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Carroll JC, Liddy C, Afkham A, Keely E, Goh ES, Graham GE, Permaul JA, Allanson J, Heisey R, Makuwaza T, Manca DP, O'Brien MA, Grunfeld E. Use of eConsult to enhance genetics service delivery in primary care: A multimethod study. Genet Med 2022; 24:2034-2041. [PMID: 35947109 DOI: 10.1016/j.gim.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE Electronic consultation (eConsult) is a freely-available secure online platform connecting primary care providers (PCPs) to geneticists. Our purpose was to determine whether eConsult is effective in improving genetics service delivery in primary care. METHODS PCP questionnaires regarding eConsult's utility, geneticists' tracking form assessments of eConsult type and appropriateness, and geneticists' interviews on implementing eConsult were carried out. RESULTS In 2 regions of Ontario, Canada, from January 2019 to June 2020, there were 305 genetics eConsults. For 169 (55%), PCPs indicated receiving good advice for a new course of action; for 110 (36%), referral was now avoided; and for 261 (86%), eConsult was perceived valuable for patient management. Of the 131 geneticist-completed tracking forms, cancer questions were most common (68, 52%). For 63 (48%), geneticists disagreed/strongly disagreed PCPs should know the answer to the referral question. From the interview data, it was observed that geneticists described eConsult positively and suggested how it might improve access and efficiencies if integrated into genetic service delivery. Dealing with eConsults virtually could reduce waitlists, and suggesting appropriate investigations for PCPs could improve efficiencies. CONCLUSION eConsult offers a potential solution for receiving timely genetics advice and avoiding unnecessary patient referrals, however, greater effect on access and wait times will need systematic integration into PCP and geneticist practice.
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Affiliation(s)
- June C Carroll
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada; Department of Family & Community Medicine, University of Toronto, Ontario, Canada.
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ontario, Canada; Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Amir Afkham
- Ontario Health East, Ottawa, Ontario, Canada
| | - Erin Keely
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Endocrinology & Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ontario, Canada
| | - Elaine S Goh
- Laboratory Medicine and Genetics and Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Department of Laboratory Medicine & Pathobiology, University of Toronto, Ontario, Canada
| | - Gail E Graham
- Department of Pediatrics, University of Ottawa, Ontario, Canada; Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Joanne A Permaul
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Judith Allanson
- Department of Pediatrics, University of Ottawa, Ontario, Canada; Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ruth Heisey
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada; Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Tutsirai Makuwaza
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Donna P Manca
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mary Ann O'Brien
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada
| | - Eva Grunfeld
- Department of Family & Community Medicine, University of Toronto, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Wood GM, van Boom S, Recourt K, Houwink EJF. FHH Quick App Review: How Can a Quality Review Process Assist Primary Care Providers in Choosing a Family Health History App for Patient Care? Genes (Basel) 2022; 13:genes13081407. [PMID: 36011320 PMCID: PMC9407515 DOI: 10.3390/genes13081407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/27/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
Family health history (FHH) is a data type serving risk assessment, diagnosis, research, and preventive health. Despite technological leaps in genomic variant detection, FHH remains the most accessible, least expensive, and most practical assessment tool for assessing risks attributable to genetic inheritance. The purpose of this manuscript is to outline a process to assist primary care professionals in choosing FHH digital tools for patient care based on the new ISO/TS 82304-2 Technical Specification (TS), which is a recently developed method to determine eHealth app quality. With a focus on eHealth in primary care, we applied the quality label concept to FHH, and how a primary care physician can quickly review the quality and reliability of an FHH app. Based on our review of the ISO TS’s 81 questions, we compiled a list of 25 questions that are recommended to be more succinct as an initial review. We call this process the FHH Quick App Review. Our ‘informative-only’ 25 questions do not produce a quality score, but a guide to complete an initial review of FHH apps. Most of the questions are straight from the ISO TS, some are modified or de novo. We believe the 25 questions are not only relevant to FHH app reviews but could also serve to aid app development and clinical implementation.
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Affiliation(s)
| | | | - Kasper Recourt
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- National eHealth Living Lab (NELL), 2333 ZD Leiden, The Netherlands
| | - Elisa J. F. Houwink
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- National eHealth Living Lab (NELL), 2333 ZD Leiden, The Netherlands
- Correspondence:
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Carroll JC, Morrison S, Miller FA, Wilson BJ, Permaul JA, Allanson J. Anticipating the primary care role in genomic medicine: expectations of genetics health professionals. J Community Genet 2021; 12:559-568. [PMID: 34379295 DOI: 10.1007/s12687-021-00544-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
Our purpose was to explore genetics health professionals' (GHPs) expectations of primary care providers' (PCPs) role in genomic medicine now and in the future. Focus groups/interviews were conducted with GHPs in Ontario, Canada. Recordings were transcribed and analysed using qualitative descriptive analysis. Five focus groups (6 clinical geneticists, 24 genetic counselors, 1 nurse, 4 laboratory staff, 3 genetics program administrators) and 3 interviews (nurses) were conducted. GHPs described a key role for PCPs in genomic medicine that could be enhanced if GHPs and PCPs worked together more effectively, making better use of GHPs as a scarce specialist resource, improving PCP knowledge and awareness of genomics, and increasing GHPs' understanding of primary care practice and how to provide PCPs meaningful education and support. Health system change is needed to facilitate the GHP/PCP relationship and improve care. This might include: PCPs ordering more genetic tests independently or with GHP guidance prior to GHP consultations, genomic expertise in primary care clinics or GHPs being accessible through buddy systems or virtually through telemedicine or electronic consultation, and developing educational materials and electronic decision support for PCPs. Our findings highlight need for change in delivering genomic medicine, which requires building the relationship between GHPs and PCPs, and creating new service delivery models to meet future needs.
