Christianson Carol A, Powell Karen Potter, Hahn Susan Estabrooks, Blanton Susan H, Bogacik Jessica, Henrich Vincent C
The Center for Biotechnology, Genomics and Health Research, The University of North Carolina at Greensboro, USA.
J Genet Couns. 2012 Oct;21(5):652-61. doi: 10.1007/s10897-011-9479-1. Epub 2012 Jan 21.
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.
初级保健提供者（PCP）就将家族健康史（FHH）风险评估工具纳入社区医疗系统（CHCS）提供了相关意见。16名初级保健提供者参加了三个焦点小组中的一个。他们意识到的障碍包括缺乏标准筛查指南、有效的筛查测试、遗传咨询资源以及针对高危患者的服务。初级保健提供者担心自己的专业水平、预防性医疗保健的成本以及基因歧视问题。他们还担心社区医疗系统中的肿瘤学家使用家族健康史工具，因为肿瘤学家和初级保健提供者之间存在沟通差距、后续跟进和法律责任不明确以及报销问题。为了将家族健康史工具整合到社区医疗系统中，初级保健提供者将需要咨询和转诊服务、基于证据的建议以及“及时”的教育资源。使用该工具的肿瘤学家需要与初级保健提供者建立简化的沟通系统，明确各自的角色，并确保对患者进行后续跟进。
