Preferences for In-Person Consultations with the Referring Physician versus Remote Care provided by the Referring Physician or another Physician among Patients with Long-Term Conditions: A Vignette-Based Survey

ObjectiveTo assess the use of remote care by patients with long-term conditions (LTC) in France to interact with their referring physician (RP), and their preferences for in-person versus remote care with their RP or another physician. Methods and AnalysisVignette-based survey among adults with at least one LTC recruited from the ComPaRe cohort, a nationwide cohort of patients with LTC in France. Data were weighted to represent French patients with LTC. The survey assessed 1) the availability and use of remote modalities (video consultation, phone contact, and asynchronous message exchange) to interact with their RP, 2) their preferences for in-person consultation or remote modalities to interact with their RP in five situations (worsening symptoms, new symptoms, annual check-up, results discussion, medication renewal), 3) their willingness to trade an in-person consultation in 20 days with their RP for a quicker Direct-to-Consumer (DTC) remote consultation with a non-RP. ResultsWe included 1995 participants (mean age 55 [SD17], 56% female, 69% with at least 2 LTC). 1) For 47% of patients, remote care with the RP was not available. 2) To interact with their RP, a remote modality was preferred over an in-person consultation by 25% to 55% of patients with higher proportions for results discussion (43%) and medication renewal (55%) than for worsening symptoms (36%), new symptoms (25%), or annual check-ups (26%). 3) Depending on the situation, 20% to 51% of patients were willing to trade an in-person consultation with the RP in 20 days for a DTC remote consultation within 5 days. Factors associated with the preference for a quicker DTC remote consultation were clinical situations (OR 3.16 [2.35-4.26] for new symptoms, p<0.001; OR 3.74 [2.77-5.08] for worsening symptoms, p<0.001, compared to medication renewal), the gender male (OR 1.32 [1.04-1.67], p=0.021), the difficulty to consult in-person (OR 1.54 [1.22-1.96], p<0.001), the unavailability of remote modalities with the RP (OR 1.33 [1.09-1.64], p=0.006), the RPs specialty (OR 1.79 [1.28-2.50] for general practitioners, p=0.001), medium or poor listening skills of the RP (OR 1.53 [1.20-1.95], p=0.001) and usual delay before the next in-person appointment < 2 weeks (OR 1.43 [1.12-1.82], p=0.003). ConclusionIn France, patients with LTC have limited access to remote care with their RP. Up to 50% of patients would consider replacing an in-person consultation with a remote modality, including with a non-RP, depending on the situation and the delay. KEY MESSAGESO_ST_ABSWhat is already known on this topicC_ST_ABSRemote care can help reduce the logistical burden of follow-up for patients with long-term conditions (LTC), yet it remains underused in many healthcare systems. Previous studies have shown conflicting findings regarding patient preferences for remote versus in-person care, and few have explored how these preferences vary depending on clinical scenarios or the physician involved. What this study addsThis nationwide, vignette-based survey shows that nearly half of patients with LTCs in France do not have access to remote care with their referring physician. Despite this, up to 55% of patients prefer remote modalities over in-person consultations in some contexts (e.g., medication renewal), and up to 51% are willing to consult an unknown physician remotely if it shortens the delay to care, especially in situations of worsening symptoms or new symptoms. How this study might affect research, practice, or policyThese findings suggest that, in France, remote care is underused not due to patient reluctance but due to limited availability and inadequate integration into care pathways. Policymakers and healthcare providers should prioritize the development of flexible, blended care models that incorporate patient preferences and clinical context to optimize continuity and accessibility of care for patients with LTCs.