Abstract
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. 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. 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. 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. 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). 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.
Highlights
Half of adults in Western countries have at least 1 chronic condition, and 27% experience multimorbidity.[1]
Participants reported 67 circumstances for which replacing traditional with alternative care modalities was considered appropriate, including 31 care activities, 25 patient characteristics, and 11 required characteristics of the alternative care modalities
The traditional care model fails to serve the increasing population of individuals with chronic illness because it is reactive and inflexible: physicians see patients most often only after they become ill, during in-person consultations scheduled at prespecified intervals.[2]
Summary
Half of adults in Western countries have at least 1 chronic condition, and 27% experience multimorbidity.[1] The traditional care model fails to serve the increasing population of individuals with chronic illness because it is reactive and inflexible: physicians see patients most often only after they become ill, during in-person consultations scheduled at prespecified intervals.[2] A more appropriate care model for patients with chronic illness would seek to prevent health deterioration, support patients outside consultations,[2] and minimize treatment burden.[3,4]. Patients in France with COVID-19 were remotely monitored with daily selfreported questionnaires through the Covidom app,[5] and separate hospital areas were dedicated to patients with COVID-19 in Italy.[6] Studies report high patient satisfaction with remote care offered during the pandemic,[7,8] and some health care organizations will continue to offer these care modalities after the pandemic, parallel to traditional care.[9]
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