Preferences for Alternative Care Modalities Among French Adults With Chronic Illness

Abstract

Importance: The COVID-19 pandemic led to the implementation of alternative care modalities (eg, teleconsultations and task shifting) that will continue to be implemented in parallel to traditional care after the pandemic. An ideal balance between alternative and traditional care modalities is unknown.

Objectives: To quantify the ideal postpandemic balance between alternative and traditional care modalities among patients with chronic illness and to qualify the circumstances in which patients consider it appropriate to replace traditional care with alternative care.

Design, setting, and participants: This survey study invited 5999 adults with chronic illness in ComPaRe, a French nationwide e-cohort of adults with chronic conditions who volunteer their time to participate in research projects, to participate in this study, which was performed from January 27 to February 23, 2021.

Main outcomes and measures: Participants rated the ideal proportion at which they would use 3 alternative care modalities instead of the traditional care equivalent on a 0% to 100% scale (with 0% indicating using alternative care modalities for none of one's future care and 100% indicating using alternative care modalities for all of one's future care) of their overall future care: (1) teleconsultations, (2) online symptom-checkers to react to new symptoms, and (3) remote monitoring to adapt treatment outside consultations. The median ideal proportion of alternative care use was calculated. Perceived appropriate circumstances in which each alternative modality could replace traditional care were collected with open-ended questions. Analyses were performed on a weighted data set representative of patients with chronic illness in France.

Results: Of the 5999 invited individuals, 1529 (mean [SD] age, 50.3 [14.7] years; 1072 [70.1%] female) agreed to participate (participation rate, 25.5%). Participants would choose teleconsultations for 50.0% of their future consultations (IQR, 11.0%-52.0%), online symptom-checkers over contacting their physician for 22.0% of new symptoms (IQR, 2.0%-50.0%), and remote monitoring instead of consultations for 52.3% of their treatment adaptations (IQR, 25.4%-85.4%). Participants reported 67 circumstances for which replacing traditional with alternative care modalities was considered appropriate, including 31 care activities (eg, prescription renewal and addressing acute or minor complaints), 25 patient characteristics (eg, stable chronic condition and established patient-physician relationship), and 11 required characteristics of the alternative care modalities (eg, quality assurance).

Conclusions and relevance: Results of this survey study suggest that after the pandemic, patients would choose alternative over traditional care for 22% to 52% of the time across different care needs. Participants proposed 67 criteria to guide clinicians in replacing traditional care with alternative care. These findings provide a guide for redesigning care in collaboration with patients after the pandemic.

Figure 1.. Ideal Proportion and Perceived Appropriate Uses of Teleconsultations

A, Circumstances in which participants consider teleconsultations to be an appropriate (gray nodes) or inappropriate (orange nodes) replacement for in-person consultations. The blue nodes indicate circumstances that were reported as both appropriate and inappropriate by different study participants. The number of participants with conflicting opinions is reported in the parentheses. B, Proportion of participants who would, ideally, conduct their future consultations entirely in person (ideal proportion of teleconsultations, 0%-5%), primarily in person (ideal proportion of teleconsultations, 6%-50%), or primarily by teleconsultation (ideal proportion of teleconsultations, >50%).

Figure 2.. Ideal Proportion and Perceived Appropriate Uses of Online Symptom-Checker Use

A, Circumstances in which participants consider using online symptom-checkers to identify the right course of action when new symptoms appear to be an appropriate (gray nodes) or inappropriate (orange nodes) replacement for contacting their physician. The blue nodes indicate circumstances that were reported as both appropriate and inappropriate by different study participants. For these nodes, the number of participants with conflicting opinions is reported in the parentheses. B, Proportion of participants who would, ideally, react to the appearance of new symptoms in the future entirely by contacting a physician (ideal proportion of symptom-checker use, 0%-5%), primarily by contacting a physician (ideal proportion of symptom-checker use, 6%-50%), or primarily by using symptom-checkers (ideal proportion of symptom-checker use, >50%).

Figure 3.. Ideal Proportion and Perceived Appropriate Uses of Remote Monitoring

A, Circumstances in which participants consider remote monitoring for treatment adaptation outside consultations to be an appropriate (gray nodes) or inappropriate (orange nodes) replacement for adapting their treatment after revising monitoring data in consultations. The blue nodes indicate circumstances that were reported as both appropriate and inappropriate by different study participants. For these nodes, the number of participants with conflicting opinions is reported in the parentheses. B, Proportion of participants who would, ideally, have their treatment adapted entirely in consultations (ideal proportion of remote monitoring, 0%-5%), primarily in consultations (ideal proportion of remote monitoring, 6%-50%), or primarily outside consultations by using remote monitoring (ideal proportion of remote monitoring, >50%).