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Telemedicine technology is a growing field, especially in the context of the COVID-19 pandemic. Consult Station (Health for Development) is the first telemedicine device enabling completely remote medical consultations, including the concurrent collection of clinical parameters and videos.
Our aim was to collect data on the multisite urban and suburban implementation of the Consult Station for primary care and assess its contribution to health care pathways in areas with a low density of medical services.
In a proof-of-concept multisite prospective cohort study, 2134 consecutive patients had teleconsultations. Consultation characteristics were analyzed from both the patient and practitioner perspective.
In this study, the main users of Consult Station were younger women consulting for low-severity seasonal infections. Interestingly, hypertension, diabetes, and preventive medical consultations were almost absent, while they accounted for almost 50% of consultations with a general practitioner (GP). We showed that for all regions where the Consult Station was implemented, the number of consultations increased as GP density decreased. The study of practitioner characteristics showed GPs from metropolitan areas are motivated to work with this device remotely, with a high level of technology acceptability.
The multisite implementation of Consult Station booths is suitable for primary care and could also address the challenge of “medical deserts.” In addition, further studies should be performed to evaluate the possible contribution of Consult Station booths to limiting work absenteeism.
Alongside the development of the internet and connected tools over the past 2 decades, a rise in the development of eHealth technologies has been observed, facilitating remote communication between patients and caregivers [
However, telemedicine is not yet ubiquitous and there are ongoing debates on how to improve the quality of patient care. This is particularly true for teleconsultations [
The year 2020 was seriously impacted by the global spread of COVID-19, which necessitated the promotion of new health care initiatives and a reorganization of telemedicine to meet patients’ expectations for broader access [
To date, none of the telemedicine technologies reported involve a single application that enables patients and physicians to conduct a comprehensive measurement of medical parameters. In 2009, Consult Station, a French telemedicine booth, was created and developed by Health for Development (H4D) to meet the growing needs of telehealth; it combines remote consultations, measurement of medical parameters, and diagnostic tools in a single location, and includes a dedicated training program for physicians.
In this proof-of-concept study, we report a multisite implementation of the Consult Station booth for primary care in France and its contribution to health care pathways in the context of generalization of telemedicine devices.
This was a multisite prospective observational cohort study that consecutively included all patients aged ≥18 years who had a teleconsultation via Consult Station in France from September 16, 2019, to January 31, 2020, with no exclusion criteria and no patient exclusion in the data analysis.
Informed consent was obtained from each patient before inclusion. Data extraction was anonymized. This noninterventional study obtained the approval of the local ethics committee for collecting and analyzing data (Avicenne hospital, number CLEA-2018-019; 020-019).
H4D is a company specifically dedicated to clinical telemedicine [
Consult station booths were implemented on the premises of large companies and town halls, and employees were informed of the device’s availability and told they had free access to it. When patients wanted a teleconsultation, they had to connect to an appointment booking website provided by H4D and agree to privacy and confidentiality rules. In accordance with the French law on teleconsultations, an appointment must be given to the patient within 48 hours. If necessary, a distant care manager helped the patient schedule the teleconsultation. There were no restrictions on the use of the device and there was no need to be referred by a practitioner to book an appointment.
GPs were recruited on a voluntary basis and systematically trained. The GP characteristics collected for this study were age, gender, medical specialty, location of private practice, and time devoted to teleconsultations per week.
For each patient, data were collected by the physician during the teleconsultation. Data collected included age, gender, date, location of consultation (ie, Paris, Paris suburbs, or other regions), reasons for consultation, and classified consultation diagnosis according to the International Classification of Diseases, Tenth Revision (ICD-10).
Categorical data were expressed as numbers and proportions, while continuous data were expressed as mean (SD) or median (IQR) as appropriate.
The number of teleconsultations was assessed according to the local GP density per 100,000 inhabitants [
The data were analyzed and graphics were generated using R statistical software (version 4.0.0; R Foundation for Statistical Computing).
A total of 2134 teleconsultations were carried out from September 16, 2019, to January 31, 2020. The teleconsultations were distributed over weekdays as follows: 419 (20%) on Mondays, 450 (21%) on Tuesdays, 411 (19%) on Wednesdays, 454 (21%) on Thursdays, and 400 (19%) on Fridays. Medical parameters measured and diagnostic tools used were as follows: weight (344/2134, 16%), height (n=344, 16%), BMI (n=344, 16%), temperature (n=1450, 68%), blood pressure (n=1351, 63%), cardiac frequency (n=823, 38.5%), oxygen saturation (n=823, 38.5%), electrocardiogram (n=14, 0.6%), stethoscope (n=896, 42%), dermatoscope (n=156, 7%), and otoscope (n=924, 43%). A teleprescription was issued for 1567 (73%) patients. A sick leave certificate was issued for 42 (3%) patients. Complete data, including the reasons for teleconsultation, were available for 1746 (82%) patients. Overall, 98% (1715/1746) of the teleconsultations were conducted in full, while 2% (n=31) of teleconsultations were abandoned as a result of connection issues.
