{"id":980,"date":"2017-09-26T22:45:39","date_gmt":"2017-09-26T21:45:39","guid":{"rendered":"https:\/\/www.basilstrategies.com\/?p=980"},"modified":"2024-05-28T10:44:03","modified_gmt":"2024-05-28T09:44:03","slug":"telemedecine-deserts-medicaux","status":"publish","type":"post","link":"https:\/\/www.basilstrategies.com\/fr\/2017\/09\/26\/telemedecine-deserts-medicaux\/","title":{"rendered":"Ne r\u00e9servons pas la #t\u00e9l\u00e9m\u00e9decine aux #d\u00e9sertsm\u00e9dicaux"},"content":{"rendered":"
\"UDMN17\"<\/a>

Universit\u00e9s d’\u00e9t\u00e9 des d\u00e9serts m\u00e9dicaux et num\u00e9riques 2017<\/p><\/div>\n

Note de Denise Silber :<\/p>\n

J’ai lu le billet publi\u00e9 en juillet, 2017\u00a0 sur le blog de l’Institut Montaigne, \u00ab\u00a0Lutte contre les d\u00e9serts m\u00e9dicaux, va-t-on enfin d\u00e9velopper la t\u00e9l\u00e9m\u00e9decine <\/a>?\u00a0\u00bb Puis, en septembre, 2017, la relation entre le num\u00e9rique et les d\u00e9serts m\u00e9dicaux a\u00a0 \u00e9galement fait l’objet d’une grande rencontre initi\u00e9e et organis\u00e9e par un citoyen, Guillaume de Durat.\u00a0 Cette rencontre \u00e9tait les Universit\u00e9s d’\u00e9t\u00e9 des d\u00e9serts m\u00e9dicaux et num\u00e9riques<\/a> 2017, auxquelles j’ai eu le plaisir de participer, en Auvergne, \u00e0 la limite de la Bourgogne…des endroits o\u00f9 le signal digital n’est pas toujours au rendez-vous.<\/p>\n

En effet, la t\u00e9l\u00e9m\u00e9decine a \u00e9t\u00e9 invent\u00e9e il y a plus de 40 ans, pour pallier l\u2019absence de m\u00e9decins (sur les champs de bataille, dans l\u2019espace, dans les prisons). La racine du mot veut dire \u00ab\u00a0\u00e0 distance,\u00a0\u00bb\u00a0 mais les besoins et possibilit\u00e9s de la t\u00e9l\u00e9m\u00e9decine d\u00e9passent largement le probl\u00e8me de la grande distance en 2017.<\/p>\n

L’exercice de la m\u00e9decine est d\u00e9sormais un travail d’\u00e9quipe multi-disciplinaire, impliquant plusieurs professionnels sp\u00e9cialis\u00e9s. Le suivi des maladies chroniques se doit d’\u00eatre permanent. La collaboration du patient et de ses proches, o\u00f9 qu’ils soient, est devenu essentiel.\u00a0\u00a0 Le passage du patient entre h\u00f4pital et ville doit s’effecteur sans heurts. Dans tous ces cas, la t\u00e9l\u00e9m\u00e9decine a sa place. M\u00e9decine et t\u00e9l\u00e9m\u00e9decine sont maintenant quasi-synonymes.<\/p>\n

Or associer la t\u00e9l\u00e9m\u00e9decine de mani\u00e8re prioritaire aux d\u00e9serts m\u00e9dicaux, risque de lui \u00ab\u00a0coller\u00a0\u00bb l’image d’un outil inf\u00e9rieur, \u00e0 d\u00e9ployer quand on ne peut pas faire autrement. D’autre part, il faut d’abord assurer l’acc\u00e8s au num\u00e9rique dans les r\u00e9gions cibl\u00e9es.<\/p>\n

C’est pourquoi, il faudrait commencer par modifier les bonnes pratiques de la m\u00e9decine, pour tenir compte des am\u00e9liorations que seules le num\u00e9rique peut faciliter. Or, comme nous le rappelle Guillaume de Durat, \u00ab\u00a0tant que les m\u00e9decins continueront de craindre la t\u00e9l\u00e9m\u00e9decine comme un concurrent,\u00a0 la t\u00e9l\u00e9m\u00e9decine n’avancera pas.\u00a0\u00bb<\/em><\/p>\n

