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. 2023 May;29(4):318-327.
doi: 10.1177/1357633X20982737. Epub 2021 Jan 20.

Utilization of telehealth in paediatric genome-wide sequencing: Health services implementation issues in the CAUSES Study

Alison M Elliott  1   2   3 , Nick Dragojlovic  4 , Teresa Campbell  1 , Shelin Adam  1   2 , Christèle du Souich  1   2 , Michele Fryer  5 , Anna Lehman  1   2 , Clara van Karnebeek  2   6 , Larry D Lynd  4   7 , Jan M Friedman  1   2
Affiliations

Utilization of telehealth in paediatric genome-wide sequencing: Health services implementation issues in the CAUSES Study

Alison M Elliott et al. J Telemed Telecare. 2023 May.

Abstract

Introduction: Genome-wide sequencing (exome or whole genome) is transforming the care and management of paediatric patients with a rare disease because of its diagnostic capabilities. Genome-wide sequencing is most effective when both parents and the child are sequenced as a trio. Genetic counselling is recommended for all families considering genome-wide sequencing. Although telehealth is well established in genetic counselling for hereditary cancer and prenatal genetics, its use with genome-wide sequencing has not been well studied. The CAUSES Clinic at BC Children's and Women's Hospitals was a translational paediatric trio-based genome-wide sequencing initiative. Pre-test genetic counselling via telehealth (at a clinical site near the family's residence) was offered to families who had been previously evaluated by a clinical geneticist. We report on the first 300 families seen in the CAUSES clinic and compare health services implementation issues of families seen via telehealth versus on-site.

Methods: Demographics, cost to families (travel and time), time to first appointment, complete trio sample accrual and diagnostic rates were studied.

Results: Of the 300 patients, 58 (19%) were seen via telehealth and 242 (81%) were seen on-site for pre-test counselling. The mean time to completion of accrual of trio samples in the telehealth group was 56.3 (standard deviation ±87.3) days versus 18.9 (standard deviation ±62.4) days in the onsite group (p < 2.2 × 10-16). The mean per-family estimated actual or potential travel/time cost savings were greater in the telehealth group (Can$987; standard deviation = Can$1151) than for those seen on-site (Can$305; standard deviation = Can$589) (p = 0.0004).

Conclusions: Telehealth allowed for access to genome-wide sequencing for families in remote communities and for them to avoid significant travel and time costs; however, there was a significant delay to accrual of the complete trio samples in the telehealth group, impacting on time of result reporting and delaying diagnoses for families for whom genome-wide sequencing was diagnostic.

Keywords: Telehealth; economics; genetic counselling; genome-wide sequencing; telemedicine; virtual health.

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