3129 — Implementation of Clinical Genetic Services in VHA
Hamilton AB, Oishi S, Marshall N, Gammage C, Canelo I, Mittman B, Chou A, Yano E, and Scheuner M, VA Greater Los Angeles Healthcare System;
VHA recently launched the National Genomic Medicine Service, yet little is known about readiness to adopt or implement genetic services in clinical practice. To investigate readiness to adopt, we conducted a qualitative study of key informants’ perspectives on organizational needs and clinical concerns.
Semi-structured interviews were conducted with 62 clinical chiefs or their designees representing primary care, neurology, cardiology, oncology, and pathology. Participants were asked about current genetic testing practices, availability of genetics expertise, delivery models for genetics services at their VA, patient-level factors influencing utilization of genetic services, and expectations of genetics services in the future. Transcripts were analyzed using the constant comparison method.
There was widely varying familiarity with genetics and experience with genetic services. Genetics expertise within the VA was sparse; availability of genetic consultation was mostly through fee-basis with academic affiliates. While most believed genetic testing had value when results inform clinical management, few perceived the existing evidence for testing to be compelling, and cost concerns were often raised. A minority perceived the value of genetic test results to extend beyond clinical decision-making, to include quality of life issues pertaining to reproductive decisions and life planning. Most believed that VHA will likely expand genetic services, particularly as evidence of clinical utility grows. Patient factors were not perceived as a barrier to adoption. All noted that education and guidelines will be necessary for expansion of genetic services, and many commented that the electronic health record will play a key role.
A significant barrier to implementation of genetic services in VHA may relate to physicians’ perceptions that the clinical value of this testing is limited. Perceptions of the value of genetic services should be considered in efforts to promote uptake of these services.
Given VHA’s commitment to the highest quality of care for Veterans, it is critical to understand how new services that enhance care should be optimally developed and spread. In the case of genetics, careful attention needs to be given to addressing knowledge and attitudinal gaps to ensure that Veterans have access to appropriate genetic services.