Abstract
BackgroundThe 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.MethodsUsing 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.ResultsParticipants 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.ConclusionsPCPs 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.
Highlights
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 PCPs in the interviews and focus group (FG) were between the ages of 30 and 60 years, and included men and women who had been in practice for a minimum of five years
Regardless of method, we found that participants highlight that when considering education intended for PCPs, program developers and organizers must consider time constraints, the level of the learner, and understand that PCPs cannot be expected to be as knowledgeable as genetic experts [7], set realistic limits on what PCPs are expected to know
Summary
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 rapid expansion of genetics in medicine has resulted in an increased role for Primary Care Providers (PCPs), which could include family physicians, nurse practitioners and nurses, to assess and educate patients about genetic risks and realities. In this current study, the PCPs are family physicians. PCPs emphasized that education should incorporate a case-based practical approach, include information on clinical applications, focus on strategies to improve patient outcomes and practice (e.g., blended learning courses, online modules, PCP involvement in face-to-face or virtual genetics appointments), and be relevant to day-to-day clinical practice [4, 5, 7, 14, 25,26,27,28,29,30]
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