Australian Institute of Heath Innovation, Macquarie University, Sydney, NSW 2113, Australia; and Australian Genomics, Murdoch Children's Research Institute, Melbourne, Vic. 3052, Australia; and Peter MacCallum Cancer Centre, Melbourne, Vic. 3000, Australia; and Victorian Comprehensive Cancer Centre Alliance, Melbourne, Vic. 3000, Australia; and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic. 3000, Australia.
Australian Institute of Heath Innovation, Macquarie University, Sydney, NSW 2113, Australia.
Aust J Prim Health. 2023 Oct;29(5):480-489. doi: 10.1071/PY23022.
BACKGROUND: As reproductive genetic carrier screening (RGCS) becomes more widely accessible, ensuring uptake by primary healthcare professionals (HCPs) is essential to equitable service provision. This study aimed to identify and prioritise implementation strategies to reduce barriers and support HCPs to routinely offer RGCS in Australia. METHODS: HCPs (n =990) involved in a large national research study, offering couples-based RGCS, were surveyed at three time points: prior to offering RGCS through the study (Survey 1: Barriers); 8+weeks after offering to their patients (Survey 2: Possible supports); and towards the end of the study (Survey 3: Prioritised supports). HCPs were from primary care (e.g. general practice, midwifery) and tertiary care (e.g. fertility, genetics) settings. Results were analysed via a novel approach of using behaviour change theory (Capability, Opportunity and Motivation - COM.B) to align theory to practice. RESULTS: Survey 1 (n =599) identified four barrier themes: time constraints, lack of HCP knowledge and skill, patient receptivity, and HCP's perceived value of RGCS. Survey 2 (n =358) identified 31 supports that could facilitate HCPs offering RGCS. Survey 3 (n =390) was analysed separately by speciality and clinic location. Prioritised supports for primary care HCPs were 'regular continuing professional development activities' and 'a comprehensive website to direct patients for information'. There was general accordance with the perceived importance of the supports, although some difference in relation to funding between professional groups and clinic locations. CONCLUSION: This study identified a range of supports acceptable to HCPs across specialties and geographic locations that policymakers may use to direct efforts to ensure the roll out of RGCS is equitable across Australia.
背景:随着生殖遗传携带者筛查(RGCS)的普及,确保初级保健医生(HCP)的参与对于公平服务的提供至关重要。本研究旨在确定和优先实施策略,以减少障碍并支持 HCP 定期在澳大利亚提供 RGCS。
方法:参与一项大型全国研究的 HCP(n=990)在三个时间点接受调查:在通过该研究提供 RGCS 之前(调查 1:障碍);向患者提供服务 8 周后(调查 2:可能的支持);和研究接近尾声时(调查 3:优先支持)。HCP 来自初级保健(例如普通科、助产士)和三级保健(例如生育、遗传学)环境。通过使用行为改变理论(能力、机会和动机-COM.B)来使理论与实践保持一致的新颖方法来分析结果。
结果:调查 1(n=599)确定了四个障碍主题:时间限制、缺乏 HCP 知识和技能、患者接受度和 HCP 对 RGCS 的感知价值。调查 2(n=358)确定了 31 项支持措施,可以促进 HCP 提供 RGCS。调查 3(n=390)根据专业和诊所地点分别进行分析。初级保健 HCP 的优先支持是“定期持续专业发展活动”和“一个全面的网站,为患者提供信息指导”。尽管在专业群体和诊所地点之间在资金方面存在一些差异,但对支持的重要性的看法普遍一致。
结论:本研究确定了一系列在专业和地理位置上都能被 HCP 接受的支持措施,政策制定者可以利用这些措施来确保 RGCS 在澳大利亚的公平推广。
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