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Coronavirus: Covidom, a mobile application that tracks patients

2020-03-27T20:30:46.871Z


Launched by the AP-HP, the system supports Covid-19 patients at their home in order to anticipate any deterioration in their condition.


They are medical students, dentists, physiotherapists, nurses, health executives, pharmacists, university professors… And joined forces to play the switchboard operators serving the patients of Covid-19, diagnosed and then sent home. Covidom, it is a hive set up in a few days by the AP-HP to ensure the follow-up of these patients, healthy enough not to be hospitalized, but to be watched closely to avoid dramas born from a brutal deterioration of their condition. "On March 2, nothing existed, and the activity was launched on March 9!" , is still surprised by Professor Patrick Jourdain, responsible for the regional telemonitoring platform. First open to Pitié-Salpêtrière and Bichat patients, "to ensure that it was suitable for infectious and emergency services" , the system was gradually extended to all hospitals in the AP-HP and, for a week now, all the liberal doctors of Île-de-France. Discussions are already underway with provincial hospitals to develop the system.

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Via a smartphone application developed for the occasion by Nouveal, questionnaires are sent once or twice a day to patients registered by the doctor who, in town or at the hospital, diagnosed them. The questions are basic: respiratory and heart rate, temperature, did you have chills, feel faint, do you have difficulty breathing, do you have trouble respecting confinement? "These are very simple things, which work very well with short tutorials to help patients," notes Patrick Jourdain. Additional data can be added if, for example, the patient has an oximeter, a device that measures the amount of oxygen in the blood. "But it is not necessarily very useful. When your saturation is low, you should already be in the hospital. ”

On-site psychiatrists can take patient over the phone

Pr Patrick Jourdain, head of the regional telesurveillance platform

The system automatically generates alerts, according to a decision tree developed with general practitioners, emergency physicians, infectious disease specialists, etc. Green, everything is fine. Orange, to watch. “At the moment, these are more patients who are difficult to reach. We also have a lot of orange alerts at the beginning, when people do not know how to use the thermometer or calculate their respiratory rate ” , notes Patrick Jourdain. In the event of a red alert, the patient is called back as soon as possible. “This is the case, for example, of a patient who claims to have a temperature of 40 ° C. According to our latest statistics, in the event of a red alert, we start talking to the patient in less than 9 minutes. And the treatment lasts on average 25 minutes. ”

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The worker begins by questioning the patient on the way in which he took the action that generated the alert. If it is only a handling error and all is well, the alert is closed. The call is then an opportunity to give some advice, answer questions, reassure, calm any anxiety. "On-site psychiatrists can take the patient on the phone , " says Patrick Jourdain. Again, he notes, the “start-up spirit” hit the big AP-HP machine: “At first, it was a dentist who told me that his father, a psychiatrist, wanted to help. Then he recruited from his professional circle. ”

A great human adventure

If the situation requires, the worker can, at any time, seek the help of a doctor. “We have a doctor for four workers. When there is a problem, the worker raises his hand and the doctor comes to take the patient on the phone, to decide whether to stay at home, contact his doctor or go to the hospital. It can also happen that we call Samu ourselves. ”

Open 7 days a week during the day, the system “is not intended to serve as a Samu bis ,” specifies Patrick Jourdain. We are complementary, our objective is to anticipate a worsening of patients. ” The doctor who registered the patient has permanent access to the file, knows when alerts were issued and what was done. "Beyond the usual logics of chapels, Covidom is a great human adventure that mixes city and hospital, teachers and students, doctors, nurses, etc." , enthuses Professor Jourdain, who still marvels at the mobilization raised by the project: "To find speakers, we contacted the deans of the faculties. They responded immediately, got organized, and the teachers came with their students to answer the phone! ” Each benefits from theoretical training of an hour and a half, then three or four hours of coaching in the care of patients.

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Over 1,000 doctors from various medical specialties have already volunteered. "We need to industrialize our schedules!" Some 300 volunteers have already been trained and new ones are trained every day. “Our objective is to permanently have 15 to 20 cells with 4 workers plus a doctor, working in parallel. But if we need to open 25 cells on Monday, we can do that. ” As for patients, mid-week, some 13,000 were registered, 300,000 questionnaires processed, and more than 10,000 alerts managed. "We are in the world's largest remote monitoring experience, and our organization allows us to adapt to the size of the epidemic."

Rush on teleconsultation: 80,000 acts performed in one week

The number of teleconsultations has jumped since the start of the Covid-19 epidemic, with a record 80,000 procedures performed the week of March 16 to 22, said Medicare on Wednesday. Or twice as much as during the whole month of February (40,000). This represents a quarter of the total number of procedures (320,000) performed in 18 months, since the entry into force of the reimbursement for teleconsultation in September 2018. Doctors for whom clinical examination remains the basis of practice have long been reluctant. medical, get there by force of circumstances. And the health authorities favor it: at the beginning of March, the government facilitated the use of this practice by lifting the obligation to go through its treating doctor, for patients with coronavirus. In addition, the teleconsultation is reimbursed 100% by Health Insurance since last Saturday (instead of 70%), and this for the duration of the epidemic.

On the Doctolib site, well known for making online appointments, the number of teleconsultations has been multiplied by 100, and that of the number of doctors using the service by at least ten. The service is free during the crisis for doctors (instead of a subscription of 79 euros monthly in normal times). "In a few days, France has become, with China, one of the first teleconsultation countries in the world," says Stanislas Niox-Château, co-founder and president of the company.

Source: lefigaro

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