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Affiliation(s)
- June C Carroll
- Department of Family and Community Medicine, Sinai Health, University of Toronto, Toronto, Canada.
| | | | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Brenda J Wilson
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Joanne A Permaul
- Ray D. Wolfe Department of Family Medicine, Sinai Health, Toronto, ON, Canada
| | - Judith Allanson
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Canada
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4
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Modernizing family health history: achievable strategies to reduce implementation gaps. J Community Genet 2021; 12:493-496. [PMID: 34028705 DOI: 10.1007/s12687-021-00531-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022] Open
Abstract
Family health history (FHH) is a valuable yet underused healthcare tool for assessing health risks for both prevalent disorders like diabetes, cancer, and cardiovascular diseases, and for rare, monogenic disorders. Full implementation of FHH collection and analysis in healthcare could improve both primary and secondary disease prevention for individuals and, through cascade testing, make at risk family members eligible for pre-symptomatic testing and preventative interventions. In addition to risk assessment in the clinic, FHH is increasingly important for interpreting clinical genetic testing results and for research connecting health risks to genomic variation. Despite this value, diverse implementation gaps in clinical settings undermine its potential clinical value and limit the quality of connected health and genomic data. The NHGRI Family Health History Group, an open-membership, US-based group with international members, believes that integrating FHH in healthcare and research is more important than ever, and that achievable implementation advances, including education, are urgently needed to boost the pace of translational utility in genomic medicine. An inventory of implementation gaps and proposed achievable strategies to address them, representing a consensus developed in meetings from 2019-2020, is presented here. The proposed measures are diverse, interdisciplinary, and are guided by experience and ongoing implementation and research efforts.
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Chou AF, Duncan AR, Hallford G, Kelley DM, Dean LW. Barriers and strategies to integrate medical genetics and primary care in underserved populations: a scoping review. J Community Genet 2021; 12:291-309. [PMID: 33523369 PMCID: PMC7849219 DOI: 10.1007/s12687-021-00508-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/18/2021] [Indexed: 01/18/2023] Open
Abstract
Despite clinical and technological advances, serious gaps remain in delivering genetic services due to disparities in workforce distribution and lack of coverage for genetic testing and counseling. Genetic services delivery, particularly in medically underserved populations, may rely heavily on primary care providers (PCPs). This study aims to identify barriers to integrating genetic services and primary care, and strategies to support integration, by conducting a scoping review. Literature synthesis found barriers most frequently cited by PCPs including insufficient knowledge about genetics and risk assessment, lack of access to geneticists, and insufficient time to address these challenges. Telegenetics, patient-centered care, and learning communities are strategies to overcome these barriers. Telegenetics supplements face-to-face clinics by providing remote access to genetic services. It may also be used for physician consultations and education. Patient-centered care allows providers, families, and patients to coordinate services and resources. Access to expert information provides a critical resource for PCPs. Learning communities may represent a mechanism that facilitates information exchange and knowledge sharing among different providers. As PCPs often play a crucial role caring for patients with genetic disorders in underserved areas, barriers to primary care-medical genetics integration must be addressed to improve access. Strategies, such as telegenetics, promotion of evidence-based guidelines, point-of-care risk assessment tools, tailored education in genetics-related topics, and other system-level strategies, will facilitate better genetics and primary care integration, which in turn, may improve genetic service delivery to patients residing in underserved communities.
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Affiliation(s)
- Ann F Chou
- Department of Family and Preventive Medicine, College of Medicine, The University of Oklahoma Health Sciences Center (OUHSC), 900 NE 10th St., Oklahoma City, OK, 73151, USA.
| | | | - Gene Hallford
- Department of Pediatrics, College of Medicine, OUHSC, Oklahoma City, OK, USA
| | - David M Kelley
- Department of Family and Preventive Medicine, College of Medicine, The University of Oklahoma Health Sciences Center (OUHSC), 900 NE 10th St., Oklahoma City, OK, 73151, USA
| | - Lori Williamson Dean
- Department of Genetic Counseling, College of Health Professions, The University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Carroll JC, Allanson J, Morrison S, Miller FA, Wilson BJ, Permaul JA, Telner D. Informing Integration of Genomic Medicine Into Primary Care: An Assessment of Current Practice, Attitudes, and Desired Resources. Front Genet 2019; 10:1189. [PMID: 31824576 PMCID: PMC6882282 DOI: 10.3389/fgene.2019.01189] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/28/2019] [Indexed: 01/24/2023] Open
Abstract
Introduction: Preparing primary care providers for genomic medicine (GM) first requires assessment of their educational needs in order to provide clear, purposeful direction and justify educational activities. More understanding is needed about primary care providers’ perspectives on their role in newer areas of GM and what resources would be helpful in practice. Our objective was to determine family physicians’ (FP) current involvement and confidence in GM, attitudes regarding its clinical value, suggestions for integration of GM into practice, and resources and education required. Methods: A self-complete anonymous questionnaire was mailed to a random sample of 2,000 FPs in Ontario, Canada in September 2012. Results: Adjusted response rate was 26% (361/1,365), mean age was 51, and 53% were male. FPs reported many aspects of traditional GM as part of current practice (eliciting family history: 93%; deciding who to refer to genetics: 94%; but few reported confidence (44%, 32% respectively). Newer areas of GM were not part of most FPs’ current practice and confidence was low (pharmacogenetics: 28% part of practice, 5% confident; direct-to-consumer genetic testing: 14%/2%; whole genome sequencing: 8%/2%). Attitudes were mixed with 59% agreeing that GM would improve patient health outcomes, 41% seeing benefits to genetic testing, but only 36% agreeing it was their responsibility to incorporate GM into practice. Few could identify useful sources of genetic information (22%) or find information about genetic tests (21%). Educational resources participants anticipated would be useful included contact information for local genetics clinics (89%), summaries of genetic disorders (86%), and genetic referral (85%) and testing (86%) criteria. About 58% were interested in learning about new genetic technologies. Most (76%) wanted to learn through in-person teaching (lectures, seminars etc.), 66% wanted contact with a local genetic counselor to answer questions, and 59% were interested in a genetics education website. Conclusion: FPs lack confidence in GM skills needed for practice, particularly in emerging areas of GM. They see their role as making appropriate referrals, are somewhat optimistic about the contribution GM may make to patient care, but express caution about its current clinical benefits. There is a need for evidence-based educational resources integrated into primary care and improved communication with genetic specialists.
