Purpose/Rationale: Genomic Medicine Service (GMS) fields 100+ consults weekly. Due to an increase in the number of consults received, without an equal increase in staffing, the wait time for a non-urgent appointment approached 6 months. We explored the use of Group Telehealth
appointments (GTAs) for individuals referred for a family history of breast cancer as one way to reduce these wait times.
Background: While oncology specializes in those with cancer, they are often asked to see unaffected individuals with a family history of cancer who need risk assessments, management recommendations, and/or genetic testing. Many of these are then referred to GMS.
GMS uses the VA telehealth infrastructure to provide genetic evaluation to 84 VAMCs. We typically schedule appointments for one-hour, with an inability to double book due to the limitations of multi-site telehealth. As risk assessment for unaffected individuals is not urgent, these Veterans were scheduled routinely. As GMS got busier, wait times for routine appointments approached 6 months.
Methods/Approach: As part of a Leadership Development Institute, one of the authors (RAR) conceived and implemented a process whereby we held GTAs for unaffected individuals with family histories of breast cancer for whom we would most likely recommend testing an affected
relative. Before the GTA, we mailed a Breast Cancer Risk Assessment (BCRA) form to collect personal/family history. Patients who complete the GTA and BCRA were sent letters that included risk assessments and testing and screening recommendations. 4 GTAs are held each month.
We recorded the number of patients scheduled, appointments attended, and BCRA forms returned. The presentation will review results of an initial 3-month period, during which we held 14 GTAs with 97 patients scheduled, 65 seen, and 58 who turned in BCRAs. We compared time
spent on patients, documentation, and risk assessment in GTAs with the time needed for individual visits for the same number of people. We modeled time saved under a range of assumptions.
Conclusions: Our GTAs were successful, allowing our providers to more efficiently use their time and reducing our wait times. We have expanded our GTAs to include non-breast cancers and reasons for referral.
