Abstract
BackgroundHumanwide was precision health embedded in primary care aiming to leverage high-tech and high-touch medicine to promote wellness, predict and prevent illness, and tailor treatment to individual medical and psychosocial needs.MethodsWe conducted a study assessing implementation outcomes to inform spread and scale, using mixed methods of semi-structured interviews with diverse stakeholders and chart reviews.Humanwide included: 1) health coaching; 2) four digital health tools for blood-pressure, weight, glucose, and activity; 3) pharmacogenomic testing; and 4) genetic screening/testing. We examined implementation science constructs: reach/penetration, acceptability, feasibility, and sustainability. Chart reviews captured preliminary clinical outcomes.ResultsFifty of 69 patients (72%) invited by primary care providers participated in the Humanwide pilot. We performed chart reviews for the 50 participating patients. Participants were diverse overall (50% non-white, 66% female). Over half of the participants were obese and 58% had one or more major cardiovascular risk factor: dyslipidemia, hypertension, diabetes. Reach/penetration of Humanwide components varied: pharmacogenomics testing 94%, health coaching 80%, genetic testing 72%, and digital health 64%. Interview participants (n=27) included patients (n=16), providers (n=9), and the 2 staff who were allocated dedicated time for Humanwide patient intake and orientation. Patients and providers reported Humanwide was acceptable; it engaged patients holistically, supported faster medication titration, and strengthened patient-provider relationships. All patients benefited clinically from at least one Humanwide component. Feasibility challenges included: low provider self-efficacy for interpreting genetics and pharmacogenomics; difficulties with data integration; patient technology challenges; and additional staffing needs. Patient financial burden concerns surfaced with respect to sustainability.ConclusionThis is the first report of implementation of a multi-component precision health model embedded in team-based primary care. We found acceptance from both patients and providers; however, feasibility barriers must be overcome to enable broad spread and sustainability. We found that barriers to implementation of precision health in a team-based primary care clinic are mundane and straightforward, though not necessarily easy to overcome. Future implementation endeavors should invest in basics: education, workflow, and reflection/evaluation. Strengthening fundamentals will enable healthcare systems to more nimbly accept the responsibility of meeting patients at the crossroads of innovative science and routinized clinical systems.
Highlights
Humanwide was precision health embedded in primary care aiming to leverage high-tech and hightouch medicine to promote wellness, predict and prevent illness, and tailor treatment to individual medical and psychosocial needs
Strengthening fundamentals will enable healthcare systems to more nimbly accept the responsibility of meeting patients at the crossroads of innovative science and routinized clinical systems
Components of Humanwide included: 1) Health coaching- a one-hour wellness assessment with primary care providers (MD or APP) trained in health coaching to establish patient-stated goals and collect social determinants of health with follow-up visits in person or by phone; 2) Digital health - four wireless tools that connect patient values taken at home to the clinic electronic health record (EHR) for blood-pressure, weight, glucose, and activity; 3) Pharmacogenomics using saliva-based screening for drug-gene interactions; and 4) Genetic screening to assess risk of Centers for Disease Control (CDC) Tier 1 markers of hereditary breast and ovarian cancer syndrome, Lynch syndrome, or familial hypercholesterolemia [9]
Summary
Humanwide was precision health embedded in primary care aiming to leverage high-tech and hightouch medicine to promote wellness, predict and prevent illness, and tailor treatment to individual medical and psychosocial needs. Precision health connotes a shift of precision medicine from individualized treatment and risk stratification to disease prevention and wellness promotion alignment with patient-focused goals [1]. These overarching goals are well-suited for the generalist approach to primary care. Reports of implementation outcomes related to integration of precision health into health care delivery, have been limited to condition-specific care protocols [2]. Pragmatic evaluation of the implementation processes of early pilots has been recommended for precision medicine to highlight insights for troubleshooting future adaptation and spread [3]
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