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Affiliation(s)
- June C Carroll
- Sinai Health System, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Judith Allanson
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Shawna Morrison
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Brenda J Wilson
- Division of Community Health and Humanities, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Joanne A Permaul
- Sinai Health System, Ray D Wolfe Department of Family Medicine, Toronto, ON, Canada
| | - Deanna Telner
- South East Toronto Family Health Team, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Weitzel KW, Duong BQ, Arwood MJ, Owusu-Obeng A, Abul-Husn NS, Bernhardt BA, Decker B, Denny JC, Dietrich E, Gums J, Madden EB, Pollin TI, Wu RR, Haga SB, Horowitz CR. A stepwise approach to implementing pharmacogenetic testing in the primary care setting. Pharmacogenomics 2019; 20:1103-1112. [PMID: 31588877 PMCID: PMC6854439 DOI: 10.2217/pgs-2019-0053] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/29/2019] [Indexed: 01/12/2023] Open
Abstract
Pharmacogenetic testing can help identify primary care patients at increased risk for medication toxicity, poor response or treatment failure and inform drug therapy. While testing availability is increasing, providers are unprepared to routinely use pharmacogenetic testing for clinical decision-making. Practice-based resources are needed to overcome implementation barriers for pharmacogenetic testing in primary care.The NHGRI's IGNITE I Network (Implementing GeNomics In pracTicE; www.ignite-genomics.org) explored practice models, challenges and implementation barriers for clinical pharmacogenomics. Based on these experiences, we present a stepwise approach pharmacogenetic testing in primary care: patient identification; pharmacogenetic test ordering; interpretation and application of test results, and patient education. We present clinical factors to consider, test-ordering processes and resources, and provide guidance to apply test results and counsel patients. Practice-based resources such as this stepwise approach to clinical decision-making are important resources to equip primary care providers to use pharmacogenetic testing.
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Affiliation(s)
- Kristin Wiisanen Weitzel
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - Benjamin Q Duong
- Department of Pharmacy, Nemours/Alfred I DuPont Hospital for Children, Wilmington, DE 19803, USA
| | - Meghan J Arwood
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - Aniwaa Owusu-Obeng
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Noura S Abul-Husn
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Barbara A Bernhardt
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Brian Decker
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Joshua C Denny
- Department of Medicine & Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Eric Dietrich
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - John Gums
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - Ebony B Madden
- National Human Genome Research Institute, Division of Genomic Medicine, Bethesda, MD 20892, USA
| | - Toni I Pollin
- Department of Medicine & Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Rebekah Ryanne Wu
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27708, USA
| | - Susanne B Haga
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27708, USA
| | - Carol R Horowitz
- Department of Health Policy & Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Harding B, Webber C, Rühland L, Dalgarno N, Armour C, Birtwhistle R, Brown G, Carroll JC, Flavin M, Phillips SP, MacKenzie JJ. Bridging the gap in genetics: a progressive model for primary to specialist care. BMC MEDICAL EDUCATION 2019; 19:195. [PMID: 31185964 PMCID: PMC6558677 DOI: 10.1186/s12909-019-1622-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 05/22/2019] [Indexed: 05/15/2023]
Abstract
BACKGROUND The rapid expansion of genetic knowledge, and the implications for healthcare has resulted in an increased role for Primary Care Providers (PCPs) to incorporate genetics into their daily practice. The objective of this study was to explore the self-identified needs, including educational needs, of both urban and rural Primary Care Providers (PCPs) in order to provide genetic care to their patients. METHODS Using a qualitative grounded theory approach, ten key informant interviews, and one urban and two rural PCP focus groups (FGs) (n = 19) were conducted. All PCPs practiced in Southeastern Ontario. Data was analyzed using a constant comparative method and thematic design. The data reported here represent a subset of a larger study. RESULTS Participants reported that PCPs have a responsibility to ensure patients receive genetic care. However, specific roles and responsibilities for that care were poorly defined. PCPs identified a need for further education and resources to enable them to provide care for individuals with genetic conditions. Based on the findings, a progressive stepped model that bridges primary and specialty genetic care was developed; the model ranged from PCPs identifying patients with genetic conditions that they could manage alone, to patients who they could manage with informal or electronic consultation to those who clearly required specialist referral. CONCLUSIONS PCPs identified a need to integrate genetics into primary care practice but they perceived barriers including a lack of knowledge and confidence, access to timely formal and informal consultation and clearly defined roles for themselves and specialists. To address gaps in PCP confidence in providing genetic care, interventions that are directed at accessible just-in-time support and consultation have the potential to empower PCPs to manage patients' genetic conditions. Specific attention to content, timing, and accessibility of educational interventions is critical to address the needs of both urban and rural PCPs. A progressive framework for bridging primary to specialty care through a 'stepped' model for providing continuing medical education, and genetic care can was developed and can be used to guide future design and delivery of educational interventions and resources.
