Implementing family health history risk stratification in primary care: Impact of guideline criteria on populations and resource demand

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 rel...
Source: American Journal of Medical Genetics Part C: Seminars in Medical Genetics - Category: Genetics & Stem Cells Authors: Tags: Research Article Source Type: research