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Padilla CD, Abadingo ME, Maceda EBG, Alcausin MMLB. Integrating Genetic Services in the Philippine Public Health Delivery System: The Value of Networks. Genes (Basel) 2024; 15:780. [PMID: 38927716 PMCID: PMC11202899 DOI: 10.3390/genes15060780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
The delivery of genetic services in developing countries is faced with significant challenges, despite medical and technological advances globally. The Philippines, being an archipelago, faces even more challenges, with significant disparities in access to healthcare, and tertiary medical centers and specialists being concentrated in the major cities. The utilization of different networks for the integration of genetic services in the existing public health delivery system has been valuable. Using the well-established network of the national newborn screening program, genetic services have been successfully integrated into the delivery of healthcare, even at the grassroot level. Equitable access to healthcare, including genetic services, was highlighted and supported by the enactment of the Rare Disease Law in 2016. The support of the academe to assure the sustainability of services was evident in the establishment of a genetic counseling program to augment the work of a handful of clinical geneticists. Professional societies and support groups have been instrumental in identifying genetic conditions to be prioritized and lobbying for increased public awareness, leading to national programs and policies. This paper primarily discusses the value of networks in the delivery of genetic services, specifically newborn screening, programs for rare diseases, birth defects, and genetic counseling.
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Affiliation(s)
- Carmencita D. Padilla
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines; (M.E.A.); (E.B.G.M.); (M.M.L.B.A.)
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines
| | - Michelle E. Abadingo
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines; (M.E.A.); (E.B.G.M.); (M.M.L.B.A.)
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines
| | - Ebner Bon G. Maceda
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines; (M.E.A.); (E.B.G.M.); (M.M.L.B.A.)
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines
| | - Maria Melanie Liberty B. Alcausin
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines; (M.E.A.); (E.B.G.M.); (M.M.L.B.A.)
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Pedro Gil St., Ermita, Manila 1000, Philippines
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Chu ATW, Chung CCY, Hue SPY, Chung BHY. The growing needs of genetic counselling-Feasibility in utilization of tele-genetic counselling in Asia and Hong Kong. Front Genet 2023; 14:1239817. [PMID: 37600657 PMCID: PMC10435751 DOI: 10.3389/fgene.2023.1239817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
The need for the expansion of genomic services has been at a record time high in the past decade. As technological advancement continues to strengthen the entire genetic and genomic pipeline and clinical operational workflow, the major challenge remains to be the speed of workforce development to meet service growth. In particular, the international expansion of genetic counselling (GC) services has been a topic of interest for the past few years. GC is an emerging profession in most of Asia, and in many countries the profession of GC often refers to physicians or front-line health workers with expertise in genetics to provide GC services rather than being a specific independent profession. As genetic and genomic services, especially pre-test and post-test GC, expand globally, the need to tackle the longstanding obstacles of GC personnel shortage and funding issues must not be overlooked. There is an urgent need internationally, and especially in Asia, where GC profession is comparatively less well-established, to seek alternative approaches to meet service demand. The present review examines the global development and feasibility of tele-genetics and tele-genetic counselling (TGC), and serves as the foundation to explore a possible roadmap in Hong Kong via the Hong Kong Genome Project.
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Affiliation(s)
| | | | | | - Brian Hon Yin Chung
- Hong Kong Genome Institute, Hong Kong, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Pestoff R, Johansson P, Danielsson H, Neher M, Gunnarsson C. Rapid Implementation of Telegenetic Counseling in the COVID-19 and Swedish Healthcare Context: A Feasibility Study. FRONTIERS IN HEALTH SERVICES 2022; 2:848512. [PMID: 36925809 PMCID: PMC10012799 DOI: 10.3389/frhs.2022.848512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022]
Abstract
This study reports the process and preliminary findings of rapid implementation of telegenetic counseling in the context of Swedish healthcare and COVID-19 pandemic, from both a patient and a provider perspective. Fourty-nine patients and 6 healthcare professionals were included in this feasibility study of telegenetic counseling in a regional Department of Clinical Genetics in Sweden. Telegenetic counseling is here defined as providing genetic counseling to patients by video (n = 30) or telephone (n = 19) appointments. Four specific feasibility aspects were considered: acceptability, demand, implementation, and preliminary efficacy. Several measures were used including the Genetic Counseling Outcome Scale 24 (collected pre- and post-counseling); the Telehealth Usability Questionnaire; a short study specific evaluation and Visiba Care evaluations, all collected post-counseling. The measures were analyzed with descriptive statistics and the preliminary results show a high level of acceptance and demand, from both patients and providers. Results also indicate successful initial implementation in the regional Department of Clinical Genetics and preliminary efficacy, as shown by significant clinically important improvement in patients' empowerment levels.
