Department of Pediatrics, Division of Medical Genetics, University of California-San Francisco, San Francisco, CA, USA.
Institute for Human Genetics, University of California-San Francisco, San Francisco, CA, USA.
Genet Med. 2020 Jan;22(1):227-231. doi: 10.1038/s41436-019-0628-5. Epub 2019 Aug 16.
Access to genetics health-care services is often complicated by the distance to hospitals, workforce shortages, and insurance coverage. Despite technological advances and decreasing costs of genetic sequencing, the benefits of personalized medicine may be inaccessible to many patients. To assess potential disparities in care, we examined the genetics workforce in California and geographical issues that people encounter in seeking care.
Data on all board-certified genetics providers were analyzed including medical geneticists (MGs) and genetic counselors (GCs) in California. To assess distance traveled for care, we computed the distance patients traveled for n = 288 visits to University of California-San Francisco (UCSF) Medical Genetics. We performed geographic optimization to minimize the distance to genetics providers.
The provider-to-patient ratio in California is 1:330,000 for MGs, 1:100,000 for GCs, and 1:1,520,000 for biochemical MGs. Genetics providers are concentrated in major metropolitan areas in California. People travel up to 386 miles for genetics care within the state (mean = 76.6 miles).
There are substantial geographic barriers to genetics care that could increase disparities. Our findings highlight a challenging genetics workforce shortage. The shortage may be even greater due to care subspecialization or lack of full-time equivalency and staffing. We are currently promoting efforts to increase remote health-care options, training, and modified models of care.
由于距离医院、劳动力短缺和保险覆盖范围等因素，获得基因保健服务通常很复杂。尽管基因测序技术取得了进步，成本也有所降低，但许多患者可能无法享受到个性化医疗的好处。为了评估护理方面的潜在差异，我们研究了加利福尼亚州的基因工作者队伍以及人们在寻求护理时遇到的地理问题。
分析了加利福尼亚州所有经董事会认证的基因提供者的数据，包括医学遗传学家（MGs）和遗传咨询师（GCs）。为了评估护理的距离，我们计算了 288 名前往加利福尼亚大学旧金山分校（UCSF）医学遗传学就诊的患者的旅行距离。我们进行了地理优化，以最小化与基因提供者的距离。
加利福尼亚州的 MG 与患者的比例为 1：3300000，GC 与患者的比例为 1：100000，生化 MG 与患者的比例为 1：1520000。基因提供者集中在加利福尼亚州的主要大都市地区。人们在本州内（平均为 76.6 英里）最多需要 386 英里的距离才能获得基因护理。
基因护理存在着巨大的地理障碍，可能会增加差异。我们的研究结果突出了基因护理劳动力短缺的挑战。由于护理专科化或缺乏全职等效性和人员配备，短缺情况可能更加严重。我们目前正在推动增加远程医疗选择、培训和改进护理模式的努力。
