[Transitional care from hospital to home: how to target the right population?] / Soins de transition entre l'hôpital et le domicile: pour quels patient-es ?

When patients are discharged from the hospital and return home, they are at risk of adverse events if the continuity of care is broken. So far, the evidence for transitional care models to reduce readmission rates has focused mainly on patients with a single condition. Based on this observation, we identified the population that may benefit the most from the development of a new transitional care model, as part of the INSTEAD project, by consensus between patients and professionals in hospitals and the community. To ensure continuity of care, it is necessary to consider the patients' perception, their understanding of the care plan and changes impacting the home care plan. Interprofessional collaboration is essential to achieve this.

Lorsqu'un-e patient-e retourne à domicile suite à une hospitalisation il-elle est souvent confronté-e à des événements indésirables si la continuité de ses soins n'est pas assurée. Jusqu'à ce jour, les modèles de soins de transition qui ont montré une diminution du taux de réadmission concernaient des patient-es ne souffrant que d'une seule pathologie. Partant de ce constat, nous avons identifié la population qui pourrait le plus bénéficier de soins de transition, dans le cadre du projet INSTEAD, par un consensus incluant d'une part des patient-es et, d'autre part, des professionnel-les hospitaliers et communautaires. Pour assurer la continuité des soins, il s'avère nécessaire de prendre en compte la perception de la personne, sa compréhension ainsi que les changements influençant son plan de soins à domicile. Pour ce faire, une collaboration interprofessionnelle est indispensable.

[Mobile applications for smoking cessation in primary care]. / Applications mobiles et désaccoutumance au tabac avec l'aide du praticien.

Primary care physicians are in an excellent position to address smoking during routine consultations. To this end, physicians have assessment tools and brief interventions appropriate for the duration of consultations. However, these tools are difficult to use consistently in practice. Mobile applications (apps) aimed at stopping smoking could help solve this problem, provided they meet certain quality criteria. This article provides criteria for evaluating these apps to facilitate their identification and use by clinicians. Five French-speaking apps are described. If integrated into routine Primary Care, these apps could facilitate smoking cessation.

Le médecin de premier recours a une place privilégiée pour aborder le problème du tabagisme en consultation de routine. Il dispose, à cet effet, d'outils d'évaluations et d'interventions brèves compatibles avec le temps de consultation. Ces outils sont difficiles à implémenter systématiquement. Les applications mobiles (apps) visant à l'arrêt du tabac pourraient contribuer à résoudre ce problème pour autant qu'elles satisfassent à certains critères de qualité. Le présent article propose des critères d'évaluation de ces apps pour faciliter leur identification et leur utilisation par le clinicien. Cinq apps francophones sont décrites. Intégrées à la consultation de médecine générale, de telles apps, pourraient faciliter la désaccoutumance au tabac.

Centre de santé de soins primaires : à quoi ressemblera-t-il dans le futur ?

Poussé par les besoins croissants des patient·e·s et l'augmentation des différents professionnel·le·s de la santé, le lieu de travail du monde ambulatoire doit évoluer. La pandémie a montré que la digitalisation des pratiques, avec toutes les questions que cette transformation soulève, est l'un des aspects du futur qui s'ouvre. Mais elle n'est de loin pas le seul enjeu du centre de santé de demain. Prévention et promotion de la santé, santé intégrative, social, économie, architecture, durabilité : les défis sont multiples. Pour les matérialiser, la Revue Médicale Suisse, en partenariat avec Unisanté, organise un concours avec une vingtaine de jeunes médecins et professionnel·le·s de la santé entourés de douze tuteur·trice·s pour imaginer le centre de santé de demain. Le résultat sera présenté dans un show-room de 200 m2 aux Assises de la médecine romande le 4 novembre 2021.

[Telemedicine in the era of COVID-19: a revolution†? The experience of the University Hospitals of Geneva]. / Télémédecine à l'ère du COVID-19†: une révolution†? Expérience des hôpitaux universitaires de Genève.

The COVID-19 pandemic has imposed a reorganization of our health care system leading to an unhoped-for boom in telemedicine, particularly in Geneva. The deployment of HUG@home at the Geneva University Hospitals and of docteur@home in the doctors' offices has allowed health professionals to come together around a single solution thus ensuring continuity of care for patients with chronic diseases but also the triage and follow-up of patients with COVID-19 in compliance with security and confidentiality rules. The ease of use of remote consultation tools is essential for the sustainable anchoring of telemedicine in practice. The supervision of practices, training and the financial valorization of telemedicine are also necessary for the development of quality care.

