DELIVERY OF MOLECULAR-GENETIC SERVICES WITHIN A HEALTH-CARE SYSTEM - TIME ANALYSIS OF THE CLINICAL WORKLOAD

The most recent discoveries in molecular genetics today are rapidly in corporated into clinical practice and have resulted in an unprecedente d expansion of medical options. Despite this, the impact of molecular genetics on health care services has yet to be evaluated. In order to begin this assessment, clinical genetic workload was prospectively col lected from cases where molecular genetic testing was considered. Part icipation involved all 16 urban and outreach genetic centers regionali zed to service the entire population of 10 million within the Canadian province of Ontario. Molecular genetic testing has been clinically av ailable for >5 years, as part of a publicly supported genetic network in which there are no direct costs to residents. Cross-sectional data were collected on 1,101 clients from 544 families involving 1,742 clin ical actions relating to diseases in which molecular (DNA) tests were considered. Median times per clinical genetic action were as follows: formal counseling (60 min), case review (15 min), phone call (10 min), letter (15 min), specimen arrangement (15 min), and interpretation of molecular test results (10 min). Times varied significantly with the inheritance pattern of the disease, topics involved, and location. For any given genetic case, multiple clinical actions resulted in substan tial time spent by the genetic professional. Clerical and administrati ve times were not captured. Workload unit measurements similar to thos e currently employed in hospital laboratories may be helpful for predi cting the clinical resources and personnel that will be required as th e use of molecular genetics by other medical specialties increases.