Determinants of the use of teleconsultation, on the side of the doctor and depressed patients in their follow-up in France

Alain Mercier

Keywords: depressed patients, telehealth,

Background:

One in five people will experience depression at some point in their lives. GPs are the frontline healthcare professionals who care for these patients, regardless the stage of the illness. Telepsychiatry is rapidly expanding worldwide, particularly in the United States, Australia, and Canada. While telepsychiatry pilot programs have been conducted in France, mainly among psychiatrists, their development remains sluggish in primary care.

Research questions:

To understand the promoting factors and barriers to the use of teleconsultation in monitoring depression by depressed patients and general practitioners.

Method:

This qualitative study adopted an approach inspired by grounded theory. Semi-structured interviews were recorded with patients with depression, recruited through their general practitioner or psychiatrist. Opinions were also collected from general practitioners, interns, and locum doctors recruited via word of mouth. The study aimed to encourage free expression on topics such as managing depressive syndrome in recent consultations, perceptions of its primary care monitoring, and experiences with teleconsultation, particularly in its role in managing depressive syndrome.

Results:

Ten patient interviews revealed key findings. Facilitators for teleconsultation in managing depressive syndrome included travel difficulties due to illness, the comfort of consulting from home, the need for prior in-person follow-up to build trust, and accelerated adoption during the COVID-19 pandemic. Barriers included the symbolic importance of travel, confidentiality concerns, severe symptoms, and the screen limiting non-verbal communication, complicating mood reassessment and treatment adjustments. Patients also feared distancing from traditional care and a dehumanized doctor-patient relationship.
For doctors, facilitators included monitoring stable patients, reassessing treatments or work stoppages, saving time, and addressing care for distant or unscheduled cases. Barriers included weakened doctor-patient relationships, technical issues, and challenges in adapting to new organizational changes.

Conclusions:

Ambivalence was observed among doctors, likely linked to fears about changes in practice. Comparing doctor and patient perspectives shows patients are less hesitant about teleconsultation than general practitioners.

Points for discussion:

What measures can be implemented to preserve the human aspect of care in a digital context?

What are the risks of widening health inequalities associated with the use of teleconsultation ?

Are these findings transferable outside this crisis context?

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