La pandémie de Coronavirus Disease 2019 (COVID-19) a imposé une réorganisation de notre système de soins conduisant à un essor inespéré de la télémédecine, en particulier à Genève. Le déploiement d'HUG@home aux HUG et de docteur@home dans les cabinets a permis la réunion des professionnels de la santé autour d'une solution unique assurant ainsi une continuité des soins de patients atteints de maladies chroniques, mais également le tri et le suivi de ceux atteints du COVID-19 dans le respect des règles de sécurité et de confidentialité. La simplicité d'utilisation des outils de consultation à distance est essentielle à un ancrage durable de la télémédecine dans la pratique. L'encadrement des pratiques, la formation ainsi que la valorisation des actes de télémédecine sont également nécessaires pour le développement de soins de qualité.

[Legal aspects of teleconsultation]. / Aspects juridiques de la téléconsultation.

There is no specific legal framework in Switzerland for the practice of telemedicine. The doctor carrying out a teleconsultation must therefore respect the general principles of medical practice : provide care online with professional recommendations, provide his patient with clear, appropriate and complete information, and also respect medical confidentiality. The doctor, due in particular to the limitation of the senses and the absence of direct physical examination, must maintain a degree of caution in the practice of remote consultations. He also remains responsible for the medical data exchanged and it is up to him to use a telemedicine solution adapted to the data security and confidentiality standards.

Il n'existe pas en Suisse de cadre légal spécifique à l'exercice de la télémédecine. Le médecin réalisant une téléconsultation doit ainsi respecter les principes généraux de l'exercice médical : apporter des soins en adéquation avec les recommandations professionnelles, délivrer à son patient une information claire, adaptée et complète, mais aussi respecter le secret médical. Le médecin, du fait notamment de la limitation des sens et de l'absence d'examen physique direct, doit garder un degré de prudence dans la pratique de consultations à distance. Il reste également responsable des données médicales échangées et il lui appartient d'utiliser une solution de télémédecine adaptée aux normes de sécurité et de confidentialité des données en vigueur.

[Teleconsultation in practice]. / Téléconsultation en pratique.

Teleconsultation is subject to the same rules as face-to-face consultation. However, doctors who wish to integrate it into their activity must be aware of a certain number of requirements linked to this practice such as the need to adapt their working environment, to comply with security rules, to ensure the continuity of medical information or to be aware of good practices and billing possibilities. In this article, we try to answer the frequently asked questions of health professionals who wish to carry out remote consultations in good conditions.

La téléconsultation est soumise aux mêmes règles que celles de la consultation en présentiel. Le médecin souhaitant l'intégrer à son activité doit cependant être sensibilisé à un certain nombre d'exigences liées à cette pratique comme la nécessité d'adapter son environnement de travail, satisfaire aux règles de sécurité, s'assurer de la continuité de l'information médicale ou encore connaître les bonnes pratiques et les possibilités de facturation. Dans cet article, nous tentons de répondre aux questions fréquentes des professionnels de la santé qui souhaitent réaliser des consultations à distance dans de bonnes conditions.

[Recommendations for the use of electronic mail in primary care]. / Utilisation du courrier électroniqueen médecine générale : recommandations pratiques.

Email is a great communication tool, but it's still rarely used by healthcare professionals. It can be used in exchanging information between healthcare professionals, but also among healthcare providers and patients. Studies that demonstrate a positive impact of email communication between health professionals and patients in the quality of healthcare are still lacking. Hence, an increasing number of patients want to communicate through email with their doctors. Clinical use of electronic mail should respect a certain number of rules, first of all using an encrypted system.

Le courrier électronique est un moyen de communication puissant mais encore peu utilisé par les professionnels de la santé. Il peut être utilisé pour des échanges entre professionnels mais aussi entre soignants et patients. Même si les études qui prouvent l'impact positif de la communication électronique entre médecins et patients sur la qualité des soins manquent encore, une part grandissante de patients souhaite pouvoir communiquer par courriel avec leurs médecins. L'utilisation médicale du courrier électronique doit répondre à un certain nombre de règles, la première étant l'utilisation d'un système de courrier sécurisé.

[The use of internet in medicine is no longer an option]. / L'utilisation d'internet en médecine n'est plus une option.

Internet is currently the most efficient source of information for doctors in their daily practice. Even though some training is necessary, it is easy to use the internet in medicine. Schematic though it may be, we can say only two websites are necessary: a research engine and a medical website. Progressively, each doctor then discovers websites that meet his/her needs.

[Patients, doctors and the internet]. / Patients, médecins et internet.

The majority of the Swiss population uses the internet to seek information about health. The objective is to be better informed, before or after the consultation. Doctors can advise their information-seeking patients about high quality websites, be it medical portals or websites dedicated to a specific pathology. Doctors should not see the internet as a threat but rather as an opportunity to strengthen the doctor-patient relationship.

The EPAGE internet guideline as a decision support tool for determining the appropriateness of colonoscopy.

