For certain patients with disabilities, cognitive and/or behavioral disorders or even communication difficulties, a simple visit to the GP can be very painful. Anxiety can increase tenfold during intrusive or even painful care, such as a routine blood test. Therefore, habituation measures have been introduced in recent years so that these populations are not in a situation where they have to give up care, which happens very often, even though their health is often more fragile compared to the general population.
From 1this one April 2022, as part of amendment no. 9 to the Medical Convention, signed in 2021 between private doctors and the National Health Insurance Fund (CNAM), general practitioners and specialists can normally perform and invoice the so-called Texts indicate that ” “white consultations are understood, on the one hand, as the planned meeting time between a patient living with a disability and a practitioner, as well as their place of consultation (appropriation of space, equipment, recognition of people), or “on the contrary, as consultations during which the planned care could not be carried out considering the patient’s disability “.
Lack of notoriety
In fact, consultation with white people does not yet appear to be well known or widespread. Fabien Ragouat, a nurse for two years at the Specialized Reception Center (MAS) in FontColombe in Montpellier, is used to accompanying his residents with autism spectrum disorders (ASD) to consultations with various doctors. He notes that few practitioners know about practice consultations or plan the time to get used to them. Having worked in the emergency department of a public hospital for eighteen years, he himself had never heard of it until he started at FontColombe. Looking back, he considers it abnormal that the hospital does not have a dedicated circle for receiving people with disabilities and regrets that 3 MAS residents have been waiting for a solution for the scanner for a long time, fortunately without urgency.
Jordi Valenzuela, directorassociation “On your side”, which promotes the development of autonomy and social connections for people with disabilities, is also used to provide care to young people suffering from behavioral disorders and autism. He notes that even neurologists and psychiatrists, who are in charge of regular follow-up of these patients, do not offer consultations for habituation, nor do general medicine doctors and private specialists in his network. Professor Sophie Siegrist, a GP who was contacted by the College of General Medicine who surveyed its members following our request, admits that it was the first time she and her intern had heard of white consultation, while she is also vice-president of the Territorial Professional Health Society (CPTS). its territory.
Rejections are more or less directly indicated
France Assos Santé survey from 2019 French and access to care, including 1002 respondents, showed that 77% of people with disabilities gave up or delayed treatment. For his part, the last one Handifaction barometer shows that 16% of people with disabilities are denied access to health services, which is illegal. Refusal of care is rarely openly expressed, but because doctors change absolutely nothing in their offices to accommodate these patients who require more attention, time and adjustment, or make it clear that it will be difficult to make another appointment, these patients and their loved ones can feel unwanted and give up care.
For Professor Siegrist, ” the formalization of white consultations by legislators can be a way to raise awareness of the difficulties in accessing care faced by patients with disabilities “. However, in everyday practice, it seems to her that it has always been “unofficial” practiced this type of consultation, which for her is a treatment in itself, even if it does not lead to a technical procedure or prescription. The creation of white consultations does not seem to him “equally relevant in general medicine as for other specialties involving more technical procedures such as ophthalmology, dentistry or gynecology”.
The HandiConsult34 habituation experiment continues
In Montpellier, Article 51 of the 2018 Social Security Financing Law, which allows for the testing of models for innovative health organizations, has enabled HandiConsult34 to set up an experiment around an ambitious system of particularly well-organized habituation consultations, called “dedicated consultations”. Created according to ministerial instructions in 2015 and until then insufficiently funded, dedicated consultations initially concern audiences of all age groups, all disabilities, all walks of life. The HandiConsult34 teams, for their part, specialize in welcoming people with discommunication, especially those suffering from autism spectrum disorders or severe physical disabilities, all of whom have failed in regular care. In the PROPARA Mutualist Neurological Center, where HandiConsult34 is located, health teams offer 6 types of consultations in general and somatic medicine, dentistry, gynecology, ophthalmology, ENT and imaging. dr. Michel Delcey, physician coordinator within the structure, specifies that ” a dedicated consultation is in terms of time, place, speaker, waiting, i.e. absence of waiting and that above all it is care support “.
At the center in Montpellier, this support is provided by medical staff and caregivers, who are specially trained and then supervised for two years, to take care of these habituation consultations. Other practitioners therefore concentrate on their expertise, agree to “lose control” of the consultation and step in when the patient is ready to accept care. More advanced than white consultations, dedicated consultations with habituation are funded in the experiment thanks to different packages for order of care, which are available according to medical specialties and types of care to be provided. The model was validated at the end of 2023 with a final evaluation report, and its transposition at the national level is planned in the coming months. Fabien Ragouat, who follows many residents of FontColombe at HandiConsult34, speaks of it as a beacon in the night. For his part, Jordi Valenzuela, who also attends the youth structure for which he is responsible, adds: “ I am particularly touched by the good treatment shown by the HandiConsult34 teams who take all the necessary time and absolutely try to avoid immobilization, either through general anesthesia or shackling. “. It remains to formalize the specifications of the dedicated consultations and the modalities of their generalization, in the hope that Hérault’s example will be a source of inspiration and will also enable the improvement, promotion and awareness of the recent white consultation system.