Vpliv epidemije covida-19 na genetsko obravnavo oddelka za onkološko klinično genetiko Onkološkega inštituta Ljubljana Impact of the covid-19 epidemic on the oncogenetic assessment at the cancer genetics clinic of Institute of Oncology Ljubljana

Abstract

Izhodišče: Pandemija covida-19 je v začetku leta 2020 močno omajala temelje zdravstvenega sistema ne samo v Sloveniji, ampak tudi po svetu. Povsem nepričakovano nas je postavila pred izzive, ki so jih prinesli ukrepi za zajezitev te nalezljive bolezni. Z njimi smo se spoprijeli tudi zaposleni na Oddelku za onkološko klinično genetiko Onkološkega inštituta Ljubljana (OIL). Ob tem nam je bilo v pomoč učinkovito timsko sodelovanje v kolektivu.
Namen: Ugotoviti vpliv epidemije covida-19 na število napotitev preiskovancev na onkološko genetsko svetovanje in testiranje, število opravljenih genetskih posvetov ter število prenaročitev in dobljene rezultate primerjati s podatki pred epidemijo ter ugotoviti razliko v povprečni starosti preiskovancev ob napotitvi v obdobju razglasitve prve in druge epidemije.
Metode: Analiza podatkov o številu napotitev, opravljenih genetskih posvetov in številu prenaročanj je bila pripravljena na podlagi podatkovne zbirke Oddelka za onkološko klinično genetiko OIL z opisno statistiko. Rast opravljenih posvetov smo dokazovali z metodo bivariatne regresije, s t-testom pa primerjavo povprečne starosti preiskovancev ob napotitvi med prvo in drugo razglasitvijo epidemije.
Rezultati: V obdobju prve razglasitve epidemije smo aprila 2020 imeli 78,8-odstotni upad rednih napotitev na genetsko svetovanje in testiranje glede na april 2019. Obenem smo v istem primerjalnem obdobju zabeležili 70,4-odstotni porast prednostnih napotitev. Starostna struktura napotenih preiskovancev se med obdobjema razglasitve epidemije ne razlikuje. V obdobju prve razglasitve epidemije smo opravili skupno 68 % manj genetskih posvetov kot v istem časovnem obdobju leto prej. V obdobju druge razglasitve epidemije smo opravili 12,7 % manj posvetov glede na enako časovno obdobje v letu pred epidemijo. Skupaj je bilo leta 2020 opravljenih 19,4 % genetskih posvetov manj kot leta 2019. V letu 2021 pa bomo napovedno opravili 21,4 % posvetov več kot v letu 2020. Ne glede na vztrajanje epidemije je število prvih posvetov v porastu. V prvem raziskovanem obdobju je bilo skupno prenaročenih 400 preiskovancev, od tega smo jih zaposleni prenaročili 227, kar znaša 55 %. V drugem raziskovanem obdobju je bilo 550 prenaročitev, zaposleni smo jih prenaročili 91, kar znaša 16 %. Več je bilo teh, ki so želeli nov termin ali pa se posveta niso udeležili brez predhodne odpovedi.
Zaključek: Epidemija covida-19 je močno posegla na vsa področja zdravstvenega sistema, kjer smo se bili primorani spopasti z zajezitvenimi ukrepi. Na Oddelku za onkološko klinično genetiko smo v skladu z uradnimi odloki in priporočenimi ukrepi reorganizirali vsakdanjo prakso. Soočili smo se z novimi izzivi, kot so prenaročanje, telegenetskimi posveti, delo od doma in uvajanje novih kliničnih poti genetske obravnave. Kljub epidemiji se onkogenetska dejavnost v nasprotju z drugimi evropskimi državami ni ustavila ne v prvem ne v drugem valu epidemije. V letu 2021 beležimo celo porast tako napotovanja zaradi zdravljenja kot tudi števila opravljenih posvetov.

Abstract (Eng)

Starting point: At the beginning of 2020, the covid-19 pandemic shook the health care system to its core, not only in Slovenia, but also around the world. Quite unexpectedly, it presented us with challenges posed by containment measures introduced to curb the spread of this contagious disease. Effective teamwork helped employees of the Department of Oncological Clinical Genetics of the Institute of Oncology Ljubljana (OIL) to overcome these challenges.
Purpose: To determine the impact of the covid-19 epidemic on the number of patient referrals for oncogenetic counselling and testing, the number of genetic consultations performed and the number of rescheduled appointments. We also analysed the age of patients whose appointments were rescheduled in the first and second epidemic wave.
Methods: Analysis of data on the number of referrals, genetic consultations and the number of rescheduled appointments was prepared on the basis of the database of the Department of Oncological Clinical Genetics OIL using descriptive statistics. The increase in consultations was demonstrated by the bivariate regression method. T-test was used to compare the age mean of the subjects at the time of referral between the first and second declaration of the epidemic.
Results: During the first epidemic wave in April 2020 we recorded a 78.8% decrease in regular referrals for genetic counselling and testing compared to April 2019. At the same time, we recorded a 70.4% increase in priority referrals in the same period. The age structure of referred patients did not differ between the two epidemic waves. In the period of the first epidemic wave, we performed 68% less genetic consultations than in the same time period the year before. In the period of the second epidemic wave, 12.7% fewer consultations were held compared to the same period in the year before the epidemic. Overall, 19.4% less genetic consultations were conducted in 2020 than in 2019. In 2021, we are projected to conduct 21.4% more consultations than in 2020. Despite the persistence of the epidemic, the number of first consultations is on the rise. In the first research period, a total of 400 patients had their appointments rescheduled, 227 of these by our department, which is 55%. In the second research period, there were 550 rescheduled appointments, 91 of these by our department, which is 16%. More patients rescheduled their appointment themselves or did not attend the consultation without prior notice in the second epidemic wave.
Conclusion: The covid-19 epidemic severely affected all areas of the health care system that were forced to face containment measures. At the Department of Oncological Clinical Genetics, we reorganized our daily practice in accordance with official requirements and recommended measures. We faced new challenges, such as having to reschedule more appointments, telegenetic consultations, working from home and introducing new clinical pathways for genetic management. Despite the epidemic, oncogenetic services were not suspended in either the first or second epidemic wave, unlike in other European countries. In 2021, we recorded an increase in both referrals and the number of consultations performed.