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Affiliation(s)
- Rebecka Pestoff
- Centre for Rare Diseases in Southeast Region of Sweden, Linköping University, Linköping, Sweden.,Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Genetics, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik Danielsson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Margit Neher
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Cecilia Gunnarsson
- Centre for Rare Diseases in Southeast Region of Sweden, Linköping University, Linköping, Sweden.,Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Clinical and Experimental Science, Linköping University, Linköping, Sweden
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Turchetti D, Battistuzzi L, Bertonazzi B, Godino L. Sudden shift to remote genetic counseling during the COVID-19 pandemic: Experiences of genetics professionals in Italy. J Genet Couns 2021; 30:1024-1037. [PMID: 34096134 PMCID: PMC8242797 DOI: 10.1002/jgc4.1441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 11/11/2022]
Abstract
The 2020 COVID‐19 pandemic has rendered in‐person provision of genetic counseling impossible for prolonged periods in many countries, mandating a sudden shift to remote delivery. We used qualitative thematic analysis to explore Italian genetics professionals’ experience with remote genetic counseling. Fourteen group and four individual interviews were conducted after participants had delivered one or more remote sessions via videoconference or on the telephone. Data were coded and grouped under themes. Three main themes were identified as follows: (a) technical and logistical issues, (b) communication issues, and (c) clinical content and outcome of the session. The participants acknowledged that not having to travel to the clinic saves consultands time and expense. They also highlighted that not sharing a physical space with consultands and having to rely on technology can negatively impact on effective communication, building trusting relationships, and performing accurate psychosocial assessments. Regarding the clinical content of sessions, remote genetic counseling was perceived to favor greater focus and succinct, to the point communication. However, participants also felt uncomfortable not being able to use visual aids to support the explanation of complex concepts. Moreover, demographics and the socio‐cultural status of consultands emerged as factors influencing the outcome of remote genetic counseling sessions. Finally, participants reported feeling that more experience with this novel approach would improve their confidence and their ability to adapt their counseling skills as appropriate. Based on these findings, we suggest that effective, equitable provision of remote genetic counseling will require an infrastructure that is able to support video counseling, sharing of clinical documents and visual aids, and connect with a wide range of devices. Moreover, the structure of sessions should be tailored to the specific requirements of remote genetic counseling and suitable training efforts should be promoted to enhance professionals’ communication skills.
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Affiliation(s)
- Daniela Turchetti
- Dipartimento di Scienze Mediche e Chirurgiche, Centro di Ricerca sui Tumori Ereditari, Università di Bologna, Bologna, Italy.,UO Genetica Medica, IRCCS AOU Policlinico di S. Orsola, Bologna, Italy
| | - Linda Battistuzzi
- Dipartimento di Informatica, Bioingegneria, Robotica e Ingegneria dei Sistemi, Università degli Studi di Genova, Genova, Italy
| | - Benedetta Bertonazzi
- Dipartimento di Scienze Mediche e Chirurgiche, Centro di Ricerca sui Tumori Ereditari, Università di Bologna, Bologna, Italy
| | - Lea Godino
- Dipartimento di Scienze Mediche e Chirurgiche, Centro di Ricerca sui Tumori Ereditari, Università di Bologna, Bologna, Italy.,UO Genetica Medica, IRCCS AOU Policlinico di S. Orsola, Bologna, Italy
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Abstract
PURPOSE OF REVIEW The aim of the article is to provide an update on recent evidence for utilization and challenges of implementation of telegenetics in the clinical practice. RECENT FINDINGS Implementation of telegenetics in health systems is still limited, below 10%, somewhat higher for cancer genetic counseling. Nevertheless, telegenetic services have been shown useful in the COVID pandemic. Key factors for efficient implementation include a patient-centered approach, engaging the major stakeholders, and incorporating telegenetics into existing health policies. Main barriers remain: limitations to billing and reimbursement, licensure, proper equipment and technical issues, engagement of referring providers and patients, coordination of services with local health providers, and lack of decision-making power. Further rigorous studies are needed to investigate the outcomes of telegenetics and to motivate health policies for change. SUMMARY Despite continuous evidence of the benefits of telegenetics, its use in health systems remains limited. Further, larger, prospective, randomized, long-term studies are needed to address the outcomes.Enabling factors contributing to the implementation of telegenetics are patient-centeredness, the involvement of major stakeholders, and aligning telegenetics with the existing national health policies.
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