Si nous regardons o\u00f9 la t\u00e9l\u00e9m\u00e9decine est bien d\u00e9velopp\u00e9e dans le monde, ce n\u2019est pas la p\u00e9nurie de m\u00e9decins qui a d\u00e9clench\u00e9 l’usage.\u00a0 Ce n\u2019est pas non plus le remboursement d\u2019actes individuels de t\u00e9l\u00e9m\u00e9decine qui a d\u00e9clench\u00e9 sa diffusion, comme on l’entend souvent en France.\u00a0 Le remboursement d\u2019actes individuels de t\u00e9l\u00e9m\u00e9decine augmentera le nombre d\u2019actes, sans pour autant rendre le syst\u00e8me plus efficient.<\/p>\n

O\u00f9 est-ce que la t\u00e9l\u00e9m\u00e9decine est utilis\u00e9e efficacement, de fa\u00e7on innovante, et \u00e0 large \u00e9chelle ? C’est le cas\u00a0 des syst\u00e8mes de sant\u00e9 connus pour l’\u00e9valuation de la qualit\u00e9 des soins, comme de la pr\u00e9vention, et de la bonne gestion. Ils associent h\u00f4pital et ville dans une structure de gestion, avec un seul payeur, et la r\u00e9gion a acc\u00e8s \u00e0 une t\u00e9l\u00e9communication suffisante.<\/p><\/blockquote>\n

En Espagne, des t\u00e9l\u00e9services sont utilis\u00e9s, pour assurer une meilleure int\u00e9gration des services publiques m\u00e9dicaux et sociaux.<\/p>\n

En Israel, les assureurs \/ \u00e9tablissements de soins (HMO) utilisent la t\u00e9l\u00e9m\u00e9decine pour rendre plus efficient le suivi des patients chroniques, pour \u00e9viter la visite inutile aux urgences ou pour remplacer la visite pour un renouvellement d\u2019ordonnance et d\u2019autres actions qui n\u2019ont pas besoin d\u2019une rencontre. Au fur et \u00e0 mesure de l\u2019arriv\u00e9e de nouveaux objets connect\u00e9s, la visite \u00e0 distance est de plus en plus riche.<\/p>\n

Aux Etats-Unis, les Veterans, un syst\u00e8me public, a introduit la t\u00e9l\u00e9m\u00e9decine il y a 20 ans, quand ils sont pass\u00e9s \u00e0 la capitation et \u00e0 l’octroi d’un budget a priori par profil de patient et diagnostic. Pour r\u00e9ussir \u00e0 soigner un insuffisant cardiaque avec le budget donn\u00e9, le VHA a d\u00e9ploy\u00e9 de la t\u00e9l\u00e9m\u00e9decine\u00a0 basique,\u00a0 chez tous les patients, en compl\u00e9ment, une t\u00e9l\u00e9m\u00e9decine g\u00e9r\u00e9e par les infirmiers. Au fil des ann\u00e9es, les outils se sont sophistiqu\u00e9s et aujourd\u2019hui le VHA b\u00e9n\u00e9ficie d\u2019un d\u00e9partement de \u00ab sant\u00e9 connect\u00e9 \u00bb.<\/p>\n

Chez Kaiser Permanente, apr\u00e8s avoir test\u00e9 puis syst\u00e9matis\u00e9 l\u2019usage du courriel \u00e9l\u00e9ctronique pour faire gagner du temps au professionnel et au patient, Kaiser r\u00e9invente la consultation. La t\u00e9l\u00e9m\u00e9decine n\u2019est pas utilis\u00e9e en cas de p\u00e9nurie, ni pour dupliquer une consultation classique mais en pr\u00e9sence du m\u00e9decin traitant, pour relier divers absents (famille, aidants, sp\u00e9cialistes et autres personnes de l\u2019\u00e9quipe m\u00e9dicale).<\/p>\n

La grande chaine de pharmacie, Walgreens, utilisent un \u00ab t\u00e9l\u00e9-chat \u00bb instantan\u00e9 entre patients et pharmaciens 24\/7 pour apporter des conseils, notamment sur le bon usage des produits, mais aussi sur la pr\u00e9vention. Ces pharmaciens sont des professionnels qui tournent entre la pharmacie et le post de chat virtuel, pour ne pas perdre la connaissance des pharmacies.<\/p>\n

