Abstract
Primary care providers (PCPs) offered input regarding the incorporation of a family health history (FHH) risk assessment tool into a community health care system (CHCS). Sixteen PCPs participated in one of three focus groups. Perceived impediments included the lack of standard screening guidelines, effective screening tests, genetic counseling resources, and services for high-risk patients. The PCPs were concerned about their level of expertise, the cost of preventive health care, and genetic discrimination. They also were concerned about the use of a FHH tool by oncologists within the CHCS because of communication gaps between oncologists and PCPs, lack of clarity regarding follow-up and legal liability, and reimbursement issues. To integrate a FHH tool into a CHCS, PCPs will need consultation and referral services, evidence-based recommendations, and “just-in-time” educational resources. Oncologists who use the tool will need to develop a streamlined communication system with PCPs, establish clearly defined roles, and ensure patient follow-up.
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References
Abrahams, E., Ginsburg, G. S., & Silver, M. (2005). The personalized medicine coalition: goals and strategies. American Journal of Pharmacogenomics, 5, 345–355.
Bell, J. (1998). The new genetics: the new genetics in clinical practice. British Journal of Medicine, 316, 618–620.
Blumenthal, D., Causino, N., Change, Y. C., Culpepper, L., Marder, W., Saglam, D., et al. (1999). The duration of ambulatory visits to physicians. Journal of Family Practice, 48, 264–271.
Burke, W., & Emery, J. (2002). Genetics education for primary-care providers. Nature Review Genetics, 3, 561–566.
Burke, W., Acheson, L., Botkin, J., Bridges, K., Davis, A., Evans, J., et al. (2002). Genetics in primary care: a USA faculty development initiative. Community Genetics, 5, 138–46.
Carroll, J. C., Rideout, A. L., Wilson, B. J., Allanson, J., Blaine, S. M., Esplen, M. J., et al. (2009). Genetic education for primary care providers: improving attitudes, knowledge, and confidence. Cancer Family Physician, 55, e92–99.
Christianson, C. A., Powell, K. P., Hahn, S. E., Bartz, D., Roxbury, T., Blanton, S. H., et al. (2010). Findings from a community education needs assessment to facilitate the integration of genomic medicine into primary care. Genetics in Medicine, 12(9), 587–593.
Clyman, J. C., Nazir, F., Tarolli, S., Black, E., Lombardi, R. Q., & Higgins, J. J. (2007). The impact of a genetics education program on physicians’ knowledge and genetic counseling referral patterns. Medical Teacher, 29, e143–e150.
Cohn, W. F., Ropka, M. E., Pelletier, S. L., Barrett, J. R., Kinzie, M. B., Harrison, M. B., et al. (2010). Health Heritage©, a web-based tool for the collection and assessment of family history: initial user experience and analytic validity. Public Health Genomics, 13, 477–491.
Collins, F. (1997). Preparing health professionals for the genetic revolution. Journal of the American Medical Association, 278, 1285–1286.
Collins, F. S., & Guttmacher, A. E. (2001). Genetics moves into the medical mainstream. Journal of the American Medical Association, 286, 2322–2324.
Core Competencies for all health care professionals. (2007). National Coalition for Health Professional Education in Genetics, available at: http://www.nchpeg.org/index.php?option=com_content&view=article&id=94&Itemid=84, accessed 23 October 2010.
de Bock, G. H., Vliet Vlieland, T. P. M., Hageman, G. C. H. A., Oosterwijk, J. C., Springer, M. P., & Kievit, J. (1999). The assessment of genetic risk of breast cancer: a set of GP guidelines. Family Practice, 16, 71–77.
Emery, J. (1999). Computer support for genetic advice in primary care. British Journal of General Practice, 49, 572–575.
Friedman, L. C., Plon, S. E., Cooper, H. P., & Weinberg, A. D. (1997). Cancer genetics: survey of primary care physicians’ attitudes and practices. Journal of Cancer Education, 12, 199–203.
Fry, A., Campbell, H., Gudmundsdottir, H., Rush, R., Porteous, M., Gorman, D., & Cull, A. (1999). GPs’ views on their role in cancer genetics services and current practice. Family Practice, 16(5), 468–474.
Ginsburg, G. S., & Willard, H. F. (2009). Genomic and personalized medicine: foundations and applications. Translational Research, 154, 277–287.
Greendale, K., & Pyeritz, R. E. (2001). Empowering primary care health professionals in medical genetics: how soon? How fast? How far? American Journal of Medical Genetics, 106, 223–232.
Guttmacher, A. E., & Collins, F. S. (2002). Genomic medicine—a primer. New England Journal of Medicine, 347, 1512–1520.
Harvey, E. K., Fogel, C. E., Peyrot, M., Christensen, K. D., Terry, S. F., & McInerney, J. D. (2007). Providers’ knowledge of genetics: a survey of 5915 individuals and families with genetic conditions. Genetics in Medicine, 9, 259–267.
Hayflick, S. J., Eiff, P., Carpenter, L., & Steinberger, J. (1998). Primary care physicians’ utilization and perception of genetics service. Genetics in Medicine, 1, 13–21.