BACKGROUND: Few studies have examined how physicians perceive guidelines, much less their perceptions of an Internet presentation of such guidelines. This study assessed physicians' acceptance ofan Internet-based guideline on the appropriateness of colonoscopy. METHODS: Gastroenterologists participating in an international observational study consulted an Internet-based guideline for consecutive patients referred for colonoscopy. The guideline was produced by the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE), using a validated method (RAND). Through the use of questionnaires, physicians were asked their opinions and perspectives of the guideline and website. RESULTS: There were 289 patients included in the study. The mean time for consulting the website was 1.8 min, and it was considered easy to use by 86% of physicians. The recommendations were easily located for 82% of patients and physicians agreed with the appropriateness in 86% of cases. According to the EPAGE criteria, colonoscopy was appropriate, uncertain, and inappropriate in 59, 28, and 13% of patients, respectively. CONCLUSIONS: The EPAGE guideline was considered acceptable and user-friendly and the use, usefulness and relevance of the website were considered acceptable. However, its actual use will depend on the removal of certain organizational and cultural obstacles.

Patient use of the Internet for health care information in Switzerland.

STUDY AIMS: The aim of this study was to examine for the first time the frequency of Internet use for medical purposes by patients in Switzerland. METHODS: In 2001 over a period of one month, 1604 patients at 8 medical practices in Switzerland completed a self-administered questionnaire on their access to the Internet and any search for medical information using this media. The attending physician supplied the patient's diagnosis and information on the severity of the disorder motivating the visit using a separate questionnaire. RESULTS: 46% of the patients included in the study had a personal computer, 33% had an Internet connection and 10% used the Internet to find medical information. Age was inversely associated with the probability of having an Internet access, whereas educational level and command of the English language were factors directly associated with this. Among those patients with access to the Internet, young adults (25 to 44 years) and those with knowledge of the English language searched for medical information significantly more frequently. Furthermore, patients attending urban medical practices and those with a more severe level of disease more often sought health care information on the Internet. CONCLUSIONS: The proportion of patients in Switzerland who search for medical information on the Internet is similar to the rates observed in European English-speaking countries. The Internet allows patients to actively search for information concerning their own health problems but is not currently the most common source of information used by patients. Since health professionals generate, directly or indirectly, most of the medical information published on the Internet, additional research is needed to better understand patients' needs and expectations concerning medical information using this media.

Use of the World Wide Web to implement clinical practice guidelines: a feasibility study.

BACKGROUND: Important efforts have been invested in the past few years in the development of quality clinical guidelines. However, the means for the effective dissemination of guidelines to practicing physicians have not been determined. Several studies have examined the possibilities offered by the World Wide Web (the Web), but studies examining the implementation of clinical guidelines in actual practice are clearly lacking. OBJECTIVE: This study assessed the potential of the Web to implement clinical practice guidelines in actual clinical settings. It also documents the obstacles perceived by the physicians in their use of guidelines on the Internet to determine the role that the Web can play in the implementation of guidelines in practice. METHODS: Two guidelines were developed using a standardized panel method and made available via the Web. One concerned indications for low-back surgery and the other dealt with indications for upper and lower digestive endoscopies. To identify obstacles to their use in clinical practice, 20 physicians were asked to consult the guidelines during consultations with patients. Answers were collected using 3 different questionnaires. RESULTS: Questionnaires were completed for consultations involving 213 patients. Less than 50% of the physicians have direct access to the Internet in their examination room. For 75%, the use of the guidelines was easy and the time required to consult them acceptable (3.4 minutes on average, or 12% of the time spent with the patient). The fear that use of such guidelines might interfere with the physician-patient relationship was mentioned as a reason for not consulting the guidelines for 27 consultations. Taking into account their experience with the Web, 75% of the physicians considered that the Web has a great or very-great potential for the dissemination of guidelines and 78% indicated that they would use such guidelines if they became generally available for clinical questions that concerned them. Only 3 physicians had consulted guidelines on the Web prior to this study. CONCLUSIONS: The acceptance of use of clinical practice guidelines via the Web is high. The main limits to further use of such Web-based guidelines seem to be the lack of a computer connection in the physician's office or examining room and the fear that use of such guidelines might interfere with the physician-patient relationship. Though most participants appreciate the considerable potential of the Web for disseminating guidelines, only a small handful regularly use guidelines available on the Web. There are still numerous obstacles to the regular use of guidelines in clinical practice, some related to the physicians, others to the guidelines themselves.

[Medical internet, for the best and the worst]. / L'Internet médical, pour le meilleur et pour le pire.

The aim of this article is to suggest to physicians some tricks that will allow them "surf" through the internet and pass the initial traps while searching medical information in the Internet. We are convinced that the physician will find most of the answers to his daily clinical questions once "able to manage" the 10 medical sites proposed in this article.