A primary care specialist genetics service: a cluster-randomised factorial trial

Westwood, Greta; Pickering, Ruth; Latter, Sue; Little, Paul; Gerard, Karen; Lucassen, Anneke; Temple, I. Karen

doi:10.3399/bjgp12x630089

Cited by 16 publications

(34 citation statements)

References 23 publications

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“…primary, secondary or tertiary care). Interventions could range from educational interventions ( Westwood 2012), to behaviour techniques to improve communication of test results to at-risk relatives (Hodgson 2014). Interventions may be targeted at the organisational level, such as doctor or nurse role substitution (Torrance 2006).…”

Section: Introductionmentioning

confidence: 99%

Interventions to improve patient access to and utilisation of genetic and genomic counselling services.

Benjamin

Thomas²,

Skirton

et al. 2015

Cochrane Database of Systematic Reviews

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This is the protocol for a review and there is no abstract. The objectives are as follows: Primary objective The primary objective is to assess the effectiveness of interventions to improve patient identification, access to and utilisation of genetic and genomic counselling services when compared to: No intervention; Usual or current practice; and Other active intervention. Secondary objective The secondary objective is to explore the resource use and costs associated with interventions aimed at improving patient identification, access to and utilisation of genetic and genomic counselling services from studies meeting the eligibility criteria. We will report on factors that may explain variation in the effectiveness of interventions aimed at improving patient identification, access to and utilisation of genetic and genomic counselling services from studies meeting the eligibility criteria. Another secondary objective is to explore how interventions which target improved patient identification, access to and utilisation of genetic and genomic counselling services affect the subsequent appropriate use of health services for the prevention or early detection of disease. It is also possible that the genetic counselling interaction itself will contribute to the possible use of preventative services.

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Section: Introductionmentioning

confidence: 99%

Interventions to improve patient access to and utilisation of genetic and genomic counselling services.

Benjamin

Thomas²,

Skirton

et al. 2015

Cochrane Database of Systematic Reviews

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“…Other studies also reported a reduction in number or an increase in the appropriateness of referrals following educational programmes. 175,177,180,182,186,188,189 However, some studies found little or no impact of education on the rates or appropriateness of referrals. 164,174,181,183 It should be noted that some of these involved a relatively modest intervention, for example a lecture or a single outreach visit, and in one case GPs were simply sent a 12-page illustrated guide to common skin lesions.…”

Section: Scoping Review (Main Study)mentioning

confidence: 99%

“…We identified 18 studies 154,164,[174][175][176][177][178][179][180][181][182][183][184][185][186][187][188][189] which assessed the effect of professional education schemes ( Table 14).…”

Section: Key Summary Pointsmentioning

confidence: 99%

Outpatient services and primary care: scoping review, substudies and international comparisons

Winpenny

Miani

Pitchforth

et al. 2016

Health Serv Deliv Res

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AimThis study updates a previous scoping review published by the National Institute for Health Research (NIHR) in 2006 (Roland M, McDonald R, Sibbald B.Outpatient Services and Primary Care: A Scoping Review of Research Into Strategies For Improving Outpatient Effectiveness and Efficiency. Southampton: NIHR Trials and Studies Coordinating Centre; 2006) and focuses on strategies to improve the effectiveness and efficiency of outpatient services.Findings from the scoping reviewEvidence from the scoping review suggests that, with appropriate safeguards, training and support, substantial parts of care given in outpatient clinics can be transferred to primary care. This includes additional evidence since our 2006 review which supports general practitioner (GP) follow-up as an alternative to outpatient follow-up appointments, primary medical care of chronic conditions and minor surgery in primary care. Relocating specialists to primary care settings is popular with patients, and increased joint working between specialists and GPs, as suggested in the NHS Five Year Forward View, can be of substantial educational value. However, for these approaches there is very limited information on cost-effectiveness; we do not know whether they increase or reduce overall demand and whether the new models cost more or less than traditional approaches. One promising development is the increasing use of e-mail between GPs and specialists, with some studies suggesting that better communication (including the transmission of results and images) could substantially reduce the need for some referrals.Findings from the substudiesBecause of the limited literature on some areas, we conducted a number of substudies in England. The first was of referral management centres, which have been established to triage and, potentially, divert referrals away from hospitals. These centres encounter practical and administrative challenges and have difficulty getting buy-in from local clinicians. Their effectiveness is uncertain, as is the effect of schemes which provide systematic review of referrals within GP practices. However, the latter appear to have more positive educational value, as shown in our second substudy. We also studied consultants who held contracts with community-based organisations rather than with hospital trusts. Although these posts offer opportunities in terms of breaking down artificial and unhelpful primary–secondary care barriers, they may be constrained by their idiosyncratic nature, a lack of clarity around roles, challenges to professional identity and a lack of opportunities for professional development. Finally, we examined the work done by other countries to reform activity at the primary–secondary care interface. Common approaches included the use of financial mechanisms and incentives, the transfer of work to primary care, the relocation of specialists and the use of guidelines and protocols. With the possible exception of financial incentives, the lack of robust evidence on the effect of these approaches and the contexts in which they were introduced limits the lessons that can be drawn for the English NHS.ConclusionsFor many conditions, high-quality care in the community can be provided and is popular with patients. There is little conclusive evidence on the cost-effectiveness of the provision of more care in the community. In developing new models of care for the NHS, it should not be assumed that community-based care will be cheaper than conventional hospital-based care. Possible reasons care in the community may be more expensive include supply-induced demand and addressing unmet need through new forms of care and through loss of efficiency gained from concentrating services in hospitals. Evidence from this study suggests that further shifts of care into the community can be justified only if (a) high value is given to patient convenience in relation to NHS costs or (b) community care can be provided in a way that reduces overall health-care costs. However, reconfigurations of services are often introduced without adequate evaluation and it is important that new NHS initiatives should collect data to show whether or not they have added value, and improved quality and patient and staff experience.FundingThe NIHR Health Services and Delivery Research programme.

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“…Five studies described patient access to genetics services. [27][28][29][30][31] Clinic or hospital location, along with patient ability to pay and health insurance coverage, were more frequently cited as barriers to genetic counselling by US-based genetics professionals (genetic counsellors and genetics service providers) than patient attitudes, norms and education. 27,28 Though social factors, such as discouragement by family members, were also identified.…”

Section: Accessmentioning

confidence: 99%

“…28 Changing clinic location facilitated access in two studies. 29,30 Delivering genetic counselling in primary care (general practice) compared with secondary care (hospital) led to higher rates of referral and attendance in a UK-based trial. 29 In a US study, telemedicine enabled access to genetics services by saving patients' time and travel costs.…”

Section: Accessmentioning

confidence: 99%

Delivering genomic medicine in the United Kingdom National Health Service: a systematic review and narrative synthesis

Pearce

Goettke

Hallowell

et al. 2019

Genetics in Medicine

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A primary care specialist genetics service: a cluster-randomised factorial trial

Cited by 16 publications

References 23 publications

Interventions to improve patient access to and utilisation of genetic and genomic counselling services.

Interventions to improve patient access to and utilisation of genetic and genomic counselling services.

Outpatient services and primary care: scoping review, substudies and international comparisons

Delivering genomic medicine in the United Kingdom National Health Service: a systematic review and narrative synthesis

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