Bridging the gap in genetics: a progressive model for primary to specialist care

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.

Attracting and retaining physicians in less attractive specialties: the role of continuing medical education

“…It has been suggested that to increase physicians’ feelings of relatedness, it is important to first carefully analyze their learning needs [ 51 ] and to connect them with their community [ 49 , 52 ]. To strengthen their feelings of competence, moreover, physicians should be continuously updated with new knowledge and practice [ 53 ] and receive close supervision via on-site follow-up and evaluation [ 54 ]. Finally, to enhance feelings of autonomy, physicians must be free to study in their own setting, undertake learning activities that are learner-centered and practical [ 35 ], and have the opportunity to independently apply new knowledge and skills to their own struggles in daily practice [ 37 , 55 ].…”

“…Primary care doctors in developing countries, for instance, need to learn basic knowledge of how to diagnose and manage common diseases in the community [ 57 ]. Their colleagues in developed countries, on the other hand, need to learn about disease pattern changes or other additional knowledge to manage patients in new emerging fields in their area, as in the case of Canadian family doctors wanting to learn genetic counseling [ 53 ] or listeriosis care during pregnancy [ 58 ]. Furthermore, LASs physicians in developed countries also want to learn about teaching and teamwork [ 59 ] or how to provide palliative care for patients in rural and remote locations, where many people prefer care at home during their end-of-life phase [ 37 ].…”

Queensland Consumers’ Awareness and Understanding of Clinical Genetics Services

“…The demand and utilization of genetic and more recently genomic testing continues to increase (Khan and Mittelman, 2018), yet all stakeholders in healthcare report low levels of awareness, comfort and confidence. For physicians, genetic education and training is limited (Harris et al, 2006;Harding et al, 2019). Internationally, non-genetic health professionals admit to having insufficient knowledge of genetics, and the role of clinical genetics services (Houwink et al, 2011;Crellin et al, 2019;Harding et al, 2019).…”

Knowledge on Genetic and Genomic Diagnostics among Sri Lankan Medical Practitioners

“…Slow adaptation of genetic technology to clinical care has been identified as a challenge to achieve genetic literacy among physicians (3). The need for a CME program particularly an online strategy to improve the genetic literacy has been highlighted in previous studies (16,17,22,26). Competing interests: Author declares that he has no competing interests.…”