Factors Influencing Healthcare Utilization in Response to Personal Genetic Testing. S. S. Kalia1, K. D. Christensen1, C. A. Chen2, J. L. Mountain3, T. A. Moreno4, J. S. Roberts5, R. C. Green1,6 for the PGen Study group 1) Department of Medicine, Division of Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; 2) Data Coordinating Center, Boston University School of Public Health, Boston, MA; 3) 23andMe, Inc., Mountain View, CA; 4) Pathway Genomics, San Diego, CA; 5) Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI; 6) Partners Center for Personalized Genetic Medicine, Boston, MA.
Background: The expansion of personal genetic testing has raised questions about whether consumers will alter their use of healthcare resources after viewing their results. In the Impact of Personal Genomics (PGen) Study, we prospectively surveyed personal genetics consumers about their use of tests, exams, or procedures after seeing their genetic risks. Hypothesis: We hypothesized that pretest intention to discuss results with physicians, post-test perceptions of results, and demographic factors would be associated with having tests, exams, or procedures after receiving personal genetic information. Methods: Participants were new customers of Pathway Genomics, recruited through the health-based social network Patients Like Me, and new customers of 23andMe. Subjects completed an anonymous online survey after purchasing the testing but before receiving results. Follow-up surveys were completed at 2-3 weeks and 6 months after receiving results. Results: Of 986 respondents to the 6-month follow-up survey, 104 (10.7%) reported having tests, medical exams, or procedures as a result of seeing their genetic risk information for at least 25 diseases, including heart disease, diabetes, arthritis and macular degeneration. Self-reported tests, exams and procedures included blood tests (e.g. glucose, lipids, rheumatoid factor), cancer screening procedures (e.g. mammography, colonoscopy), MRI, ultrasound, and ophthalmology exams, among others. In bivariate analyses, older age was associated with increased likelihood of having tests, exams, or procedures (F=13.3, p<0.001). In logistic regression, after controlling for demographic factors, having tests, exams, or procedures was associated with poorer self-reported health (OR=2.4, p<0.001), higher pretest anxiety (OR=2.4, p=0.002), pretest plans to discuss results with ones PCP (OR=1.8, p=0.008) or another medical professional (OR=1.8, p=0.010), and perceiving many or all results as interesting (OR=2.2, p=0.005), useful for improving ones health (OR=3.4, p<0.001) or above average risk (OR=2.0, p=0.010). Conclusions: Pretest intentions, self-reported health, and psychological states were associated with healthcare utilization after receiving personal genetic information, as were post-test risk perceptions and perceptions about test utility. Results suggest ways to identify customers who are more likely to pursue additional tests or exams through their physicians in response to personal genetic testing.
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