Distribution of the reasons for teleconsultation among 1715 patients.
Reasons for teleconsultation | Patients, n (%) | |
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Cough disorders | 343 (20) |
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Rhinitis | 154 (9) |
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Fever, unspecified | 137 (8) |
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Functional urinary symptoms | 103 (6) |
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Unspecified pains | 187 (11) |
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Joint diseases/pain | 137 (8) |
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Unspecified abdominal pain | 51 (3) |
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Headache | 51 (3) |
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Asthenia | 67 (4) |
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Skin disorders | 51 (3) |
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Unspecified allergy | 86 (5) |
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Prescription renewal | 51 (3) |
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Prevention | 120 (7) |
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Laboratory results | 343 (20) |
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Othera | 154 (9) |
aOther included unspecified visual disorders (n=19), gynecological disorders (n=17), unspecified vertigo (n=17), pregnancy (n=16), unspecified screening (n=15), nausea or vomiting (n=14), unspecified sleep disorders (n=8), myalgia (n=8), and psychological demands (n=7).
The main users of Consult Station were younger women with a mean age of 38.7 (SD 10.3; range 20-77) years.
Characteristics of 1715 consecutive patients with teleconsultations.
Variable | Whole cohort (N=1715), n (%) | Women (N=1230), n (%) | |
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20-39 | 948 (56) | 722 (59) |
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40-59 | 723 (42) | 488 (40) |
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≥60 | 34 (2) | 20 (1) |
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Women | 1230 (72) | N/Aa |
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Men | 475 (28) | N/A |
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Otorhinolaryngology | 756 (44) | 555 (45) |
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Osteoarticular | 189 (11) | 129 (11) |
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Normal clinical examination | 187 (11) | 111 (9) |
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Pneumonology | 112 (7) | 77 (6) |
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Dermatology | 77 (5) | 66 (6) |
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Urology | 77 (5) | 58 (5) |
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Gastroenterology | 52 (3) | 33 (3) |
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Ophthalmology | 45 (3) | 27 (2) |
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Abnormal laboratory results | 35 (2) | 27 (2) |
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Neurology | 35 (2) | 28 (2) |
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Prevention | 34 (2) | 25 (2) |
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Gynecology | 29 (2) | 24 (2) |
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Cardiovascular/high blood pressure | 26 (2) | 13 (1) |
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Psychiatry | 18 (1) | 15 (1) |
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Asthenia | 12 (1) | 9 (0.7) |
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Dental | 10 (0.5) | 8 (0.6) |
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Endocrinology/diabetes | 6 (0.3) | 4 (0.3) |
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Sexually transmitted infection | 6 (0.3) | 4 (0.3) |
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Missing data | 8 (0.5) | 7 (0.6) |
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No orientation | 994 (58) | 716 (58) |
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General practitioner | 387 (23) | 273 (22) |
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Complementary examination | 159 (9) | 115 (9) |
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Specialist | 104 (6) | 70 (6) |
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Other health professional | 53 (3) | 42 (3) |
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Emergency department | 10 (0.5) | 7 (0.6) |
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Missing data | 8 (0.5) | 7 (0.6) |
aN/A: not applicable.
A total of 31 Consult Station booths were implemented in France for primary care management, mainly on the premises of large companies (≥5000 employees) and local authorities, with one of them set up inside a town hall (
We then considered a French composite indicator for access to a GP, namely LPA, which provides the completed number of GP consultations per patient in relation to the number of available GP consultations. Medical deserts are defined by an LPA value under 2.5 per year, which applies to 5.1% of France, while the national LPA value is 3.7 (range 1.4-12.1). Using this threshold of 2.5, none of the Consult Station booths were in a medical desert. We then further classified LPA into 3 categories as follows: low LPA (2.5-3.2), moderate LPA (3.3-4.0), and high LPA (≥4.1). This showed that 19% (6/31) and 55% (17/31) of the Consult Station booths were located in moderate- or low-LPA areas, respectively.
Implementation of Consult Station booths according to general practitioner density in France (left panel) and in the Île-de-France region (ie, Paris and its suburbs; right panel).
