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Implementing family health history risk stratification in primary care: Impact of guideline criteria on populations and resource demand
Author(s) -
Orlando Lori A.,
Wu R. Ryanne,
Beadles Chris,
Himmel Tiffany,
Buchanan Adam H.,
Powell Karen P.,
Hauser Elizabeth R.,
Henrich Vincent C.,
Ginsburg Geoffrey S.
Publication year - 2014
Publication title -
american journal of medical genetics part c: seminars in medical genetics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.419
H-Index - 101
eISSN - 1552-4876
pISSN - 1552-4868
DOI - 10.1002/ajmg.c.31388
Subject(s) - medicine , family history , breast cancer , referral , genetic counseling , family medicine , population , guideline , genetic testing , gynecology , colorectal cancer , cancer , pathology , environmental health , biology , genetics
The Genomic Medicine Model aims to facilitate patient engagement, patient/provider education of genomics/personalized medicine, and uptake of risk‐stratified evidence‐based prevention guidelines using MeTree, a patient‐facing family health history (FHH) collection and clinical decision support (CDS) program. Here we report the number of increased risk (above population‐level risk) patients identified for breast/ovarian cancer, colon cancer, hereditary syndrome risk, and thrombosis; the prevalence of FHH elements triggering increased‐risk status; and the resources needed to manage their risk. Study design : hybrid implementation‐effectiveness study of adults with upcoming well‐visits in 2 primary care practices in Greensboro, NC. Participants : 1,184, mean age = 58.8, female = 58% (N = 694), non‐white = 20% (N = 215). Increased Risk : 44% (N = 523). Recommendations : genetic counseling = 26% (N = 308), breast MRI = 0.8% (N = 10), breast chemoprophylaxis = 5% (N = 58), early/frequent colonoscopies = 19% (N = 221), ovarian cancer screening referral = 1% (N = 14), thrombosis testing/counseling = 2.4% (N = 71). FHH elements : 8 FHH elements lead to 37.3% of the increased risk categorizations (by frequency): first‐degree‐relative (FDR) with polyps age ≥60 (7.1%, N = 85), three relatives with Lynch‐related cancers (5.4%, N = 65), FDR with polyps age <60 (5.1%, N = 61), three relatives on same side of family with same cancer (4.9%, N = 59), Gail score ≥1.66% (4.9%, N = 58), two relatives with breast cancer (one ≤age 50) (4.1%, N = 49), one relative with breast cancer ≤age 40 (4.1%, N = 48), FDR with colon cancer age ≥60 (1.7%, N = 20). MeTree identifies a high percentage of individuals in the general primary care population needing non‐routine risk management/prevention for the selected conditions. Implementing risk‐stratification in primary care will likely increase demand for related‐resources, particularly colon screening and GC. Understanding the prevalence of FHH elements helps predict resource needs and may aid in guideline development. © 2014 Wiley Periodicals, Inc.