Understanding Disparities in Access to Genomic Medicine Proceedings of a Workshop (2018) / Chapter Skim
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3 The Role of Health Systems in Delivering Equitable Access
3 The Role of Health Systems in Delivering Equitable Access
Pages 23-34
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From page 23... ...
• Primary care providers have a difficult time navigating genetic screening and the referral processes due to competing demands and a lack of awareness and education about genomic medi cine. Guidelines that define the role of primary care providers could help alleviate this problem, as could electronic health record (EHR)
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From page 24... ...
During the workshop, attendees considered various perspectives of health care delivery systems as they relate to providing fair and equitable access to genetic and genomic services. Each of the three speakers in this session -- Larry Meyer, the national director of genomic services and chief officer for specialty care at the Veterans Affairs Medical Center; Katherine Anderson, a primary care specialist at Denver Health; and Kent Hoskins, an associate professor of medicine and director of the familial breast cancer program at the University of Illinois at Chicago -- discussed programs that involve coordination at a higher level than the individual health provider.
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From page 25... ...
In 2011, VHA launched a centralized clinical service based at its Salt Lake City medical center and established memoranda of understanding and telemedicine service agreements with VHA medical centers throughout the country to allow direct patient care and to increase patient access to clinicians. Most encounters today are tele-video genetic counseling appointments, Meyer said, but electronic consults and other approaches are used, too.
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From page 26... ...
PROVIDING GENOMIC MEDICINE IN A RESOURCE-CONSTRAINED SYSTEM Challenges Faced by Providers with Delivering Genomic Medicine At Denver Health, a primary integrated safety net health system that encompasses nine outpatient federally qualified health centers (FQHCs) 2 and a regional trauma center, there are unique circumstances that make delivering genomic medicine a challenge, Anderson said.
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From page 27... ...
Anderson collected data from across the health system showing that not all medical specialties collect family health history information in the same manner. Her data demonstrated that at Denver Health it is practitioners in internal medicine who do the best job of taking a family health history, along with Denver Health's midwives and obstetrics and gynecology specialists.
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From page 28... ...
There need to be clear genetic services guidelines about which parts of the patient's care belong to the primary care physician and which belong to the specialist, Anderson said. Anderson added that it is her goal to have genomic screening for disease become part of the core preventive health and primary care services that Denver Health offers.
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From page 29... ...
Certain members of this group may qualify for chemoprevention, Hoskins said, and identifying those individuals would allow clinicians to intervene and ideally lower the risk of disease. There is also a smaller group of individuals in the general population with a high-risk family history who meet the criteria for genetic counseling and genetic testing.
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From page 30... ...
However, despite the apparent interest in screening, the percentage of women who actually took advantage of the onsite genetic counseling was only 5 to 10 percent. Based on a quick follow-up survey, it appears that one reason for the low rate of follow-through on the genetic counseling was a disonnect c between how medical professionals view future disease risk and how patients interpret this information when they receive it.
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From page 31... ...
Health care providers and system administrators, he said, need to be creative about addressing all of the aspects that surround the health care experience that may be influencing interest or non-interest in genetic counseling, particularly for underserved populations. A new paradigm called point-of-care genetic counseling, where counseling is provided onsite in primary care clinics using trained nurse ractitioners and physician assistants in formal collaboration with a cancer p genetic specialist, is one interesting way to approach the challenge, Hoskins said.
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From page 32... ...
DISCUSSION Using Electronic Health Records to Address Disparities Workshop speakers and participants discussed opportunities for addressing disparities at the health system level, and one participant suggested that EHRs could be used to track patients who were not following up on a referral to genetic counseling or to track other issues related to accessing genetic services. VHA is deploying a new EHR system that uses data to do predictive modeling in real time for things such as suicidality, Meyer said.
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From page 33... ...
Racial disparities in breast cancer mortality arose starting in the mid- to late 1980s when mammography screening became widespread and when advances in treatment, particularly systemic adjuvant therapies, became the standard of care, Hoskins said. This is an example of how health disparities emerge in the wake of medical advances, and he cautioned that the progress in precision medicine and genomics could make the gap in survival between whites and African Americans grow larger.
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From page 34... ...
34 UNDERSTANDING DISPARITIES IN ACCESS TO GENOMIC MEDICINE them (e.g., for hearing-impaired individuals)
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