Modell M, Wonke B, Anionwu E, Khan M, Tai S S, Lloyd M, Modell B
Royal Free and University College Medical School, Whittington Hospital, London N19 5NF.
BMJ. 1998 Sep 19;317(7161):788-91. doi: 10.1136/bmj.317.7161.788.
To investigate the feasibility of improving screening for carriers of haemoglobin disorders in general practice by using a nurse facilitator to work with primary care teams and the relevant haematology laboratories; to identify problems in communication between all those involved in delivering the service, and to implement solutions.
Two year, practice based randomised controlled trial.
North London area where 29% of residents and 43% of births are in ethnic groups at risk for haemoglobin disorders.
26 of the 93 practices using the services of the area's haematology laboratory agreed to take part and were randomly divided into control and intervention practices.
Change in number of requests for screening tests for haemoglobin disorders made by control and intervention practices in baseline and intervention years.
The number of screening tests requested varied from 0-150 in the 93 practices in the baseline year. Study practices tended to have made a moderate number of requests (10-50) during this period. During the intervention year intervention practices made 292 more requests (99% increase) and control practices made 74 fewer requests (23% decrease; P=0.001 for difference in median change). Four practices, three of which were singlehanded, accounted for 75% of the increase. The number of requests from intervention practices, adjusted for baseline requests, was 3.2 times higher than control practices (P<0.0001).
General practitioners and practice nurses are willing to undertake a new genetic screening service (or expand an existing one) if they are persuaded that it benefits the health of a significant proportion of their practice population. They need appropriate tools (for example, information materials for carriers and groups at risk), and the laboratory must be sensitive to their needs. Preconceptional carrier screening and counselling need to be coupled with antenatal screening.
通过使用护士协助人员与基层医疗团队及相关血液学实验室合作，探讨在全科医疗中改善血红蛋白病携带者筛查的可行性；识别提供该服务的所有相关人员之间的沟通问题，并实施解决方案。
基于实践的为期两年的随机对照试验。
北伦敦地区，该地区29%的居民和43%的新生儿属于有血红蛋白病风险的种族群体。
使用该地区血液学实验室服务的93家诊所中的26家同意参与，并被随机分为对照组和干预组诊所。
对照组和干预组诊所在基线年和干预年进行血红蛋白病筛查试验请求数量的变化。
在基线年，93家诊所中筛查试验请求数量从0至150不等。在此期间，参与研究的诊所倾向于提出中等数量的请求（10至50）。在干预年，干预组诊所的请求增加了292项（增加99%），而对照组诊所的请求减少了74项（减少23%；中位数变化差异P = 0.001）。四项实践（其中三项是单人诊所）占增加量的75%。经基线请求调整后，干预组诊所的请求数量比对照组高3.2倍（P < 0.0001）。
如果全科医生和执业护士相信新的基因筛查服务（或扩大现有服务）能使相当比例的诊所人群受益，他们愿意开展此项服务。他们需要适当的工具（例如，针对携带者和高危群体的信息材料），并且实验室必须对他们的需求保持敏感。孕前携带者筛查和咨询需要与产前筛查相结合。