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Affiliation(s)
- Brittany Harding
- Department of Pediatrics, McMaster University, Hamilton, Ontario Canada
| | - Colleen Webber
- Queen’s University, 99 University Avenue, Kingston, Ontario K7L 3N6 Canada
| | - Lucia Rühland
- Queen’s University, 99 University Avenue, Kingston, Ontario K7L 3N6 Canada
| | - Nancy Dalgarno
- Botterell Hall, Queen’s University, 18 Stuart Street, Kingston, Ontario K7L 3N6 Canada
| | - Christine Armour
- Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
| | | | - Glenn Brown
- Centre for Studies in Primary Care, Queen’s University, 220 Bagot Street, P.O.#8888, Kingston, Ontario K7L 5E9 Canada
| | - June C. Carroll
- Department of Family and Community Medicine, Granovsky Gluskin Family Medicine Centre, Mount Sinai Hospital, University of Toronto, 60 Murray St., 4th Floor, Box 25, Toronto, Ontario M5T 3L9 Canada
| | - Michael Flavin
- Department of Pediatrics, Faculty of Health Sciences, Queen’s University, Kingston, Ontario Canada
| | - Susan P. Phillips
- Centre for Studies in Primary Care, Queen’s University, 220 Bagot Street, P.O.#8888, Kingston, Ontario K7L 5E9 Canada
| | - Jennifer J. MacKenzie
- Department of Pediatrics, McMaster Children’s Hospital, 1280, Main St. West, 3N11-G, Hamilton, Ontario L8S 4K1 Canada
- Department of Medicine, Queen’s University, Kingston, Ontario Canada
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Rubanovich CK, Cheung C, Mandel J, Bloss CS. Physician preparedness for big genomic data: a review of genomic medicine education initiatives in the United States. Hum Mol Genet 2018; 27:R250-R258. [PMID: 29750248 PMCID: PMC6061688 DOI: 10.1093/hmg/ddy170] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 12/11/2022] Open
Abstract
In the last decade, genomic medicine education initiatives have surfaced across the spectrum of physician training in order to help address a gap in genomic medicine preparedness among physicians. The approaches are diverse and stem from the belief that 21st century physicians must be proficient in genomic medicine applications as they will be leaders in the precision medicine movement. We conducted a review of literature in genomic medicine education and training for medical students, residents, fellows, and practicing physicians with articles published between June 2015 and January 2018 to gain a picture of the current state of genomic medicine education with a focus on the United States. We found evidence of progress in the development of new and innovative educational programs and other resources aimed at increasing physician knowledge and readiness. Three overarching educational approach themes emerged, including immersive and experiential learning; interdisciplinary and interprofessional education; and electronic- and web-based approaches. This review is not exhaustive, nevertheless, it may inform future directions and improvements for genomic medicine education. Important next-steps include: (i) identifying and studying ways to best implement low-cost dissemination of genomic information; (ii) emphasizing genomic medicine education program evaluation and (iii) incorporating interprofessional and interdisciplinary initiatives. Genomic medicine education and training will become more and more relevant in the years to come as physicians increasingly interact with genomic and other precision medicine technologies.
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Affiliation(s)
- Caryn Kseniya Rubanovich
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Cynthia Cheung
- The Qualcomm Institute of Calit2, University of California, San Diego, La Jolla, CA, USA
| | - Jess Mandel
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Cinnamon S Bloss
- The Qualcomm Institute of Calit2, University of California, San Diego, La Jolla, CA, USA
- Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
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10
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Thomford NE, Dzobo K, Chimusa E, Andrae-Marobela K, Chirikure S, Wonkam A, Dandara C. Personalized Herbal Medicine? A Roadmap for Convergence of Herbal and Precision Medicine Biomarker Innovations. ACTA ACUST UNITED AC 2018; 22:375-391. [DOI: 10.1089/omi.2018.0074] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Nicholas Ekow Thomford
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology and Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- School of Medical Sciences, University of Cape Coast, Cape Coast, PMB, Ghana
| | - Kevin Dzobo
- International Centre for Genetic Engineering and Biotechnology, Cape Town component, University of Cape Town, Cape Town, South Africa
- Department of Integrative Biomedical Science, Division of Medical Biochemistry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Emile Chimusa
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology and Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kerstin Andrae-Marobela
- Molecular Cell Biology, Department of Biological Sciences, University of Botswana, Gaborone, Botswana
| | - Shadreck Chirikure
- Department of Archaeology, University of Cape Town, Cape Town, South Africa
| | - Ambroise Wonkam
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology and Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Collet Dandara
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology and Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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11
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Harding B, Webber C, Ruhland L, Dalgarno N, Armour CM, Birtwhistle R, Brown G, Carroll JC, Flavin M, Phillips S, MacKenzie JJ. Primary care providers' lived experiences of genetics in practice. J Community Genet 2018; 10:85-93. [PMID: 29700759 PMCID: PMC6325046 DOI: 10.1007/s12687-018-0364-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 04/12/2018] [Indexed: 12/28/2022] Open
Abstract
To effectively translate genetic advances into practice, engagement of primary care providers (PCPs) is essential. Using a qualitative, phenomenological methodology, we analyzed key informant interviews and focus groups designed to explore perspectives of urban and rural PCPs. PCPs endorsed a responsibility to integrate genetics into their practices and expected advances in genetic medicine to expand. However, PCPs reported limited knowledge and difficulties accessing resources, experts, and continuing education. Rural practitioners’ additional concerns included cost, distance, and poor patient engagement. PCPs’ perspectives are crucial to develop relevant educational and systems-based interventions to further expand genetic medicine in primary care.
