29 research outputs found
L'autonomie alimentaire chez la personne ùgée
La perte d'autonomie dans les activités liées aux repas a été peu étudiée chez les personnes ùgées, malgré une forte prévalence dans les ùges les plus avancés. Les difficultés dans les préparations des repas, les courses, la planification des menus ou encore l'acte de s'alimenter peuvent à la fois résulter d'une diminution des capacités physiques et cognitives, d'un déclin sensoriel ou d'une perte de motivation. Ces difficultés semblent également modulées par des facteurs socio-démographiques et environnementaux, comme le sexe, le mode de vie, les liens sociaux ainsi que l'environnement géographique de la personne. Nous souhaitons étudier si une diminution de l'autonomie dans les activités liées aux repas peut participer à l'altération de l'état nutritionnel chez la personne ùgée. Nous faisons l'hypothÚse que la présence de difficultés dans la préparation des repas ou l'approvisionnement modifie les apports alimentaires, du point de vue quantitatif et /ou qualitatif. Le risque nutritionnel pourrait ainsi se traduire à la fois par une dénutrition, si les apports sont insuffisants pour couvrir les besoins calorico-azotés, ou une malnutrition, liée à un état d'excÚs (obésité) ou une alimentation de faible qualité nutritionnelle. L'objectif de ce travail doctoral était de (1) de définir un cadre conceptuel pour mieux caractériser l'autonomie liée aux repas ou " autonomie alimentaire ", et (2) d'analyser ses déterminants et les conséquences de la perte d'autonomie alimentaire, en particulier sur l'alimentation et l'état nutritionnel des personnes ùgées.
La revue de la littĂ©rature effectuĂ©e dans le cadre de ce travail de recherche montre que le concept d'autonomie alimentaire est peu dĂ©fini et peut recouvrir des situations diffĂ©rentes. Elle est Ă la fois liĂ©e aux compĂ©tences et aux capacitĂ©s des personnes. Nous avons tentĂ© de dĂ©finir les contours de ce concept et de classifier les diffĂ©rentes activitĂ©s qui la composent. L'Ă©valuation de ces activitĂ©s reste trĂšs hĂ©tĂ©rogĂšne dans les diffĂ©rents travaux retrouvĂ©s dans la littĂ©rature, avec de multiples indicateurs, ce qui, appliquĂ© Ă la pratique clinique, pourrait limiter son repĂ©rage et sa prise en charge. Nous avons Ă©tudiĂ© la perte d'autonomie dans les deux principales activitĂ©s liĂ©es aux repas (prĂ©paration des repas et approvisionnement) Ă partir de trois bases de donnĂ©es issues de populations ĂągĂ©es : i) des patients de l'hĂŽpital de jour des fragilitĂ©s du CHU de Toulouse, ii) des sujets autonomes suivis durant 3 ans dans l'essai Mapt et iii) des sujets ayant une fragilitĂ© cognitive et inclus dans la cohorte CogFrail. Nous avons ainsi analysĂ© les facteurs associĂ©s Ă la perte d'autonomie alimentaire dans chacune de ces populations. Si nous n'avons pas dĂ©montrĂ© d'impact des difficultĂ©s Ă cuisiner ou faire les courses sur la survenue d'une perte de poids au cours du suivi sur 3 ans, nous avons retrouvĂ© une association significative avec la qualitĂ© de l'alimentation. Les personnes dĂ©clarant des difficultĂ©s Ă prĂ©parer les repas ont une moindre consommation d'aliments frais (lĂ©gumes et produits laitiers), mais une consommation plus importante de plats cuisinĂ©s prĂȘts Ă l'emploi. Cela pourrait expliquer que les apports caloriques soient maintenus, Ă©vitant ainsi la perte de poids dans cette population. Cette population reste toutefois Ă risque de malnutrition.The loss of autonomy in meal-related activities has been little studied in older people, despite a high prevalence in the oldest ages. Difficulties in meal preparation, food shopping, menu planning or even the act of eating may result from a decrease in physical and cognitive capacities, sensory decline or a loss of motivation. These difficulties also seem to be modulated by socio-demographic and environmental factors, such as gender, lifestyle, social ties and geographical environment. We studied whether a decrease in autonomy in meal-related activities can contribute to of nutritional status alteration in the older people. We hypothesized that the presence of difficulties in meal preparation or food shopping modifies food intake, in either quantity or quality. The nutritional risk could thus translate into both undernutrition, if food intake is insufficient to cover nutritional needs, or malnutrition, linked to a state of excess (obesity) or a diet of low quality. The objective of this doctoral work was (1) to define a conceptual framework to better characterize meal-related autonomy or "food autonomy", and (2) to analyze its determinants and the consequences of