent for translation) and the number of translated text items, showing that the doctors used more text when they had no success with speech. CONCLUSIONS: In emergency settings, when no interpreter is available, speech-enabled fixed-phrase translators can be a good alternative to reliably collect information from the patient.

[Teleconsultation : a doctor-patient communication tool or a revolution in medical practice ?] / Téléconsultation : outil de communication médecin-patient ou révolution dans la pratique médicale ?

Modern communication technologies have opened up new perspectives for modern medicine. Developed and used in many countries since the 1990s, teleconsultation responds to societal change. It facilitates communication between doctors but also between doctors and patients. It helps to improve access to care and reduce health costs. The studies showing its interest in practice are numerous as for example: follow-up of chronic diseases, psychiatric follow-up or post-operative follow-up in outpatient surgery, etc. Teleconsultation is increasingly popular with patients but still encounters cultural and other obstacles by calling into question certain fundamental aspects of the doctor-patient relationship.

Les technologies modernes de communication ont ouvert de nouvelles perspectives pour la médecine moderne. Développée et utilisée dans de nombreux pays depuis les années 90, la téléconsultation répond à l'évolution sociétale. Elle facilite la communication entre médecins, mais également entre médecins et patients. Elle contribue à améliorer l'accès aux soins et à réduire les coûts de la santé. Les études montrant son intérêt en pratique sont nombreuses comme par exemple : suivis de maladies chroniques, psychiatrique ou postopératoire en chirurgie ambulatoire, etc. La téléconsultation est de plus en plus plébiscitée par les patients, mais se heurte encore à des obstacles entre autres culturels en remettant en cause certains aspects fondamentaux de la relation médecin-patient.

[Medical fitness and sick leave documentation: rules and uses]. / Certificat médical d'arrêt de travail et certificat médical de bonne santé: règles et usages.

Primary care physicians frequently have to respond to patients' requirements for medical documentation. Those include certification about fitness and ability to engage in specific activities and about inability to work due to ongoing health problems, which engages physicians' legal and profesionnal responsability. To clarify the rules and modalities of this activity, we present here the legal framework and the good practices. Regarding the sick leave certification, there are well-defined profesionnal and legal guidelines, which is not the case for certification about fitness.