Keywords: teleconsultations, inequalities in access to healthcare, rurality, territories, healthcare pathways

Background:

The Centre-Val de Loire region is characterised by a chronic shortage and an uneven distribution of doctors. Rural areas suffer from a combination of socio-economic vulnerability and difficulties in accessing healthcare. Following the COVID-19 crisis, teleconsultations were rapidly developed to provide faster access to care and avoid delays in treatment. However, without territorial coordination, local initiatives led by healthcare professionals coexist with an unregulated private sector offering.

Aim of the study:

This research aims to assess whether the development of teleconsultation in the region helps to reduce inequalities in access to healthcare linked to medical desertification, particularly in rural areas.

Methodology:

We carried out bivariate and multivariate treatment of data from the National Health Data System from 2022 to 2024 (location of patients and doctors, number of procedures, rate of work stoppages, etc.), mortality data from CepiDC and socio-economic data from INSEE, coupled with a qualitative methodology involving questionnaires and interviews with doctors.

Results:

Between 2022 and 2024, teleconsultations increased by 500%, with only 36% carried out by a local doctor, which partly offsets the fall in face-to-face consultations. However, the 3- and 5-day review rates show major variations depending on whether the teleconsultation is carried out with the patient’s GP, and on how rural the beneficiary’s living area is. Spatial analysis reveals a paradox: greater development of teleconsultations in urban areas already better endowed with GPs, to the detriment of rural areas disadvantaged by a shortage of healthcare services, and its use by rather young populations from affluent social backgrounds.

Conclusions:

The development of telemedicine can be an essential element in the reorganisation of healthcare provision in rural areas. However, to be effective, telemedicine must be organised as closely as possible with local healthcare professionals, to provide patients with a high-quality response, as part of a regionalised care pathway that allows for post-expertise care if necessary.