the loss of food autonomy, in particular on the diet and nutritional status of older people. The literature review carried out within the framework of this research work shows that the concept of food autonomy is poorly defined and can cover different situations. It is linked to both the skills and abilities of individuals. We have tried to define the contours of this concept and to classify the different activities. The evaluation of these activities remains very heterogeneous accross the literature, with multiple indicators, which, applied to clinical practice, could limit its identification and management. We studied the loss of autonomy in the two main meal-related activities (meal preparation and food shopping) from three databases from older populations: i) patients from the frailty day hospital of the Toulouse University Hospital, ii) autonomous subjects followed for 3 years in the Mapt trial and iii) subjects with cognitive frailty included in the CogFrail cohort. We analyzed the factors associated with the loss of dietary autonomy in each of these populations. Although we did not demonstrate an impact of difficulties in cooking or food shopping on the occurrence of weight loss during the 3-year follow-up, we did find a significant association with the quality of the diet. Individuals reporting difficulties in preparing meals had a lower consumption of fresh foods (vegetables and dairy products), but a higher consumption of ready-made meals. This could explain why caloric intake is maintained, thus avoiding weight loss in this population. However, this population remains at risk of malnutrition
Inequity in access to personalized medicine in France: Evidences from analysis of geo variations in the access to molecular profiling among advanced non-small-cell lung cancer patients: Results from the IFCT Biomarkers France Study
In this article, we studied geographic variation in the use of personalized genetic testing for advanced non-small cell lung cancer (NSCLC) and we evaluated the relationship between genetic testing rates and local socioeconomic and ecological variables. We used data on all advanced NSCLC patients who had a genetic test between April 2012 and April 2013 in France in the frame of the IFCT Biomarqueurs-France study (n = 15814). We computed four established measures of geographic variation of the sex-adjusted rates of genetic testing utilization at the âdĂ©partmentâ (the French territory is divided into 94 administrative units called âdĂ©partementsâ) level. We also performed a spatial regression model to determine the relationship between dĂ©partement-level sex-adjusted rates of genetic testing utilization and economic and ecological variables. Our results are the following: (i) Overall, 46.87% lung cancer admission patients obtained genetic testing for NSCLC; dĂ©partement-level utilization rates varied over 3.2-fold. Measures of geographic variation indicated a relatively high degree of geographic variation. (ii) there was a statistically significant relationship between genetic testing rates and per capita supply of general practitioners, radiotherapists and surgeons (negative correlation for the latter); lower genetic testing rates were also associated with higher local poverty rates. French policymakers should pursue effort toward deprived areas to obtain equal access to personalized medicine for advanced NSCLC patients
L'autonomie alimentaire chez la personne ùgée
The loss of autonomy in meal-related activities has been little studied in older people, despite a high prevalence in the oldest ages. Difficulties in meal preparation, food shopping, menu planning or even the act of eating may result from a decrease in physical and cognitive capacities, sensory decline or a loss of motivation. These difficulties also seem to be modulated by socio-demographic and environmental factors, such as gender, lifestyle, social ties and geographical environment. We studied whether a decrease in autonomy in meal-related activities can contribute to of nutritional status alteration in the older people. We hypothesized that the presence of difficulties in meal preparation or food shopping modifies food intake, in either quantity or quality. The nutritional risk could thus translate into both undernutrition, if food intake is insufficient to cover nutritional needs, or malnutrition, linked to a state of excess (obesity) or a diet of low quality. The objective of this doctoral work was (1) to define a conceptual framework to better characterize meal-related autonomy or "food autonomy", and (2) to analyze its determinants and the consequences of the loss of food