What would make the patients prefer a medical teleconsultation in a community pharmacy?
Résumé
The medical teleconsultation (MT) has been authorized in French community pharmacies, which have a terminal within a confidentiality area, since 2018. The patient is in contact with a doctor from the service provider. The community pharmacist can assist the patient as needed during the consultation at the request of the patient or the physician. The confinements due to the Covid-19 pandemic have upset the regulations: the MT are authorized from home since April 2019. What is the current place of teleconsultation in pharmacies compared to teleconsultation at home, at the end of the health crisis? The objective of the study to define patient preferences for medical teleconsultation. This study is based on a discrete choice experiment. The MT was modelled according to 4 attributes: (i) the physician's specialty; (ii) the reason for consultation; (iii) the waiting time to access the physician; (iv) the reimbursement by the health insurance. These attributes were declined in 11 modalities (2 for the first attribute, 3 for the others) which gives a total of 54 scenarios to be tested. For each scenario, the participant must indicate whether he prefers to teleconsult from home or from a community pharmacy. Given the number of scenarios to be tested, 9 versions of questionnaires were created, each proposing 6 scenarios. The questionnaire was distributed to people over the age of 18 physically and on social networks. A logistic regression was performed to estimate the weight of each modality within the attributes. A total of 226 responses were collected and 1338 scenarios were performed. Respondents are on average 39.1 ± 4.1 years old and 67.7% (n = 153) are women. It appears that 25.7% (n=58) of the participants have already carried out at least one medical teleconsultation. All scenarios combined, 70.8% (n = 947) of responses are in favor of medical teleconsultation from home. The specialty of the doctor does not influence the choice of the respondents. The modalities that have a positive impact in the participants’ choice in favour of a MT in a community pharmacy are: “urgent” for the attribute reason for the consultation” (OR = 1.57 [1.16; 2.13]); "shorter delay" for the attribute “waiting time” (OR = 3.24 [2.43; 4.35]) and “Without advance payment” for the attribute "Reimbursement" (OR = 1.39 [1.90; 1.02]). As it stands, it seems difficult to revitalize the MT in community pharmacies. A rapid access to care seems to be a major criterion that influence the choice of the participants. The results confirm that it seems important to rethink them about in terms of the primary care journey. As the participants return to the community pharmacies for rapid treatment, it is appropriate to highlight pharmaceutical expertise with a prescription for minor ailments, with a second-line access to MT for complex cases, as it is done the in Switzerland with the Netcare project.