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Affiliation(s)
- Brittany Harding
- Office of Health Sciences Education, Queen's University, Botterell Hall, Room 217, Kingston, Ontario, K7L 2N6, Canada
| | - Colleen Webber
- Queen's University, 99 University Avenue, Kingston, Ontario, K7L 3N6, Canada
| | - Lucia Ruhland
- Queen's University, 99 University Avenue, Kingston, Ontario, K7L 3N6, Canada
| | - Nancy Dalgarno
- Office of Health Sciences Education, Queen's University, Botterell Hall, Room 217, 18 Stuart Street, Kingston, Ontario, K7L 3N6, Canada
| | - Christine M Armour
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Richard Birtwhistle
- Centre for Studies in Primary Care, Queen's University, 220 Bagot Street, P.O.#8888, Kingston, Ontario, K7L 5E9, Canada
| | - Glenn Brown
- Department of Family Medicine, 220 Bagot Street, Kingston, Ontario, K7L 5E9, Canada
| | - June C Carroll
- Department of Family & Community Medicine, Mount Sinai Hospital, Granovsky Gluskin Family Medicine Centre, University of Toronto, 60 Murray St., 4th Floor, Box 25, Toronto, Ontario, M5T 3L9, Canada
| | - Michael Flavin
- Kingston General Hospital, 76 Stuart Street, Kingston, Ontario, K7L 2V7, Canada
| | - Susan Phillips
- Department of Family Medicine, 220 Bagot Street, Kingston, Ontario, K7L 5E9, Canada
| | - Jennifer J MacKenzie
- Department of Pediatrics, McMaster Children's Hospital, 1280 Main St. West, 3N11-G, Hamilton, ON, L8S 4K1, Canada.
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12
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Puryear L, Downs N, Nevedal A, Lewis ET, Ormond KE, Bregendahl M, Suarez CJ, David SP, Charlap S, Chu I, Asch SM, Pakdaman N, Chang SI, Cullen MR, Palaniappan L. Patient and provider perspectives on the development of personalized medicine: a mixed-methods approach. J Community Genet 2017; 9:283-291. [PMID: 29280052 DOI: 10.1007/s12687-017-0349-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/14/2017] [Indexed: 12/16/2022] Open
Abstract
While genetic testing gains adoption in specialty services such as oncology, neurology, and cardiology, use of genetic and genomic testing has yet to be adopted as widely in primary care. The purpose of this study is to identify and compare patient and primary care provider (PCP) expectations of genetics services in primary care. Patient and PCP perspectives were assessed through a mixed-method approach combining an online survey and semi-structured interviews in a primary care department of a large academic medical institution. A convenience sample of 100 adult primary care patients and 26 PCPs was gathered. The survey and interview questions focused on perceptions of genetic testing, experience with genetic testing, and expectations of genetic services in primary care. Patients felt that their PCP was knowledgeable about genetic testing and expected their PCP to be the first to recognize a need for genetic testing based on family history. Nonetheless, patients reported that PCPs rarely used family history information to discuss genetic risks or order testing. In contrast, PCPs felt uncertain about the clinical utility and scientific value of genetic testing. PCPs were concerned that genetic testing could cause anxiety, frustration, discrimination, and reduced insurability, and that there was unequal access to testing. PCPs described themselves as being "gatekeepers" to genetic testing but did not feel confident or have the desire to become experts in genetic testing. However, PCPs were open to increasing their working knowledge of genetic testing. Within this academic medical center, there is a gap between what patients expect and what primary care providers feel they are adequately prepared to provide in terms of genetic testing services.
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Affiliation(s)
- Lauren Puryear
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Natalie Downs
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrea Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Livermore, CA, USA
| | - Eleanor T Lewis
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Livermore, CA, USA
| | - Kelly E Ormond
- Department of Genetics and Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
| | - Maria Bregendahl
- Division of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Road, MC: 5475, Stanford, CA, 94305, USA
| | - Carlos J Suarez
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Sean P David
- Division of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Road, MC: 5475, Stanford, CA, 94305, USA
| | | | - Isabella Chu
- Center for Population Health Sciences, Stanford University, Stanford, CA, USA
| | - Steven M Asch
- Division of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Road, MC: 5475, Stanford, CA, 94305, USA
| | - Neda Pakdaman
- Division of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Road, MC: 5475, Stanford, CA, 94305, USA
| | - Sang-Ick Chang
- Division of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Road, MC: 5475, Stanford, CA, 94305, USA
| | - Mark R Cullen
- Center for Population Health Sciences, Stanford University, Stanford, CA, USA
| | - Latha Palaniappan
- Division of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Road, MC: 5475, Stanford, CA, 94305, USA.
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13
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Dingel MJ, Ostergren J, Heaney K, Koenig BA, McCormick J. "I don't have to know why it snows, I just have to shovel it!": Addiction Recovery, Genetic Frameworks, and Biological Citizenship. BIOSOCIETIES 2017; 12:568-587. [PMID: 29552089 PMCID: PMC5851475 DOI: 10.1057/s41292-017-0045-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The gene has infiltrated the way citizens perceive themselves and their health. However, there is scant research that explores the ways genetic conceptions infiltrate individuals' understanding of their own health as it relates to a behavioral trait, like addiction. Do people seeking treatment for addiction ground their self-perception in biology in a way that shapes their experiences? We interviewed 63 participants in addiction treatment programs, asking how they make meaning of a genetic understanding of addiction in the context of their recovery, and in dealing with the stigma of addiction. About two-thirds of people in our sample did not find a genetic conception of addiction personally useful to them in treatment, instead believing that the cause was irrelevant to their daily struggle to remain abstinent. One-third of respondents believed that an individualized confirmation of a genetic predisposition to addiction would facilitate their dealing with feelings of shame and accept treatment. The vast majority of our sample believed that a genetic understanding of addiction would reduce the stigma associated with addiction, which demonstrates the perceived power of genetic explanations in U.S. society. Our results indicate that respondents (unevenly) ground their self-perception of themselves as an addicted individual in biology.