autonomy, in particular on the diet and nutritional status of older people. The literature review carried out within the framework of this research work shows that the concept of food autonomy is poorly defined and can cover different situations. It is linked to both the skills and abilities of individuals. We have tried to define the contours of this concept and to classify the different activities. The evaluation of these activities remains very heterogeneous accross the literature, with multiple indicators, which, applied to clinical practice, could limit its identification and management. We studied the loss of autonomy in the two main meal-related activities (meal preparation and food shopping) from three databases from older populations: i) patients from the frailty day hospital of the Toulouse University Hospital, ii) autonomous subjects followed for 3 years in the Mapt trial and iii) subjects with cognitive frailty included in the CogFrail cohort. We analyzed the factors associated with the loss of dietary autonomy in each of these populations. Although we did not demonstrate an impact of difficulties in cooking or food shopping on the occurrence of weight loss during the 3-year follow-up, we did find a significant association with the quality of the diet. Individuals reporting difficulties in preparing meals had a lower consumption of fresh foods (vegetables and dairy products), but a higher consumption of ready-made meals. This could explain why caloric intake is maintained, thus avoiding weight loss in this population. However, this population remains at risk of malnutrition.La perte d'autonomie dans les activitĂ©s liĂ©es aux repas a Ă©tĂ© peu Ă©tudiĂ©e chez les personnes ĂągĂ©es, malgrĂ© une forte prĂ©valence dans les Ăąges les plus avancĂ©s. Les difficultĂ©s dans les prĂ©parations des repas, les courses, la planification des menus ou encore l'acte de s'alimenter peuvent Ă la fois rĂ©sulter d'une diminution des capacitĂ©s physiques et cognitives, d'un dĂ©clin sensoriel ou d'une perte de motivation. Ces difficultĂ©s semblent Ă©galement modulĂ©es par des facteurs socio-dĂ©mographiques et environnementaux, comme le sexe, le mode de vie, les liens sociaux ainsi que l'environnement gĂ©ographique de la personne. Nous souhaitons Ă©tudier si une diminution de l'autonomie dans les activitĂ©s liĂ©es aux repas peut participer Ă l'altĂ©ration de l'Ă©tat nutritionnel chez la personne ĂągĂ©e. Nous faisons l'hypothĂšse que la prĂ©sence de difficultĂ©s dans la prĂ©paration des repas ou l'approvisionnement modifie les apports alimentaires, du point de vue quantitatif et /ou qualitatif. Le risque nutritionnel pourrait ainsi se traduire Ă la fois par une dĂ©nutrition, si les apports sont insuffisants pour couvrir les besoins calorico-azotĂ©s, ou une malnutrition, liĂ©e Ă un Ă©tat d'excĂšs (obĂ©sitĂ©) ou une alimentation de faible qualitĂ© nutritionnelle. L'objectif de ce travail doctoral Ă©tait de (1) de dĂ©finir un cadre conceptuel pour mieux caractĂ©riser l'autonomie liĂ©e aux repas ou " autonomie alimentaire ", et (2) d'analyser ses dĂ©terminants et les consĂ©quences de la perte d'autonomie alimentaire, en particulier sur l'alimentation et l'Ă©tat nutritionnel des personnes ĂągĂ©es. La revue de la littĂ©rature effectuĂ©e dans le cadre de ce travail de recherche montre que le concept d'autonomie alimentaire est peu dĂ©fini et peut recouvrir des situations diffĂ©rentes. Elle est Ă la fois liĂ©e aux compĂ©tences et aux capacitĂ©s des personnes. Nous avons tentĂ© de dĂ©finir les contours de ce concept et de classifier les diffĂ©rentes activitĂ©s qui la composent. L'Ă©valuation de ces activitĂ©s reste trĂšs hĂ©tĂ©rogĂšne dans les diffĂ©rents travaux retrouvĂ©s dans la littĂ©rature, avec de multiples indicateurs, ce qui, appliquĂ© Ă la pratique clinique, pourrait limiter son repĂ©rage et sa prise en charge. Nous avons Ă©tudiĂ© la perte d'autonomie dans les deux principales activitĂ©s liĂ©es aux repas (prĂ©paration des repas et approvisionnement) Ă partir de trois bases de donnĂ©es issues de populations ĂągĂ©es : i) des patients de l'hĂŽpital de jour des fragilitĂ©s du CHU de Toulouse, ii) des sujets autonomes suivis durant 3 ans dans l'essai Mapt et iii) des sujets ayant une fragilitĂ© cognitive et inclus dans la cohorte CogFrail. Nous avons ainsi analysĂ© les facteurs associĂ©s Ă la perte d'autonomie alimentaire dans chacune de ces populations. Si nous n'avons pas dĂ©montrĂ© d'impact des difficultĂ©s Ă cuisiner ou faire les courses sur la survenue d'une perte de poids au cours du suivi sur 3 ans, nous avons retrouvĂ© une association significative avec la qualitĂ© de l'alimentation. Les personnes dĂ©clarant des difficultĂ©s Ă prĂ©parer les repas ont une moindre consommation d'aliments frais (lĂ©gumes et produits laitiers), mais une consommation plus importante de plats cuisinĂ©s prĂȘts Ă l'emploi. Cela pourrait expliquer que les apports caloriques soient maintenus, Ă©vitant ainsi la perte de poids dans cette population. Cette population reste toutefois Ă risque de malnutrition
