Using Geographic Information Systems to Understand Utilization and Access to Prenatal Genetic Services (PGS).

Settings and Life Stages: Maternal and Child Health Using Geographic Information Systems to Understand Utilization and Access to Prenatal Genetic Services Background Clinical Genetic Services are changing our understanding of the epidemiology of perinatal disease. Access to genetic services can improve the health of both babies and mothers by ensuring they are receiving appropriate care during pregnancy. Providing specialist services for rare conditions in Canada is challenging due to the large geographic spread of areas. Clinical genetic services are delivered in southern Alberta, Canada using a hub and spoke model. Questions remain as to whether services are being offered to those with highest need. Methods Numerator data on utilization of genetic services (2009-2013) came from the Southern Alberta Clinical Genetics Services database, while denominator data on live births and pregnancies affected by congenital anomalies were obtained from the Alberta Perinatal Health Program and Alberta Congenital Anomalies Surveillance System. All data was provided according to 6 digit patient postal code, which allowed for geographic analysis and presentation of the data. Using a Geographic Information System, enhanced two-step floating catchment area (E2SFCA) method was used to understand spatial accessibility to genetic services. Results Geographic variability in the rate of congenital anomalies was observed across southern Alberta. The location of services did not always correspond to demand. For example, rural areas had a higher rate of anomalies and lower service utilization, while in urban areas there were lower rates of anomalies and higher rates of utilization. It was found that 10.1% of the population had no access to genetic services. In contrast, 53.3% of the population had a high access to genetic services. The E2SFCA method indicated that urban regions enjoyed greater access to genetic services while gaps in service existed in rural areas. Conclusion There are differences in utilization and spatial access to genetic services based on residential location. This information can be used to help plan appropriate locations of new services.