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2019 HSR&D/QUERI National Conference Abstract

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4046 — Genomic medicine consults within VA: are there differences by gender?

Lead/Presenter: Catherine Chanfreau,  Resource Center - VINCI
All Authors: Chanfreau C (VA Salt Lake City Healthcare System, VINCI), Huynh AK (VA Greater Los Angeles Healthcare System), Lerner B (VA Boston Healthcare System) Russell MM (VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA) Scheuner MT (VA San Francisco Healthcare System, UCSF School of Medicine)

Objectives:
VA efforts have focused on improving women Veterans' access to comprehensive healthcare within VA. Little is known about women Veterans' access to specialty care like genetic services that are an essential component of precision medicine. We examined the use of genomic medicine consults by gender among VA patients.

Methods:
Retrospective study using clinical data from VA Corporate Data Warehouse for all genetic consult requests from 2010-2017. We collected patient characteristics (gender, age at request, race/ethnicity, Veteran status), consult status (completed or not); referral reason. Sites delivering genetic services were classified as VA versus non-VA care. For services received within VA, information on mode of service delivery (e-consult, telehealth, telephone or in-person) and provider (geneticist or genetic counselor) was extracted from clinical notes. We examined the association of patient gender and other characteristics in multivariate logistic regressions.

Results:
In 2010-2017, 24,956 unique patients were referred for a genetic consult, with similar proportions of women (51%) and men (49%). Most patients were Veterans (men, 99.8%; women, 95.1%). Predominant reasons for referral were breast/ovarian cancer for women (42%), and polyps and colorectal cancer for men (11% and 10%, respectively). In multivariate analyses, we observed no gender difference in completion of genetic consult requests, or in the likelihood of referral to VA versus non-VA care. Compared to men, women were more likely to be younger than age 40 (OR 1.69 [1.58,1.81]) and African American than white (OR 1.71 [1.59,1.85]). For services received within VA, women were twice as likely as men to receive care from a genetic counselor compared to a geneticist, and 40% more likely to get care via telehealth than in-person.

Implications:
Though women are a minority of the Veteran population (9%), they account for half of the genetic consults in the VA. Most genetic consultations for women were completed by genetic counselors via telehealth.

Impacts:
Genetic services are highly relevant for female Veterans, particularly for younger women at risk for hereditary cancer syndromes. Genomic medicine should be an integral component of women's health programs in the VA, given the disproportionate use of genetic services by women Veterans.