L'autonomie alimentaire chez la personne ùgée
The loss of autonomy in meal-related activities has been little studied in older people, despite a high prevalence in the oldest ages. Difficulties in meal preparation, food shopping, menu planning or even the act of eating may result from a decrease in physical and cognitive capacities, sensory decline or a loss of motivation. These difficulties also seem to be modulated by socio-demographic and environmental factors, such as gender, lifestyle, social ties and geographical environment.We studied whether a decrease in autonomy in meal-related activities can contribute to of nutritional status alteration in the older people. We hypothesized that the presence of difficulties in meal preparation or food shopping modifies food intake, in either quantity or quality. The nutritional risk could thus translate into both undernutrition, if food intake is insufficient to cover nutritional needs, or malnutrition, linked to a state of excess (obesity) or a diet of low quality. The objective of this work was (1) to define a conceptual framework to better characterize meal-related autonomy or "food autonomy", and (2) to analyze its determinants and the consequences of the loss of food autonomy, in particular on the diet and nutritional status of older people.The literature review carried out within the framework of this research work shows that the concept of food autonomy is poorly defined and can cover different situations. It is linked to both the skills and abilities of individuals. We have tried to define the contours of this concept and to classify the different activities. The evaluation of these activities remains very heterogeneous accross the literature, with multiple indicators, which, applied to clinical practice, could limit its identification and management. We studied the loss of autonomy in the two main meal-related activities (meal preparation and food shopping) from three databases from older populations: i) patients from the frailty day hospital of the Toulouse University Hospital, ii) autonomous subjects followed for 3 years in the Mapt trial and iii) subjects with cognitive frailty included in the CogFrail cohort. We analyzed the factors associated with the loss of dietary autonomy in each of these populations.Although we did not demonstrate an impact of difficulties in cooking or food shopping on the occurrence of weight loss during the 3-year follow-up, we did find a significant association with the quality of the diet. Individuals reporting difficulties in preparing meals had a lower consumption of fresh foods (vegetables and dairy products), but a higher consumption of ready-made meals. This could explain why caloric intake is maintained, thus avoiding weight loss in this population. However, this population remains at risk of malnutrition.La perte dâautonomie dans les activitĂ©s liĂ©es aux repas a Ă©tĂ© peu Ă©tudiĂ©e chez les personnes ĂągĂ©es, malgrĂ© une forte prĂ©valence dans les Ăąges les plus avancĂ©s. Les difficultĂ©s dans les prĂ©parations des repas, les courses, la planification des menus ou encore lâacte de sâalimenter peuvent Ă la fois rĂ©sulter dâune diminution des capacitĂ©s physiques et cognitives, dâun dĂ©clin sensoriel ou dâune perte de motivation. Ces difficultĂ©s semblent Ă©galement modulĂ©es par des facteurs socio-dĂ©mographiques et environnementaux, comme le sexe, le mode de vie, les liens sociaux ainsi que lâenvironnement gĂ©ographique de la personne.Nous souhaitons Ă©tudier si une diminution de lâautonomie dans les activitĂ©s liĂ©es aux repas peut participer Ă lâaltĂ©ration de lâĂ©tat nutritionnel chez la personne ĂągĂ©e. Nous faisons lâhypothĂšse que la prĂ©sence de difficultĂ©s dans la prĂ©paration des repas ou lâapprovisionnement modifie les apports alimentaires, du point de vue quantitatif et /ou qualitatif. Le risque nutritionnel pourrait ainsi se traduire Ă la fois par une dĂ©nutrition, si les apports sont insuffisants pour couvrir les besoins calorico-azotĂ©s, ou une malnutrition, liĂ©e Ă un Ă©tat dâexcĂšs (obĂ©sitĂ©) ou une alimentation de faible qualitĂ© nutritionnelle. Lâobjectif de ce travail doctoral Ă©tait de (1) de dĂ©finir un cadre conceptuel pour mieux caractĂ©riser