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Increasing scale and throughput of telehealth genetic counseling across the spectrum of reproductive care, while maintaining high patient satisfaction

Poster presented at the 2020 American Society for Reproductive Medicine Virtual Congress

Authors: Kiley Johnson, Jill Davies, Colleen Caleshu

Objective: Multiple professional societies recommend genetic counseling alongside reproductive genetic testing, including the American Society for Reproductive Medicine and the American College of Obstetrics and Gynecology. However, access to genetic counselors (GCs) continues to be an issue. Efforts are being made to remedy this with increased GC throughput and novel approaches to service delivery. We sought to describe one such approach by examining the volume, scope, and capacity of a high throughput telehealth genetic counseling service that provides care to reproductive patients across the country.

Design: Retrospective review of consult data from a telehealth genetic counseling service.

Materials and methods: We examined data from reproductive genetic counseling consults that occurred between 1/1/2018 and 12/31/2019. Extracted data included indication, time required to complete consult, and patient satisfaction. To assess throughput, the number of reproductive consults a GC could complete per week was estimated.

Results: In 2018, 541 reproductive genetic counseling consults were performed, and 1922 were performed in 2019. Care was provided to patients from reproductive endocrinology clinics, genetic testing laboratories, and maternal fetal medicine clinics. Indications included carrier screening, preimplantation genetic testing (PGT), egg donor screening, abnormal aneuploidy screen, advanced maternal age, ultrasound findings, and family history of a genetic condition. The mean time to complete all aspects of a consult (preparation, counseling, and writing genetic counseling summary report) was 40.6 minutes (standard deviation 6.7 minutes). At 40.6 minutes per consult, a full-time GC working in this efficient and high-throughput model can perform 53 consults per week, assuming the same mix of routine and complex cases. This is more than double the weekly caseloads for reproductive GCs reported by the National Society of Genetic Counselors (15.6-20.5 consults per week), which primarily represents traditional lower throughput models. Despite the high throughput nature of the service, patient satisfaction remained high during the study period (95.6%). Consistent with their complexity, PGT consults took longer than other consults in preparation and counseling (preparation: 13.0 minutes vs. 4.0 minutes, p<0.001; counseling: 29.2 minutes vs. 16.0 minutes, p<0.001; documentation: 10.4 minutes vs. 9.0 minutes, p=0.18). In contrast, carrier screening consults took less time than other consults (preparation: 5.5 minutes vs. 9.6 minutes, p<0.001; counseling: 18.3 minutes vs. 21.2 minutes, p<0.001; documentation: 7.5 minutes vs. 11.4 minutes, p<0.001).

Conclusions: Genetic counseling provided by a national telehealth organization covers the full range of reproductive indications, from routine to complex. The approach is scalable, with a 3.5 fold increase in consult volumes from 2018 to 2019. Given the high patient satisfaction, increased throughput, and nation-wide nature of this approach, it is a promising option for increasing access to reproductive genetic counseling.

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