Telemedicine between a rehabilitation center and home nurses or home: Organization and results after 500 teleconsultations for patients with disabilities suffering from chronic wounds

Objective In 2014, our Rehabilitation Center (Pole MPR, Saint-Helier, Rennes) has been selected for a regional telemedicine project about chronic wounds. The aim was to improve the care access for patients with disabilities suffering from chronic wounds in nursing homes or at home. Material/patients and methods Targeted population is constituted by patients: whose access to care is decreased due to moving difficulties, of which the health care team is struggling in the care (wound care but also disability, nutrition…). The members of our telemedicine team are specialist doctors and nurses for wounds. On request the occupational therapist or dietician is involved in the consultation (multidisciplinary approach). Our project is integrated into the regional health policy with other regional telemedicine projects to create a single global regional project for deployment of telemedicine in Brittany named STERENN (secure regional videoconference and files). Results Since July 2014, over 500 tele-consultations have been done. Fifty percent of requests come from the nursing home, 50% from nurses at home people (pressure ulcers stages 3 and 4, arterial ulcers, venous or mixed). The mean age was 74 years (20–101 years). Duration of consultations is on average 25 minutes. In 30% of cases, the teleconsultation is extended by a real live training time for the nurse at home guided by the expert nurses of the team (learning organization). Without teleconsultation, in 83% of cases, transportation request for consultation would have been made, in 10% hospitalization. In 7%, no request would have been done. More than 70% of followed wounds in 2016 were cured or improved, 20,000 km were already avoided. Discussion – conclusion These organization leads to an improvement of the quality of care by promoting access to care, by providing expertise directly to the home (multidisciplinary), by assisting the nurse at home to redo the dressing (training). Telemedicine could help us to mitigate the effects of ageing population or the dependence of disabled people with difficulties to move. It could help us to guaranty the access to care for all despite difficult economic conditions. These are challenges for the health policy.