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Affiliation(s)
- Molly J Dingel
- University of Minnesota Rochester, 300 University Square, 111 South Broadway, Rochester, Minnesota, 55904, USA, , (507) 258-8206
| | - Jenny Ostergren
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, USA,
| | - Kathleen Heaney
- Hennepin County Medical Center, 701 Park Avenue, Minneapolis, Minnesota, USA,
| | - Barbara A Koenig
- University of California, San Francisco, Institute for Health & Aging, 3333 Calif. St, Laurel Heights, San Francisco CA 94143,
| | - Jennifer McCormick
- Pennsylvania State University, 1743C Humanities, Hershey Medical Center, Hershey, PA 17033
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14
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Coors ME, Westfall N, Zittleman L, Taylor M, Westfall JM. Translating Biobank Science into Patient-Centered Language. Biopreserv Biobank 2017; 16:59-63. [PMID: 29190122 PMCID: PMC5808390 DOI: 10.1089/bio.2017.0089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: This project used Boot Camp Translation (BCT) to translate the complex medical jargon of biobanking into locally relevant evidence-based messages and materials to support increased knowledge and understanding in the local community. Methods: Biobank BCT was a partnership of 16 community members and 5 academic researchers. The partnership met for 8 months. Results: The partnership developed five main and seven submessages to assist patients and community members in making an informed decision about enrollment in a biobank. Discussion: The resulting messages balance an individual's right to privacy and choice, while encouraging participation for the greater good.
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Affiliation(s)
- Marilyn E. Coors
- Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, Colorado
- Colorado Clinical Translational Sciences Institute, University of Colorado School of Medicine, Aurora, Colorado
| | - Noah Westfall
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Linda Zittleman
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Matthew Taylor
- Adult Medical Genetics Program, University of Colorado School of Medicine, Aurora, Colorado
| | - John M. Westfall
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
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15
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Taher A. Science, research and technology in primary health care: Covering from neglected tropical diseases to personalized medicine. MEDICAL JOURNAL OF INDONESIA 2017. [DOI: 10.13181/mji.v26i2.2108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
[no abstract available]
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16
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West KM, Burke W, Korngiebel DM. Identifying "ownership" through role descriptions to support implementing universal colorectal cancer tumor screening for Lynch syndrome. Genet Med 2017; 19:1236-1244. [PMID: 28471433 PMCID: PMC5671377 DOI: 10.1038/gim.2017.39] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/08/2017] [Indexed: 12/31/2022] Open
Abstract
Purpose Lynch Syndrome cases are under-identified, and universal colorectal cancer tumor screening for Lynch Syndrome (UTS) has been recommended. UTS implementation is challenging and few successful examples exist to date, and colorectal cancer patients and at-risk family members exhibit low uptake of genetic services. This study sought to identify the elements that could guide the choice of specialties to implement UTS through three main stages: initiating the screen, returning positive screen results, and providing follow-up. Methods To understand stakeholder views on the UTS process, twenty semi-structured interviews were conducted with clinicians from six medical specialties crucial for implementing UTS. Data were analyzed using directed content analysis and additional thematic analysis across content categories. Results Several clinical specialties could fill necessary roles at each of the main stages of UTS implementation. Participants suggested owners based on attributes of specialty roles, clinical settings, and the routes patients take through the system. Conclusion UTS is considered possible in a range of healthcare settings, with tailoring. Health systems need to choose who best fills the role’s needs based on local resources and processes. These results offer implementation guidance based on role needs, not clinical specialty, in resolving the issue of UTS “ownership.”
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Affiliation(s)
- Kathleen M West
- Department of Bioethics and Humanities, Institute for Public Health Genetics, University of Washington, Seattle, Washington, USA
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington, USA
| | - Diane M Korngiebel
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington, USA
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17
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Carroll JC, Makuwaza T, Manca DP, Sopcak N, Permaul JA, O'Brien MA, Heisey R, Eisenhauer EA, Easley J, Krzyzanowska MK, Miedema B, Pruthi S, Sawka C, Schneider N, Sussman J, Urquhart R, Versaevel C, Grunfeld E. Primary care providers' experiences with and perceptions of personalized genomic medicine. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:e626-e635. [PMID: 27737998 PMCID: PMC5063789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess primary care providers' (PCPs') experiences with, perceptions of, and desired role in personalized medicine, with a focus on cancer. DESIGN Qualitative study involving focus groups. SETTING Urban and rural interprofessional primary care team practices in Alberta and Ontario. PARTICIPANTS Fifty-one PCPs. METHODS Semistructured focus groups were conducted and audiorecorded. Recordings were transcribed and analyzed using techniques informed by grounded theory including coding, interpretations of patterns in the data, and constant comparison. MAIN FINDINGS Five focus groups with the 51 participants were conducted; 2 took place in Alberta and 3 in Ontario. Primary care providers described limited experience with personalized medicine, citing breast cancer and prenatal care as main areas of involvement. They expressed concern over their lack of knowledge, in some circumstances relying on personal experiences to inform their attitudes and practice. Participants anticipated an inevitable role in personalized medicine primarily because patients seek and trust their advice; however, there was underlying concern about the magnitude of information and pace of discovery in this area, particularly in direct-to-consumer personal genomic testing. Increased knowledge, closer ties to genetics specialists, and relevant, reliable personalized medicine resources accessible at the point of care were reported as important for successful implementation of personalized medicine. CONCLUSION Primary care providers are prepared to discuss personalized medicine, but they require better resources. Models of care that support a more meaningful relationship between PCPs and genetics specialists should be pursued. Continuing education strategies need to address knowledge gaps including direct-to-consumer genetic testing, a relatively new area provoking PCP concern. Primary care providers should be mindful of using personal experiences to guide care.
