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Preferences for Alternative Care Modalities Among French Adults With Chronic Illness

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What is an ideal balance between alternative care modalities implemented during the COVID-19 pandemic and traditional care in the postpandemic care model?

Findings  This survey study of 1529 chronically ill adults found that patients would choose alternative care (ie, teleconsultations, symptom-checkers, and remote monitoring) over the traditional care equivalent for 22% to 52% of their future needs. The study identified 67 care activities, patient characteristics, and characteristics of alternative care modalities for which patients considered it appropriate to replace traditional with alternative care.

Meaning  Alternative care modalities implemented during the pandemic could be used to deliver nearly half of patients’ postpandemic care.


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.

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Article Information

Accepted for Publication: November 1, 2021.

Published: December 29, 2021. doi:10.1001/jamanetworkopen.2021.41233

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Oikonomidi T et al. JAMA Network Open.

Corresponding Author: Theodora Oikonomidi, MSc, Clinical Epidemiology Unit, Hôpital Hôtel-Dieu, One Place du Parvis Notre Dame, 75004 Paris, France (theodora.oikonomidi@inserm.fr).

Author Contributions: Ms Oikonomidi had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Oikonomidi, Ravaud, Tran.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Oikonomidi.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Oikonomidi, Tran.

Administrative, technical, or material support: Ravaud.

Supervision: Ravaud, Tran.

Conflict of Interest Disclosures: Dr Oikonomidi reported receiving a 3-year doctoral scholarship from the French School of Public Health during the conduct of the study. Dr Barger reported a postdoctoral research fellowship from Agence nationale de recherche maladies emergentes and speaking fees from ViiV Healthcare and Gilead Healthcare outside the submitted work. Dr Tran reported being a minority stakeholder in SKEZI outside the submitted work. No other disclosures were reported.

Additional Contributions: Elise Diard, MPS (Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France), designed eFigure 2 in the Supplement, and Caroline Barnes, RN, MPH (Universidad Internacional SEK, Quito, Ecuador), edited the manuscript. Elise Diard was not compensated for her contribution. Caroline Barnes was compensated for her contribution. We thank the doctoral network of the Ecole des Hautes Etudes en Santé Publique.

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