Julian-Reynier, C., Nippert, I., Calefato, J. M., Harris, H., Kristofferson, U., Schmidtke, J., et al. (2008). Genetics in clinical practice: general practitioners’ educational priorities in European countries. Genetics in Medicine, 10(2), 107–113.
Kemper, A. R., Trotter, T. L., Lloyd-Puryear, M. A., Kyler, P., Feero, W. G., & Howell, R. R. (2010). A blueprint for maternal and child health primary care physician education in medical genetics and genomic medicine. Genetics in Medicine, 12(2), 77–80.
Khoury, M. J., Burke, W., & Thomson, E. J. (2000). Genetics and public health in the 21st century: Using genetic information to improve health and prevent disease. New York: Oxford University Press.
Korf, B. R. (2002). Integration of genetics into clinical teaching in medical school education. Genetics in Medicine, 4, 33S–38S.
Krueger, R. (1994). Focus groups: A practical guide for applied research (2nd ed.). California: SAGE Publications.
Laberge, A. M., Fryer-Edwards, K., Kyler, P., Lloyd-Puryear, M. A., & Burke, W. (2009). Long-term outcomes of the “Genetics in Primary Care” faculty development initiative. Family Medicine, 41(4), 266–70.
Lucassen, A., Watson, E., Harcourt, J., Rose, P., & O’Grady, J. (2001). Guidelines for referral to a regional genetics service: GPs respond by referring more appropriate cases. Family Practice, 18, 135–140.
Metcalf, S., Hurworth, R., Newstead, J., & Robins, R. (2002). Needs assessment study of genetics education for general practitioners in Australia. Genetics in Medicine, 4(2), 71–77.
My family health portrait: A tool from the Surgeon General. (2010). U.S. Department of Health and Human Services, available at https://familyhistory.hhs.gov/fhh-web/home.action, accessed 7 May 2010.
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™). (2011). National Comprehensive Cancer Network, available at: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp, accessed 1 March 2011.
Qureshi, N., Wilson, B., Santaguida, P., Little, J., Carroll, J., Allanson, J., et al. (2009). NIH State-of-the-Science Conference: Family History and Improving Health. Evidence Report/Technology Assessment No. 186. (Prepared by the McMaster University Evidence-based Practice Center, under Contract No. 290-2007-10060-I.) AHRQ Publication No. 09-E016. Rockville, MD: Agency for Healthcare Research and Quality.
Rich, E. C., Burke, W., Heaton, C. J., Haga, S., Pinsky, L., Short, M. P., & Acheson, L. (2004). Reconsidering the family history in primary care. Journal of General Internal Medicine, 19, 273–280.
Smith, A. N., & Scott, J. A. (1988). Innovations in human genetics education. Genetic applications for health professionals: an outreach continuing-education model program. American Journal of Human Genetics, 43, 559–562.
Suther, M. A., & Goodson, P. (2003). Barriers to the provision of genetic services by primary care physicians: a systematic review of the literature. Genetics in Medicine, 5(2), 70–76.
Trinidad, S. B., Fryer-Edwards, K., Crest, A., Kyler, P., Lloyd-Puryear, M. A., & Burke, W. (2008). Educational needs in genetic medicine: primary care perspective. Community Genetics, 11, 160–165.
Valdez, R., Yoon, P. W., Qureshi, N., Green, R. F., & Khoury, M. J. (2010). Family history in public health practice: a genomic tool for disease prevention and health promotion. Annual Review of Public Health, 31, 69–87.
Watson, E. K., Shickle, D., Qureshi, N., Emery, J., & Austoker, J. (1999). The “new genetics” and primary care: GPs’ views on their role and their educational needs. Family Practice, 16, 420–425.
Yoon, P. W., Scheuner, M. T., Jorgensen, C., & Khoury, M. J. (2009). Developing Family Healthware, a family history screening tool to prevent common chronic diseases. Preventing Chronic Disease, 6(1), 1–11.
Acknowledgments
This work was performed under the auspices of *The Genomedical Connection: Margaret Pericak-Vance, Ph.D., (PI), Jeffery Vance, Ph.D., M.D, Susan Blanton, Ph.D., Susan Hahn, M.S., William Scott, Ph.D., (Miami Institute of Human Genetics, University of Miami, FL), Elizabeth Hauser, Ph.D., Mark Donahue, M.D., Adam Buchanan, M.S. MPH., (Center of Human Genetics and Department of Medicine, Duke University); Vincent Henrich, Ph.D., Karen Powell, M.S., Carol Christianson, M.S., Debra Wallace, Ph.D., Susan Letvak, Ph.D., (The Center for Biotechnology, Genomics and Health Research, The University of North Carolina at Greensboro); Pamela Lietz, MBA, and Astrid Agbaje, MA (Cone Health). Funding for this project was provided by the U. S. Department of the Army (W81XWH-05-1-0383).
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Christianson, C.A., Powell, K.P., Hahn, S.E. et al. The Use of a Family History Risk Assessment Tool within a Community Health Care System: Views of Primary Care Providers. J Genet Counsel 21, 652–661 (2012). https://doi.org/10.1007/s10897-011-9479-1
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DOI: https://doi.org/10.1007/s10897-011-9479-1