As demand for genetic services grows, innovative genetic counseling service delivery models (SDMs) are needed. However, there is limited research on the barriers and needs of genetic counselors (GCs) interested in implementing new SDMs into their practice. In fall 2017, the National Society of Genetic Counselors (NSGC) Access and Service Delivery Committee’s SDM Subcommittee sent an online survey to the NSGC membership regarding the use of SDMs, which aimed to update the understanding of current SDM use and how this has changed over time. The survey included several questions with open‐response components assessing the need for new SDMs and barriers to implementation. Inductive thematic analysis was used to identify common themes. Among 517 usable responses (16% response rate), more than half (54.4%) of respondents indicated their current SDM was inadequate to address the patient need in their area. Nearly two‐thirds (64.8%) indicated they were in the process of or planning to make changes to their SDM, although 40.6% did not have a specific timeline. Three major themes related to expanding access, reimbursement for services, and lack of support were identified from responses to questions about implementation of additional SDMs. Access included subthemes of geographic and physical location limitations, addressing long wait times, and the need to expand services. Reimbursement for services included issues with billing, genetic counselor licensure, and limitations due to the need for physician involvement in billing. The lack of support was evident with issues related to understaffing; difficulty gaining support at the administrative, institutional, or physician level; time constraints; and funding concerns. This study shows that GCs need education, tools, and resources to overcome barriers in implementing new or adapting current SDMs, and there is a need for policy change, including new billing and coverage models.

中文翻译：

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遗传咨询服务提供模式：对遗传咨询师的兴趣、需求和实施障碍的研究

随着对遗传服务需求的增长，需要创新的遗传咨询服务提供模式 (SDM)。然而，关于有兴趣在实践中实施新 SDM 的遗传咨询师 (GC) 的障碍和需求的研究有限。2017 年秋季，国家遗传咨询师协会 (NSGC) 获取和服务提供委员会的 SDM 小组委员会向 NSGC 成员发送了一份关于 SDM 使用的在线调查，旨在更新对当前 SDM 使用的理解以及这种情况如何改变时间。该调查包括几个问题，其中包括评估对新 SDM 的需求和实施障碍的开放式回答部分。归纳主题分析用于确定共同主题。在 517 个可用回复中（16% 的回复率），超过一半（54. 4%) 的受访者表示他们目前的 SDM 不足以满足他们所在地区的患者需求。近三分之二 (64.8%) 表示他们正在或计划对其 SDM 进行更改，尽管 40.6% 没有具体的时间表。从对有关实施额外 SDM 的问题的回答中确定了与扩大获取、服务报销和缺乏支持相关的三个主要主题。访问包括地理和物理位置限制、解决漫长的等待时间以及扩展服务的需要等子主题。服务报销包括计费问题、遗传咨询师执照以及由于需要医生参与计费而产生的限制。与人员不足有关的问题显然缺乏支持；难以获得行政部门的支持，机构或医生级别；时间限制; 和资金问题。这项研究表明，GC 需要教育、工具和资源来克服实施新的或适应当前 SDM 的障碍，并且需要改变政策，包括新的计费和覆盖模型。