The number of teleconsultations was high in the Paris suburbs where GP density is low (124 GPs/100,000 inhabitants) and the LPA value is moderate (3.3 consultations/year). Across France, the number of teleconsultations increased as GP density decreased (
The mean age of the 15 GPs was 39 (SD 8.5, range 30-60) years and 10 (80%) GPs worked in high-LPA areas. The number of years since the GPs’ graduation ranged from 3-35 years. Of the participants, 60% (9/15) worked in a mixed setting, in both private practice and a hospital, and 47% (7/15) worked in a group practice. None had been previously trained for teleconsultations, but 3 of them reported occasional experiences in teleconsultation. Reasons provided by the doctors for their choice to practice telemedicine included the following: the innovative aspect of this device, collaborative work, diversification of their activity, and provision of care to people in medical deserts. For 73% (11/15) of them, the COVID-19 pandemic had not influenced their perception of teleconsultation and 87% (13/15) would recommend teleconsultation to other colleagues. It is worth noting that they were urban practitioners, as none worked in a low-LPA area (
Number of teleconsultations with the Consult Station according to general practitioner density and LPA (N=2134).
Area | Teleconsultations, n (%) | Mean general practitioner densitya | C/D ratiob | Mean LPAc |
Paris (center) | 222 (10) | High (248) | 0.9 | High (4.5) |
Other regions | 660 (31) | Moderate (148) | 4.4 | High (4.6) |
Paris suburbs | 1252 (59) | Low (124) | 10 | Moderate (3.3) |
aGeneral practitioner density in number per 100,000 inhabitants in France.
bC/D ratio: number of consultations/mean general practitioner density per 100,000 people.
cLPA: localized potential accessibility.
Scatter plot of the number of teleconsultations according to (A) GP density or (B) LPA. GP: general practitioner; LPA: localized potential accessibility.
The Consult Station booth is the first telemedicine device enabling completely remote medical teleconsultation with concurrent collection of clinical parameters, as otherwise teleconsultations are often limited to telephone consultations [
In our study, seasonal infections of low severity were the main reason for teleconsultations among younger patients. Interestingly, hypertension, diabetes, and preventive medical teleconsultations were almost absent, whereas they accounted for almost 50% of in-person consultations with a GP in France [
Most of the patients were younger working women of childbearing age. This gender ratio might be explained by women being overrepresented in the use of the internet and telemedicine [
With the emergence of COVID-19, Consult Station could also be used to help manage patient flows in compliance with barrier measures [
With a multisite implementation, we believe that Consult Station booths could contribute to addressing the challenge of medical deserts. Even though they were largely implemented on business premises and none were in medical deserts, there was no real bias linked to the geographical distribution of Consult Station booths in our study, since 36% were implemented in areas with low GP density.
From the patients’ perspective, the device offers easy access to doctors even in areas with low GP density. This implies a willingness among practitioners from metropolitan areas to respond to this challenge. Our study results showed a high level of technology acceptability among practitioners and our teleconsultation device addressed several of the barriers previously identified by GPs for the use of telemedicine. With acceptance by both patients and GPs, this type of teleconsultation device provides proof of concept for the generalization of telemedicine, and could succeed where public health policies have failed to address the growing problem of access to care in underpopulated rural areas [
The multisite implementation of Consult Station booths is suitable for primary care, but it also could meet the challenge of medical deserts. Although various types of telehealth or telemedicine facilities were already available in early 2020, the COVID-19 pandemic has highlighted the need for videoconsultations using remote tools such as those included in the Consult Station. In addition, further studies should be conducted to evaluate the possible contribution of Consult Station booths to limiting work absenteeism.
The Consult Station booth.
Characteristics of the 15 general practitioners who performed teleconsultations.
general practitioner
Health for Development
International Classification of Diseases, Tenth Revision
localized potential accessibility
We thank Ms Angela Swaine and Ms Sarah Leyshon for English revisions. Health for Development (H4D) paid for the English language revision. We thank H4D for its authorization to reproduce a commercial image (ie,
GF, GB, AW, FB, and FP conceived and designed the study. AW, VF, AB, and CG collected the data. GF, GB, AW, FP, IR, and SM analyzed the data. GF, GB, AW, IR, and SM interpreted the data. GF, AB, AW, VF, CG, FB, FP, IR, and SM wrote and revised the manuscript. All authors read and approved the final manuscript and agreed to be accountable for all aspects of the work.
AW, VF, AB, CG, and FB are funded by Health for Development (H4D). GF, GB, IR, SM, and FP have no conflicts of interest to report.