Au total, les services num\u00e9riques permettent de repenser et d\u2019am\u00e9liorer l\u2019organisation du syst\u00e8me de sant\u00e9 en combinant rendez-vous physiques et t\u00e9l\u00e9services sur tout le territoire. Nous ne manquons pas d’exemples pilotes qui marchent. Mais ce ne sera pas possible sans modifier le mod\u00e8le \u00e9conomique, non pas pour simplement rembourser les actes de t\u00e9l\u00e9m\u00e9decine, mais pour introduire une r\u00e9elle logique de pr\u00e9vention et\u00a0 de suivi.<\/p>\n","protected":false},"excerpt":{"rendered":"

Note de Denise Silber : J’ai lu le billet publi\u00e9 en juillet, 2017\u00a0 sur le blog de l’Institut Montaigne, \u00ab\u00a0Lutte contre les d\u00e9serts m\u00e9dicaux, va-t-on enfin d\u00e9velopper la t\u00e9l\u00e9m\u00e9decine ?\u00a0\u00bb … Read More<\/a><\/p>\n","protected":false},"author":1,"featured_media":998,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13],"tags":[],"class_list":["post-980","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-actualite"],"yoast_head":"\nNe r\u00e9servons pas la #t\u00e9l\u00e9m\u00e9decine aux #d\u00e9sertsm\u00e9dicaux - Basil Strategies<\/title>\n<meta name=\"description\" content=\"lancer la t\u00e9l\u00e9m\u00e9decine par les d\u00e9serts m\u00e9dicaux risque de lui couper ses ailes\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.basilstrategies.com\/fr\/2017\/09\/26\/telemedecine-deserts-medicaux\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ne r\u00e9servons pas la #t\u00e9l\u00e9m\u00e9decine aux #d\u00e9sertsm\u00e9dicaux - Basil Strategies\" \/>\n<meta property=\"og:description\" content=\"lancer la t\u00e9l\u00e9m\u00e9decine par les d\u00e9serts m\u00e9dicaux risque de lui couper ses ailes\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.basilstrategies.com\/fr\/2017\/09\/26\/telemedecine-deserts-medicaux\/\" \/>\n<meta property=\"og:site_name\" content=\"Basil Strategies\" \/>\n<meta property=\"article:published_time\" content=\"2017-09-26T21:45:39+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-05-28T09:44:03+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.basilstrategies.com\/wp-content\/uploads\/2017\/09\/speakersUDMN17.jpeg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"1180\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"adminaccount505\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"adminaccount505\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.basilstrategies.com\\\/fr\\\/2017\\\/09\\\/26\\\/telemedecine-deserts-medicaux\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.basilstrategies.com\\\/fr\\\/2017\\\/09\\\/26\\\/telemedecine-deserts-medicaux\\\/\"},\"author\":{\"name\":\"adminaccount505\",\"@id\":\"https:\\\/\\\/www.basilstrategies.com\\\/fr\\\/#\\\/schema\\\/person\\\/e8717d8f8e0655a48803245f77fb878a\"},\"headline\":\"Ne r\u00e9servons pas la #t\u00e9l\u00e9m\u00e9decine aux #d\u00e9sertsm\u00e9dicaux\",\"datePublished\":\"2017-09-26T21:45:39+00:00\",\"dateModified\":\"2024-05-28T09:44:03+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.basilstrategies.com\\\/fr\\\/2017\\\/09\\\/26\\\/telemedecine-deserts-medicaux\\\/\"},\"wordCount\":981,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/www.basilstrategies.com\\\/fr\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/www.basilstrategies.com\\\/fr\\\/2017\\\/09\\\/26\\\/telemedecine-deserts-medicaux\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.basilstrategies.com\\\/wp-content\\\/uploads\\\/2017\\\/09\\\/speakersUDMN17.jpeg\",\"articleSection\":[\"actualit\u00e9\"],\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/www.basilstrategies.com\\\/fr\\\/2017\\\/09\\\/26\\\/telemedecine-deserts-medicaux\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.basilstrategies.com\\\/fr\\\/2017\\\/09\\\/26\\\/telemedecine-deserts-medicaux\\\/\",\"url\":\"https:\\\/\\\/www.basilstrategies.com\\\/fr\\\/2017\\\/09\\\/26\\\/telemedecine-deserts-medicaux\\\/\",\"name\":\"Ne r\u00e9servons pas la #t\u00e9l\u00e9m\u00e9decine aux #d\u00e9sertsm\u00e9dicaux - 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