Improving the Quality of Diagnostic Procedures of Autism Spectrum Disorders by Telemedicine

Background:  Despite a widespread assumption of the advantages of telemedicine, medical and economic interest has been rather limited to date. Nevertheless, with developments in information and communication technologies increased interest is apparent in telehealth and telemedicine. The World Health Organization and the European Commission have encouraged the development of the sector, viewing these as means streamline the organization of the health system and the distribution of health care provision at local level, as well as a vehicle for economic growth. In the context of autism spectrum disorders (ASD) in France, diagnostic assessment tools ADOS and ADI, which are considered as gold standards in the domain, remain insufficiently disseminated. They are mainly used by regional centres for diagnostic assessment, where access may be difficult for children with suspected ASD who do not live nearby.

Objectives: We made the assumption that telehealth tools could facilitate the use of ADOS by practitioners and thereby improve the quality of diagnostic procedures to the benefit of patients.

Methods:  This paper provides an account of an experiment of practice exchanges using videoconferences, a process akin to distance learning, conducted from the regional unit of ASD assessment at the University Hospital of Toulouse (Midi-Pyrenees region, France), with the support of a regional telemedicine network. It took place over six months during 2010, involved six primary care teams for patients away from the regional capital, and included 22 professionals. Each was offered the opportunity to participate in 3 videoconferences, with the ultimate goal of improving the compatibility of autism diagnostic procedures with national professional guidelines. The evaluation of the experimental protocol was aimed at both the acceptability of the technical sessions, the perception of skills transfer and the prospects for change in clinical practice. It relied on answers to questionnaires about qualitative and quantitative perceptions of these aspects. In a medico-economic approach, a cost / benefit analysis was also based on a comparison with traditional training tools.

Results:  The protocol was very well received by the local professionals involved, who appreciated the positive transfer of skills despite a technical context that could be improved. After three sessions of exchange of 150 minutes, the level of knowledge of ADOS improved threefold, and half of the professionals said they were ready to use the tool.

Conclusions:  We conclude that the acceptability of this approach to distance education is quite good, and that the economic balance is positive. Demonstrating improved quality of diagnostic procedures by primary care teams will require extending the protocol, but these early results are sufficiently encouraging to warrant further studies on teleconsultation and teleexpertise in autism and ASD.