lâautonomie liĂ©e aux repas ou « autonomie alimentaire », et (2) dâanalyser ses dĂ©terminants et les consĂ©quences de la perte dâautonomie alimentaire, en particulier sur lâalimentation et lâĂ©tat nutritionnel des personnes ĂągĂ©es.La revue de la littĂ©rature effectuĂ©e dans le cadre de ce travail de recherche montre que le concept dâautonomie alimentaire est peu dĂ©fini et peut recouvrir des situations diffĂ©rentes. Elle est Ă la fois liĂ©e aux compĂ©tences et aux capacitĂ©s des personnes. Nous avons tentĂ© de dĂ©finir les contours de ce concept et de classifier les diffĂ©rentes activitĂ©s qui la composent. LâĂ©valuation de ces activitĂ©s reste trĂšs hĂ©tĂ©rogĂšne dans les diffĂ©rents travaux retrouvĂ©s dans la littĂ©rature, avec de multiples indicateurs, ce qui, appliquĂ© Ă la pratique clinique, pourrait limiter son repĂ©rage et sa prise en charge. Nous avons Ă©tudiĂ© la perte dâautonomie dans les deux principales activitĂ©s liĂ©es aux repas (prĂ©paration des repas et approvisionnement) Ă partir de trois bases de donnĂ©es issues de populations ĂągĂ©es : i) des patients de lâhĂŽpital de jour des fragilitĂ©s du CHU de Toulouse, ii) des sujets autonomes suivis durant 3 ans dans lâessai Mapt et iii) des sujets ayant une fragilitĂ© cognitive et inclus dans la cohorte CogFrail. Nous avons ainsi analysĂ© les facteurs associĂ©s Ă la perte dâautonomie alimentaire dans chacune de ces populations.Si nous nâavons pas dĂ©montrĂ© dâimpact des difficultĂ©s Ă cuisiner ou faire les courses sur la survenue dâune perte de poids au cours du suivi sur 3 ans, nous avons retrouvĂ© une association significative avec la qualitĂ© de lâalimentation. Les personnes dĂ©clarant des difficultĂ©s Ă prĂ©parer les repas ont une moindre consommation dâaliments frais (lĂ©gumes et produits laitiers), mais une consommation plus importante de plats cuisinĂ©s prĂȘts Ă lâemploi. Cela pourrait expliquer que les apports caloriques soient maintenus, Ă©vitant ainsi la perte de poids dans cette population. Cette population reste toutefois Ă risque de malnutrition
CoĂ»ts unitaires standards ou coĂ»ts unitaires spĂ©cifiques : quels critĂšres de choix pour lâĂ©valuation Ă©conomique de stratĂ©gies de santĂ© dans les Ă©tudes multicentriques ?
International audienceThe question of what monetary value should be assigned to consumed resources, that is to say the choice of the unit cost, is a major consideration in terms of impact on the cost analysis results. To date, no agreement has been reached regarding this methodological question. The choices made by methodologists and the subsequent impact on the results of the analysis are only rarely put forward. This work addresses the theoretical framework of health strategy evaluations that can be carried out either in the normative framework of the conventional economic approach of well-being, referred to as welfarist, or in that of an approach referred to as extra-welfarist. It also provides elements that help clarify the choice of the hospital unit costs used to calculate the cost of health strategies, so as to reconcile the use of such studies and improve their comparability. What is preferable, opting for specific per hospital unit costs or applying a standard unit cost to all facilities? How should a standard cost be calculated? Is it appropriate to calculate an average of the unit costs, as recommended by certain guidelines? The advantages and the limitations of the various modes of assessing hospital resources in the setting of multicentric trials are discussed
Sex Differences in the Return-to-Work Process of Cancer Survivors 2 Years After Diagnosis: Results From a Large French Population-Based Sample
This work was presented at the Eighth World Congress on Health Economics, July 10-13, 2011, Toronto, Canada.International audiencePURPOSE:To investigate the effects of clinical, sociodemographic, and occupational factors on time to return to work (RTW) during the 2 years after cancer diagnosis and to analyze whether sex differences exist.PATIENTS AND METHODS:This study was based on a French national cross-sectional survey involving 4,270 cancer survivors. Time to RTW was estimated through the duration of sick leave of 801 cancer survivors younger than 58 years who were employed during the 2-year survey. Multivariate analysis of the RTW after sick leave was performed using a Weibull accelerated failure time model.RESULTS:We found some sex differences in the RTW process. Older men returned to work more slowly than older women (P = .013), whereas married men returned to work much faster than married women (P = .019). Duration dependence was also sex-specific. In men, the time