A study of disparities in access to genetic care pre- and post-pandemic
Ashlee Joan Macalino1, Randall S Porter1,2, Lindsay Smith1,3
1University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
Insights
The COVID-19 pandemic improved pediatric genetics care delivery by shortening wait times and increasing telemedicine use. No disparities in care were found based on race, ethnicity, or socioeconomic status.
Area of Science:
- Medical Genetics
- Public Health
- Healthcare Delivery
Background:
- The COVID-19 pandemic significantly disrupted healthcare services globally.
- Understanding its impact on specialized pediatric care, such as genetics, is crucial.
Purpose of the Study:
- To analyze changes in pediatric genetic care delivery before and during the COVID-19 pandemic.
- To identify any emerging or existing disparities in care based on patient demographics.
Main Methods:
- Retrospective review of electronic medical records for patients aged 18 or younger.
- Comparison of care metrics (wait times, testing completion, telemedicine use) between pre-pandemic (Sept 2019-Mar 2020) and pandemic (Apr-Oct 2020) cohorts.
- Analysis of outcomes across ethnicity, race, age, insurance, socioeconomic status (SES), and interpreter use.
Main Results:
- The pandemic cohort (Cohort 2) showed shorter referral-to-visit times and increased telemedicine utilization.
- A higher proportion of genetic testing was completed in Cohort 2.
- No disparities in care were observed across ethnicity, race, SES, or interpreter use.
- Younger patients experienced shorter wait times; Medicaid/uninsured patients had longer waits pre-pandemic.
Conclusions:
- The pandemic accelerated improvements in pediatric genetics care delivery, enhancing efficiency and access through telemedicine.
- Despite changes, care remained equitable across diverse patient populations, indicating resilience in the system.
- Findings offer insights into optimizing pediatric genetics services during public health crises.
Abstract:
We aimed to explore the delivery of pediatric genetic care before and during the COVID-19 pandemic and assess if disparities in care existed or emerged. We retrospectively reviewed the electronic medical record for patients 18 years old or younger seen in the Division of Pediatric Genetics between September 2019-March 2020 and April-October 2020. Outcomes included time between referral and new visit, recommendation and completion of genetic testing and/or follow-up visit within 6 months, and telemedicine versus in-person format. Outcomes were compared pre- and post-COVID-19 emergence across ethnicity, race, age, health insurance, socioeconomic status (SES), and use of medical interpretation services. Three hundred thirteen total records were reviewed with comparable demographics between cohorts. Cohort 2 had shorter times between referral and new visit, greater telemedicine utilization, and a greater proportion of testing completed. Younger patients tended to have shorter times between referral and initial visit. In Cohort 1, those with Medicaid insurance or no coverage had longer referral-initial visit times. In Cohort 2, there were differences in testing recommendation based on age. For all outcomes, no disparities were observed across ethnicity, race, SES, or use of medical interpretation services. This study characterizes the impact of the pandemic on pediatric genetics care delivery at our center and may have wider implications.
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