TY - JOUR
T1 - A health systems assessment of genetic counseling in cardiovascular care in a large health system
T2 - Adherence to genetics recommendations in the Military Health System
AU - Hellwig, Lydia D.
AU - Banaag, Amanda
AU - Olsen, Cara
AU - Turner, Clesson
AU - Haigney, Mark
AU - Koehlmoos, Tracey
N1 - Funding Information:
This study was funded through the Comparative Effectiveness and Provider‐Induced Demand Collaboration (EPIC)/Low‐Value Care in the National Capital Region Project, by the United States Defense Health Agency, Grant # HU0001‐11‐1‐0023. LDH's time was funded by NHLBI Grant: IAA‐A‐HL‐007.001 and Uniformed Services University Grant # HU00012120102. The funding agency played no role in the design, analysis, or interpretation of findings. The research presented in this paper was conducted to fulfill the degree requirements of the first author (LDH).
Publisher Copyright:
© 2023 National Society of Genetic Counselors. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.
PY - 2023/9/28
Y1 - 2023/9/28
N2 - Genetic counseling and genetic testing are important tools for diagnosis, screening, and employment of effective medical management strategies for hereditary cardiovascular diseases. Despite widespread recognition of the benefits of genetic counseling and testing in cardiovascular care, little is published regarding their use in large healthcare systems. We conducted a retrospective cross-sectional study using administrative claims data in the US Military Health System to assess the state of recommended genomic counseling in clinical cardiovascular care. Logistic regression models were used to examine associations of genetic counseling among beneficiaries with hereditary cardiovascular conditions. Approximately 0.44% of beneficiaries in fiscal year 2018 had a diagnosis of a hereditary cardiovascular condition. Among the 23,364 patients with a diagnosis of hereditary cardiovascular disease, only 175 (0.75%) had documented genetic counseling and 196 (0.84%) had documented genetic testing. Genetic counseling did not differ by race, sex, service, or diagnosis. Age group, Active Duty status, rank as a proxy for socioeconomic status, and geographic location contributed significantly to the likelihood of receiving genetic counseling. These findings suggest that genetic counseling is underutilized in clinical cardiovascular care in the Military Health System and may be more broadly, despite expert consensus recommendations for its use and potential life-saving benefits. Unlike previous studies in the US civilian health sector, there did not appear to be disparities in genetic counseling by race or sex in the Military Health System. Strategies to improve care for cardiovascular disease should address the underutilization of recommended genetics evaluations for heritable diagnoses and the challenges of assessing use in large health systems studies.
AB - Genetic counseling and genetic testing are important tools for diagnosis, screening, and employment of effective medical management strategies for hereditary cardiovascular diseases. Despite widespread recognition of the benefits of genetic counseling and testing in cardiovascular care, little is published regarding their use in large healthcare systems. We conducted a retrospective cross-sectional study using administrative claims data in the US Military Health System to assess the state of recommended genomic counseling in clinical cardiovascular care. Logistic regression models were used to examine associations of genetic counseling among beneficiaries with hereditary cardiovascular conditions. Approximately 0.44% of beneficiaries in fiscal year 2018 had a diagnosis of a hereditary cardiovascular condition. Among the 23,364 patients with a diagnosis of hereditary cardiovascular disease, only 175 (0.75%) had documented genetic counseling and 196 (0.84%) had documented genetic testing. Genetic counseling did not differ by race, sex, service, or diagnosis. Age group, Active Duty status, rank as a proxy for socioeconomic status, and geographic location contributed significantly to the likelihood of receiving genetic counseling. These findings suggest that genetic counseling is underutilized in clinical cardiovascular care in the Military Health System and may be more broadly, despite expert consensus recommendations for its use and potential life-saving benefits. Unlike previous studies in the US civilian health sector, there did not appear to be disparities in genetic counseling by race or sex in the Military Health System. Strategies to improve care for cardiovascular disease should address the underutilization of recommended genetics evaluations for heritable diagnoses and the challenges of assessing use in large health systems studies.
KW - disparities
KW - genetic counseling
KW - genetic testing
KW - military
KW - public health
UR - http://www.scopus.com/inward/record.url?scp=85173113070&partnerID=8YFLogxK
U2 - 10.1002/jgc4.1791
DO - 10.1002/jgc4.1791
M3 - Article
C2 - 37766662
SN - 1059-7700
JO - Journal of Genetic Counseling
JF - Journal of Genetic Counseling
ER -