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Affiliation(s)
- June C Carroll
- Family physician in the Granovsky Gluskin Family Medicine Centre at Sinai Health System in Toronto, Ont, and Clinician Scientist and Professor in the Department of Family and Community Medicine at the University of Toronto.
| | - Tutsirai Makuwaza
- Qualitative research assistant in the Departments of Family and Community Medicine, Sinai Health System, and at the University of Toronto
| | - Donna P Manca
- Clinical Director of the Alberta Family Practice Research Network, Director of the Northern Alberta Primary Care Research Network, and Director of Research in the Department of Family Medicine at the University of Alberta in Edmonton
| | - Nicolette Sopcak
- Researcher in the Department of Family Medicine at the University of Alberta
| | - Joanne A Permaul
- Research associate in the Department of Family Medicine at Mount Sinai Hospital, Sinai Health System
| | - Mary Ann O'Brien
- Assistant Professor in the Department of Family and Community Medicine at the University of Toronto and Scientific Associate with the Knowledge Translation Research Network, Health Services Research Program, Ontario Institutefor Cancer Research
| | - Ruth Heisey
- Chief of the Department of Family and Community Medicine at Women's College Hospital in Toronto, a GP-oncologist at Princess Margaret Hospital in Toronto, and Clinician Investigator and Associate Professor in the Department of Family and Community Medicine at the University of Toronto
| | - Elizabeth A Eisenhauer
- Head of the Department of Oncology at Queen's University in Kingston, Ont, Research Lead for the Canadian Partnership Against Cancer, and Co-Chair of the Canadian Cancer Research Alliance
| | - Julie Easley
- Research coordinator at the Dalhousie Family Medicine Teaching Unit in Fredericton, NB
| | - Monika K Krzyzanowska
- Medical oncologist at Princess Margaret Cancer Centre in Toronto and Provincial Clinical Lead for Quality Care and Access within the Systemic Treatment Program at Cancer Care Ontario
| | - Baukje Miedema
- Professor and Director of Research at the Dalhousie Family Medicine Teaching Unit
| | - Sandhya Pruthi
- Consultant in the Division of General Internal Medicine and Breast Diagnostic Clinic in the Department of Internal Medicine at the Mayo Clinic in Rochester, Minn
| | - Carol Sawka
- Medical oncologist and Adjunct Clinical Professor in the Department of Medicine at the University of Toronto and Adjunct Professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto
| | - Nancy Schneider
- Recently retired from a senior position with the Government of Alberta
| | - Jonathan Sussman
- Radiation oncologist and Clinician Scientist in the Department of Oncology at McMaster University in Hamilton, Ont, and Chair of the Survivorship Advisory Committee at Cancer Care Ontario
| | - Robin Urquhart
- Assistant Professor in the Department of Surgery, with a cross-appointment in the Department of Community Health and Epidemiology, at Dalhousie University in Halifax, NS, and is Senior Scientist at the Beatrice Hunter Cancer Research Institute in Halifax
| | | | - Eva Grunfeld
- Giblon Professor and Vice-Chair of Research in the Department of Family and Community Medicine at the University of Toronto and Director of Knowledge Translation Research in the Health Services Research Program at the Ontario Institute for Cancer Research
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18
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Cabrera M, Finkelstein J. A Use Case to Support Precision Medicine for Frequently Hospitalized Older Adults with Polypharmacy. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2016; 2016:16-21. [PMID: 27570642 PMCID: PMC5001756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Polypharmacy in older adults results in multiple negative clinical consequences including increased risk of hospital readmissions. Precision medicine may provide tools to optimize complex medication regimens however its potential in older adults with polypharmacy is unknown. We carried out pharmacogenetic testing in an older adult with multiple chronic conditions and polypharmacy who was concerned about frequent readmissions despite receiving guideline-concordant care and being adherent to medication regimen. The testing identified patients' CYP2D6 rapid metabolizer status. This may have resulted in decreased exposure to Carvedilol which was primary drug for CHF management in this patient. Additional nine drug-drug interactions were identified during personalized drug regimen review. We concluded that, though precision medicine has enormous potential in older adults with polypharmacy, the complexity of pharmacogenetic information requires innovative informatics solutions to support optimal workflows, decision support, and medication optimization and management in order to fully utilize its potential in routine clinical care.
