An Internet-based system could be a useful tool for screening adults for mental health disorders and giving preliminary diagnoses, according to a new Dutch study.

This eDiagnostics system is already used in primary care practices in The Netherlands, the researchers say, but nowhere else, and more study is needed to determine if it is reliable, valid and cost-effective.

“Using the Internet to diagnose mental health problems in primary care seems very promising,” writes lead author Ies Dijksman and colleagues from Maastricht University.

“The great advantage of an electronic system is that patients can complete diagnostic tests at home,” Dijksman told Reuters Health in an email, adding that people may be quicker to reveal themselves over the Internet and provide genuine responses to questions because of their perceived anonymity.

“This could lead to a more accurate information collection process compared to conventional clinical interviews,” Dijksman said.

Yet conventional interviews may still have a place in primary care, since the complete use of Internet-based activity may present some “unforeseen obstacles,” the researcher said. “For example, there are no visual cues to guide the physician.”

Dr. Eric Bender, who was not involved in Dijksman’s study, also noted the importance of visual cues. “Someone may say, ‘I’m feeling fine,’ but they may look like they’re on the verge of tears,” he told Reuters Health. He also questioned whether the use of an Internet-based tool may inadvertently cause a delay in diagnosis of mental health disorders among the elderly and people who are not computer literate.

“As a clinical provider, I want to see people,” said Bender, a private-practice child/adolescent, adult and forensic psychiatrist who also works as a staff psychiatrist at the University of California, San Francisco. “I think it’s critical to see patients,” he said.

For their study Dijksman and her colleagues surveyed general practitioners (GPs), practice nurses (PNs) and adult patients about their experiences with TelePsy, an eDiagnostic system that was introduced into primary care practices in The Netherlands in September 2011.

In The Netherlands - similar to the UK, Spain and some managed care plans in the U.S. - patients who desire to see a specialist health care provider must first visit a primary care provider for a referral. TelePsy assists those doctors and nurse practitioners in identifying symptoms and potential causes of psychological problems and gives advice about a patient’s need for referral to specialty care.

After an initial referral from the primary care provider, the eDiagnostics process requires patients to complete a questionnaire. The profile created from those responses is reviewed by a TelePsy psychologist who then does a telephone consultation with the patient, and afterward prepares a report that is submitted back to the primary care provider.

The report includes a preliminary diagnosis based on the standard psychiatric diagnostic manual, DSM-IV, and provides advice on whether the patient should be referred to mental health care and the extent of care required - primary, secondary or tertiary, with tertiary indicating a need for inpatient psychiatric treatment.

The most common diagnoses identified via TelePsy were mood disorders, including depression and anxiety, Dijksman and colleagues report. Other less-common diagnoses included suspicion of a personality disorder, substance abuse disorder and developmental disorder.

Overall, the 242 patients surveyed said they were generally “quite satisfied” with the TelePsy system and were neutral about whether they would prefer a face-to-face consultation with a psychologist over the computerized system.

The 49 doctors and nurse practitioners surveyed in the study were very satisfied with the TelePsy system as well. They also tended to agree with the diagnoses suggested by the eHealth system and the referral advice given, the researchers note in the journal Family Practice.

There were some differences in the decisions made by the program and the doctors, however. For instance, the TelePsy system suggested patient referral to more serious secondary-level mental health care about half of the time, compared to primary care providers who arrived at that conclusion about a third of the time.

“In our view the disagreement between the system and the GPs is a positive result of our study,” Dijksman said. “If the system would give the same results as the GPs expectations, the system would not have additional value.”

If further studies show TelePsy to be “valid and reliable, it could be a useful tool,” for use outside The Netherlands, Bender said, adding that it could be helpful in the early detection of mental health disorders. Still, “I wouldn’t want it to take the place of a clinical interview,” he said.

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SOURCE: Family Practice, September 2013

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