spent on sick leave was independent of the probability of returning to work, whereas in women, this duration dependence was positive (P < .001). For both men and women, clinical factors including chemotherapy, adverse effects, and cancer severity were found to delay RTW (P = .035, P = .001, and P < .001, respectively). Survivors investing most strongly in their personal lives also delayed their RTW (P = .006), as did those with a permanent work contract (P = .042). The factor found to accelerate RTW was a higher educational level (P = .014).CONCLUSION:The RTW process 2 years after cancer diagnosis differed between men and women. A better knowledge of this process should help the national implementation of more cost-effective strategies for managing the RTW of cancer survivors
A cost minimization analysis comparing asynchronous tele-expertise with face-to-face consultation for prenatal diagnosis in France
Timely detection of congenital anomalies using ultrasound improves neonatal care. As specialist sonographers are often geographically dispersed, they are sometimes requested to provide a second opinion via tele-expertise. The present study aimed to evaluate the economic impact of asynchronous tele-expertise in obstetric ultrasound care in private medical practice through a comparison with face-to-face consultations. We conducted a cost minimization analysis using decision tree modeling in order to determine whether asynchronous tele-expertise or face-to-face consultation had the lowest cost, under the assumption of equivalent effectiveness in terms of prenatal diagnosis. Costs were measured from the societal perspective. The data for the base case of our modeling came from a retrospective analysis of the clinical practice of an expert who had been conducting asynchronous tele-expertise for 4 years in France. The study included 260 patients for whom 322 requests for expert opinions were made by physicians/midwives from January 2016 to January 2020. The expected average total cost for tele-expertise for a patient was âŹ74.45 (95% CI: âŹ66.36ââŹ82.54) compared to âŹ195.02 (95% CI: âŹ183.90ââŹ206.14) for the conventional face-to-face strategy. Accordingly, using tele-expertise led to a statistically significant reduction of âŹ120.57 in the average total cost per patient. A sensitivity analysis confirmed the robustness of the model produced. The results of the present study underline the efficiency of tele-expertise and highlight related economic benefits. Accordingly, they could inform public health policy on the dissemination of tele-expertise in the field of obstetric ultrasound care
Asynchronous tele-expertise (ASTE) for prenatal diagnosis is feasible and cost saving: Results of a French case study
Objective: The objective of this study was to assess the potential of the use of asynchronous tele-expertise (ASTE) to provide prenatal diagnosis from a medical and economic point of view.Population: Patients screened by a midwife at a primary center.Methods: A technical and clinical evaluation was conducted retrospectively, and a cost minimization study compared asynchronous tele-expertise to face-to-face consultations that would have been performed without ASTE.Main outcome measures: In our study we assessed the feasibility of ASTE, what were the origins of the requests for expertise, whether patients need to be moved and the reasons for doing so, and the costs of tele-expertise and conventional consultation.Results: In this retrospective analysis 322 advices from 260 patients were interpreted remotely via a platform. The results revealed a 90.68% feasibility of transmitting in a satisfactory and interpretable way ultrasound images and videos via the tele-expertise platform (292/322 files). In our series, asynchronous analysis allowed the required physician to make an accurate diagnosis and identify 74 (28.5%, 95% CI [23% -33.9%]) pregnancies associated with malformations and rule out abnormalities in 186 (71.5%, 95% CI [66.1% -77%]) of the cases. The ASTE was not associated with face-to-face consultations for 72.7% (189/260) of the patients, who without moving, were able to have access to a precise diagnosis by ruling out the presence of anomalies in 163/189 of these patients and confirming them in 26/189 patients. The practice of ASTE would result from a societal point of view, an average saving of 61.8% (⏠120.57) per patient compared to a face-to-face consultation.Conclusion: The use of asynchronous tele-expertise (ASTE) using fetal ultrasound, is feasible and may contribute to increased diagnostic accuracy while generating a significant reduction in costs for society