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19
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Oo C, Noveck RJ. Proposed Strategies for the Integration of Genomics in Primary Care. Am J Med 2016; 129:e87. [PMID: 27320714 DOI: 10.1016/j.amjmed.2016.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/08/2016] [Accepted: 01/11/2016] [Indexed: 11/19/2022]
Affiliation(s)
| | - Robert J Noveck
- Department of Clinical Pharmacology, Duke University Medical Center, Durham, NC
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20
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Finkelstein J, Friedman C, Hripcsak G, Cabrera M. Potential utility of precision medicine for older adults with polypharmacy: a case series study. Pharmgenomics Pers Med 2016; 9:31-45. [PMID: 27143951 PMCID: PMC4846041 DOI: 10.2147/pgpm.s101474] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Pharmacogenomic (PGx) testing has been increasingly used to optimize drug regimens; however, its potential in older adults with polypharmacy has not been systematically studied. In this hypothesis-generating study, we employed a case series design to explore potential utility of PGx testing in older adults with polypharmacy and to highlight barriers in implementing this methodology in routine clinical practice. Three patients with concurrent chronic heart and lung disease aged 74, 78, and 83 years and whose medication regimen comprised 26, 17, and 18 drugs, correspondingly, served as cases for this study. PGx testing identified major genetic polymorphisms in the first two cases. The first case was identified as "CYP3A4/CYP3A5 poor metabolizer", which affected metabolism of eleven prescribed drugs. The second case had "CYP2D6 rapid metabolizer" status affecting three prescribed medications, two of which were key drugs for managing this patient's chronic conditions. Both these patients also had VKORC1 allele *A, resulting in higher sensitivity to warfarin. All cases demonstrated a significant number of potential drug-drug interactions. Both patients with significant drug-gene interactions had a history of frequent hospitalizations (six and 23, respectively), whereas the person without impaired cytochrome P450 enzyme activity had only two acute episodes in the last 5 years, although he was older and had multiple comorbidities. Since all patients received guideline-concordant therapy from the same providers and were adherent to their drug regimen, we hypothesized that genetic polymorphism may represent an additional risk factor for higher hospitalization rates in older adults with polypharmacy. However, evidence to support or reject this hypothesis is yet to be established. Studies evaluating clinical impact of PGx testing in older adults with polypharmacy are warranted. For practical implementation of pharmacogenomics in routine clinical care, besides providing convincing evidence of its clinical effectiveness, multiple barriers must be addressed. Introduction of intelligent clinical decision support in electronic medical record systems is required to address complexities of simultaneous drug-gene and drug-drug interactions in older adults with polypharmacy. Physician training, clear clinical pathways, evidence-based guidelines, and patient education materials are necessary for unlocking full potential of pharmacogenomics into routine clinical care of older adults.
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Affiliation(s)
- Joseph Finkelstein
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Carol Friedman
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Manuel Cabrera
- Department of Medicine, Columbia University, New York, NY, USA
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21
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Abstract
BACKGROUND The emerging health care system increasingly values patient engagement and shared decision-making between patients and their providers. The practice of these values is gaining importance as the patient-centered medical home model and personalized medicine come into greater use. OPPORTUNITY FOR IMPROVEMENT Exploration of patient preferences about personal health data use for research and quality improvement is a fundamental element of the provider-patient relationship. Giving patients an explicit opportunity to discuss their options about use of their data and implementing a process that allows patients to receive desired communications about how their information is used can help build patient trust, a requirement for successful care partnerships. PRACTICE ADVANCEMENT Working to change organizational cultures that exclude patients from participation in important decisions related to personal health information use promotes a strong patient-provider relationship and, ultimately, lays the foundation for improved health care through expanded use of patient data.
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22
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Abe F, Marceau F, Talmadge JE. Introduction: Natural product-based drug discovery in Immunopharmacology. Int Immunopharmacol 2016; 37:1-2. [PMID: 26987504 DOI: 10.1016/j.intimp.2016.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 01/14/2016] [Indexed: 01/24/2023]
Affiliation(s)
- Fuminori Abe
- SBI Pharmaceuticals Co., Ltd., 1-6-1 Roppongi, Minato-ku, Tokyo 106-6020, Japan
| | - François Marceau
- Department of Microbiology, Infectious Disease and Immunology, T1-49, CHU de Québec, Université Laval, 2705 Laurier Blvd., Quebec City, QC G1V 4G2, Canada
| | - James E Talmadge
- Department of Pathology and Microbiology, Laboratory of Transplantation Immunology, University of Nebraska Medical Center, 987660 Nebraska Medical Center, Omaha, NE 68198-7660, USA
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23
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Dye T, Li D, Demment M, Groth S, Fernandez D, Dozier A, Chang J. Sociocultural variation in attitudes toward use of genetic information and participation in genetic research by race in the United States: implications for precision medicine. J Am Med Inform Assoc 2016; 23:782-6. [PMID: 26984047 PMCID: PMC4926739 DOI: 10.1093/jamia/ocv214] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/23/2015] [Indexed: 11/21/2022] Open
Abstract
Background “Precision medicine” (PM) requires
researchers to identify actionable genetic risks and for clinicians to interpret
genetic testing results to patients. Whether PM will equally benefit all
populations or exacerbate existing disparities is uncertain. Methods We ascertained attitudes toward genetic testing and genetic
research by race in the United States using the online Amazon mTurk US workforce
(n = 403 White; n = 56 African
American (AA)). Generalized linear models were used to test differences in
beliefs and preferences by race, adjusting for sociodemographics and prior
genetic experience. Results AA were less likely than White to believe that genetic tests
should be promoted or made available. Further, AA were less likely to want
genetic testing results or to participate in genetic research. Conclusions Important dimensions that underlay PM are not
universally accepted by all populations. Without clear attention to concerns, AA
communities may not equally benefit from the rapidly-emerging trend in
PM-centered research and clinical practice.
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Affiliation(s)
- Timothy Dye
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
| | - Dongmei Li
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
| | - Margaret Demment
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
| | - Susan Groth
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Diana Fernandez
- Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Ann Dozier
- Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Jack Chang
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
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