Purpose: To document primary care physicians' utilization and perceptions of genetics services. Methods: A randomized survey of physicians in the Pacific Northwest. Results: The greatest factor prompting a genetics referral was the patient's interest in the evaluation, and the most common reason not to obtain a consultation was the perception that it was of no benefit to the patient. Genetics consultation was rarely sought for a family history of cancer or for deafness, polycystic kidney disease, or congenital heart disease. Even when uncertain about relative risk, physicians usually counseled a patient themselves rather than referring to a specialist. Concluslon: Primary care physicians need more education about the genetic component of many diseases to provide directly and to refer appropriately for genetics services.Key words: Genetics services, primary care, attitudes, perceptions, utilization Many physicians believe that genetic disease is rare. Although most individual disorders are uncommon, there are thousands of human genetic diseases.' In aggregate, genetic disease is common and accounts for substantial morbidity and mortality.'v2 As genetic factors in common diseases are identified, genetics will become even more relevant to the health of an increasing number of individuals. These advances demand commensurate growth in the awareness and recognition of genetic components of disease by physicians and in their preparedness to provide genetics services. This is especially true in today's climate of managed health care, in which primary care physicians play a pivotal role in coordinating services.Potential barriers to the effective utilization of genetic testing and services are deficiencies in the knowledge of genetics, limited awareness of genetics services, financial pressures within managed care plans, and perceptions of a limited benefit or even risk of harm from these services. Deficiencies in primary care physicians' knowledge of genetics and genetics tests are well documentedM and have been linked with referral practices.", ' -l o These deficiencies are not unexpected because most health care providers were educated and trained before the genetics revolution of the past decade.In this study, we sought to determine primary care physicians' knowledge of local and regional genetics services, their patterns of use of these services, and their perceptions of the benefits and detriments of these services. To evaluate the direct delivery of genetics services by primary care physicians, we asked about routine genetic screening practices and management of patients with a specific genetic disorder or family history. MEIHODSThe Pacific Northwest region includes Alaska, Idaho, Oregon, and Washington and encompasses a population of nearly 10 million people spread across more than 835,000 square miles. It includes several large metropolitan areas, a substantial rural population, and areas of extreme geographic isolation.Medical genetics services currently are delivered in academic medical centers, outreach clini...

We conducted a prospective trial at a military medical center to determine which treatment for first-time ankle sprains, early mobilization or immobilization, is more effective. Eighty-two patients with a lateral ankle sprain were randomly selected for one of two treatment groups. The Early Mobilization Group received an elastic wrap for 2 days followed by functional bracing for 8 days. Two days after injury, this group began weight-bearing and an ankle rehabilitation program. Patients in the Immobilization Group were placed in a nonweight-bearing plaster splint for 10 days followed by weight-bearing and the same rehabilitation program. Patients in the Early Mobilization Group had less pain at 3 weeks (57% versus 87%, P = 0.02); otherwise, there were no significant differences between groups in the frequency of residual symptoms. Only one patient in each group had residual symptoms 1 year after injury. Three patients (8%) in each group resprained their ankles. Ten days after injury, patients in the Early Mobilization Group were more likely to be back to full work (54% versus 13%, P < 0.001). We conclude that in first-time lateral ankle sprains, although both immobilization and early mobilization prevent late residual symptoms and ankle instability, early mobilization allows earlier return to work and may be more comfortable for patients.

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Introduction We recently completed a strategic planning process to better understand the development of our five-year-old PBRN and to identify gaps between our original vision and current progress. While many of our experiences are not new to the PBRN community, our reflections may be valuable for those developing or re-shaping PBRNs in a changing health care environment. Lessons Learned We learned about the importance of: (1) Shared vision and commitment to a unique patient population; (2) Strong leadership, mentorship, and collaboration; (3) Creative approaches to engaging busy clinicians and bridging the worlds of academia and community practice; (4) Harnessing data from electronic health records and navigating processes related to data protection, sharing, and ownership. Challenges Ahead We must emphasize research that is timely, relevant, and integrated into practice. One model supporting this goal involves a broader partnership than was initially envisioned for our PBRN, one which includes clinicians, researchers, information architects and quality improvement experts partnering to develop an Innovation Center. This Center could facilitate development of relevant research questions while also addressing ‘quick-turnaround’ needs. Conclusions Gaps remain between our PBRN’s initial vision and current reality. Closing these gaps may require future creativity in partnership building and nontraditional funding sources.