A primary care specialist genetics service: a cluster-randomised factorial trial
A primary care specialist genetics service: a cluster-randomised factorial trial
Background: GPs do not have the confidence to identify patients at increased genetic risk. A specialist primary care clinical genetics service could support GPs with referral and provide local clinics for their patients.
Aim: to test whether primary care genetic-led genetics education improves both non-cancer and cancer referral rates, and primary care-led genetics clinics improve the patient pathway.
Design and setting: cluster-randomised factorial trial in 73 general practices in the south of England.
Method: practices randomised to receive case scenario based seminar (intervention) or not (control), and referred patients a primary (intervention) or secondary (control) care genetic counsellor (GC)-led appointment. Outcome measures: GP referral and clinic attendance rates (primary), appropriate cancer and case scenario referral rates, patient satisfaction, clinic costs, and case management (secondary).
Results: eighty-nine and 68 referrals made by 36 intervention and 37 control practices respectively. There was a trend towards an overall higher referral rate among educated GPs (referral rate ratio [RRR] 1.34, 95% confidence interval [CI] = 0.89 to 2.02; P = 0.161), and they made more appropriate cancer referrals (RRR 2.36, 95% CI = 1.07 to 5.24; P = 0.035). No indication of difference in clinic attendance rates (odds ratio 0.91, 95% CI = 0.43 to 1.95; P = 0.802) or patient satisfaction (P = 0.189). Patients spent 49% less travelling (£3.60 versus £6.62; P<0.001) and took 33% less time (39.7 versus 57.7 minutes; P<0.001) to attend a primary than secondary care appointment; 83% of GC-managed appointments met the 18-week referral to treatment, NHS target.
Conclusion: an integrated primary care genetics service both supports GPs in appropriate cancer referral and provides care in the right place by the right person
191-197
Westwood, Greta
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Pickering, Ruth
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Latter, Sue
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Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Gerard, Karen
1aef0321-add2-425f-8cd6-48f1adeef928
Lucassen, Anneke
2eb85efc-c6e8-4c3f-b963-0290f6c038a5
Temple, I Karen
d63e7c66-9fb0-46c8-855d-ee2607e6c226
March 2012
Westwood, Greta
7e66fb5e-d3b9-42db-affe-6f6727963221
Pickering, Ruth
4a828314-7ddf-4f96-abed-3407017d4c90
Latter, Sue
83f100a4-95ec-4f2e-99a5-186095de2f3b
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Gerard, Karen
1aef0321-add2-425f-8cd6-48f1adeef928
Lucassen, Anneke
2eb85efc-c6e8-4c3f-b963-0290f6c038a5
Temple, I Karen
d63e7c66-9fb0-46c8-855d-ee2607e6c226
Westwood, Greta, Pickering, Ruth, Latter, Sue, Little, Paul, Gerard, Karen, Lucassen, Anneke and Temple, I Karen
(2012)
A primary care specialist genetics service: a cluster-randomised factorial trial.
British Journal of General Practice, 62 (596), .
(doi:10.3399/bjgp12X630089).
(PMID:22429436)
Abstract
Background: GPs do not have the confidence to identify patients at increased genetic risk. A specialist primary care clinical genetics service could support GPs with referral and provide local clinics for their patients.
Aim: to test whether primary care genetic-led genetics education improves both non-cancer and cancer referral rates, and primary care-led genetics clinics improve the patient pathway.
Design and setting: cluster-randomised factorial trial in 73 general practices in the south of England.
Method: practices randomised to receive case scenario based seminar (intervention) or not (control), and referred patients a primary (intervention) or secondary (control) care genetic counsellor (GC)-led appointment. Outcome measures: GP referral and clinic attendance rates (primary), appropriate cancer and case scenario referral rates, patient satisfaction, clinic costs, and case management (secondary).
Results: eighty-nine and 68 referrals made by 36 intervention and 37 control practices respectively. There was a trend towards an overall higher referral rate among educated GPs (referral rate ratio [RRR] 1.34, 95% confidence interval [CI] = 0.89 to 2.02; P = 0.161), and they made more appropriate cancer referrals (RRR 2.36, 95% CI = 1.07 to 5.24; P = 0.035). No indication of difference in clinic attendance rates (odds ratio 0.91, 95% CI = 0.43 to 1.95; P = 0.802) or patient satisfaction (P = 0.189). Patients spent 49% less travelling (£3.60 versus £6.62; P<0.001) and took 33% less time (39.7 versus 57.7 minutes; P<0.001) to attend a primary than secondary care appointment; 83% of GC-managed appointments met the 18-week referral to treatment, NHS target.
Conclusion: an integrated primary care genetics service both supports GPs in appropriate cancer referral and provides care in the right place by the right person
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Published date: March 2012
Organisations:
Faculty of Health Sciences, Cancer Sciences, Primary Care & Population Sciences, Human Development & Health
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Local EPrints ID: 337157
URI: http://eprints.soton.ac.uk/id/eprint/337157
ISSN: 0960-1643
PURE UUID: 897cb1d7-4c85-4ea1-bec7-375004352d08
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Date deposited: 20 Apr 2012 07:43
Last modified: 11 Jul 2024 01:40
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Author:
Greta Westwood
Author:
Karen Gerard
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