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Journal ArticleDOI

Genetics education for primary-care providers.

01 Jul 2002-Nature Reviews Genetics (Nature Publishing Group)-Vol. 3, Iss: 7, pp 561-566
TL;DR: In an era of growing knowledge about genetics and health, primary-care physicians will have increasing responsibility for evaluating genetic risk and using genetic tests, and successful educational programmes will need to forge partnerships between primary care and genetics.
Abstract: In an era of growing knowledge about genetics and health, primary-care physicians will have increasing responsibility for evaluating genetic risk and using genetic tests. Although most have little knowledge of genetics, their expertise in the prudent use of technology is relevant to the task. Successful educational programmes will need to forge partnerships between primary care and genetics.
Citations
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Journal ArticleDOI
TL;DR: An anonymous, cross‐sectional, fax‐based, national survey of US physicians' level of knowledge and extent of use of pharmacogenomic testing highlights the need for more effective physician education on the clinical value, availability, and interpretation of Pharmacogenomic tests.
Abstract: To develop a benchmark measure of US physicians' level of knowledge and extent of use of pharmacogenomic testing, we conducted an anonymous, cross-sectional, fax-based, national survey. Of 397,832 physicians receiving the survey questionnaire, 10,303 (3%) completed and returned it; the respondents were representative of the overall US physician population. The factors associated with the decision to test were evaluated using χ(2) and multivariate logistic regression. Overall, 97.6% of responding physicians agreed that genetic variations may influence drug response, but only 10.3% felt adequately informed about pharmacogenomic testing. Only 12.9% of physicians had ordered a test in the previous 6 months, and 26.4% anticipated ordering a test in the next 6 months. Early and future adopters of testing were more likely to have received training in pharmacogenomics, but only 29.0% of physicians overall had received any education in the field. Our findings highlight the need for more effective physician education on the clinical value, availability, and interpretation of pharmacogenomic tests.

359 citations

Journal ArticleDOI
TL;DR: The overall knowledge levels of genetics in many nongeneticist health care providers show clear deficiencies, in line with reports from other countries, showing that these deficiencies are a global problem.

211 citations

Journal ArticleDOI
TL;DR: The FH Australasia Network (Australian Atherosclerosis Society) has developed a consensus model of care (MoC) for FH, which aims to provide a standardised, high-quality and cost-effective system of care that is likely to have the highest impact on patient outcomes.

201 citations


Cites background from "Genetics education for primary-care..."

  • ...The uture should see more education of GPs in medical genetics nd this will increase their role in predictive testing of famlies for FH [249]....

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Journal ArticleDOI
TL;DR: These nationally representative data indicate limited physician knowledge about key cancer genetics concepts in 1999–2000, particularly among general primary care physicians, and specialists were more knowledgeable about syndromes they might treat or refer elsewhere.
Abstract: Background: Clinically relevant genetics knowledge is essential for appropriate assessment and management of inherited cancer risk, and for effective communication with patients. This national physician survey assessed knowledge regarding basic cancer genetics concepts early in the process of introduction of predictive genetic testing for breast/ovarian and hereditary non-polyposis colorectal cancer (HNPCC) syndromes. Methods: A stratified random sample was selected from the American Medical Association Masterfile of all licensed physicians. In total, 1251 physicians (820 in primary care, 431 in selected subspecialties) responded to a 15 minute questionnaire (response rate 71%) in 1999–2000. Multivariate logistic regression analyses were conducted to identify demographic and practice characteristics associated with accurate response to three knowledge questions. Results: Of the study population, 37.5% was aware of paternal inheritance of BRCA1/2 mutations, and 33.8% recognised that these mutations occur in <10% of breast cancer patients. Only 13.1% accurately identified HNPCC gene penetrance as ⩾50%. Obstetrics/gynaecology physicians, oncologists, and general surgeons were significantly more likely than general and family practitioners to respond accurately to the breast/ovarian questions, as were gastroenterologists to the HNPCC question. Conclusions: These nationally representative data indicate limited physician knowledge about key cancer genetics concepts in 1999–2000, particularly among general primary care physicians. Specialists were more knowledgeable about syndromes they might treat or refer elsewhere. Recent dissemination of practice guidelines and continued expansion of relevant clinical literature may enhance knowledge over time. In addition to educational efforts to assist physicians with the growing knowledge base, more research is needed to characterise the organisational changes required within the healthcare system to provide effective cancer genetics services.

155 citations


Cites background from "Genetics education for primary-care..."

  • ...Research suggests that physicians are receptive to educational interventions to strengthen their understanding of cancer genetics,[32][33][34] and that they are able to recommend risk reduction options tailored to individual patients’ risk levels....

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Journal ArticleDOI
TL;DR: The case is made, through real-world examples, that personalized medicine is delivering significant value to individuals, to industry, and to the health care system overall and that it will continue to grow in importance if the authors can lift the barriers that impede its adoption and build incentives to encourage its practice.
Abstract: Personalized medicine may be considered an extension of traditional approaches to understanding and treating disease, but with greater precision. Physicians may now use a patient's genetic variation or expression profile as well as protein and metabolic markers to guide the selection of certain drugs or treatments. In many cases, the information provided by molecular markers predicts susceptibility to conditions. The added precision introduces the possibility of a more preventive, effective approach to clinical care and reductions in the duration and cost of clinical trials. Here, we make the case, through real-world examples, that personalized medicine is delivering significant value to individuals, to industry, and to the health care system overall and that it will continue to grow in importance if we can lift the barriers that impede its adoption and build incentives to encourage its practice.

146 citations

References
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Journal ArticleDOI
01 Sep 1999-JAMA
TL;DR: The data show some evidence that interactive CME sessions that enhance participant activity and provide the opportunity to practice skills can effect change in professional practice and, on occasion, health care outcomes.
Abstract: ContextAlthough physicians report spending a considerable amount of time in continuing medical education (CME) activities, studies have shown a sizable difference between real and ideal performance, suggesting a lack of effect of formal CME.ObjectiveTo review, collate, and interpret the effect of formal CME interventions on physician performance and health care outcomes.Data SourcesSources included searches of the complete Research and Development Resource Base in Continuing Medical Education and the Specialised Register of the Cochrane Effective Practice and Organisation of Care Group, supplemented by searches of MEDLINE from 1993 to January 1999.Study SelectionStudies were included in the analyses if they were randomized controlled trials of formal didactic and/or interactive CME interventions (conferences, courses, rounds, meetings, symposia, lectures, and other formats) in which at least 50% of the participants were practicing physicians. Fourteen of 64 studies identified met these criteria and were included in the analyses. Articles were reviewed independently by 3 of the authors.Data ExtractionDeterminations were made about the nature of the CME intervention (didactic, interactive, or mixed), its occurrence as a 1-time or sequenced event, and other information about its educational content and format. Two of 3 reviewers independently applied all inclusion/exclusion criteria. Data were then subjected to meta-analytic techniques.Data SynthesisThe 14 studies generated 17 interventions fitting our criteria. Nine generated positive changes in professional practice, and 3 of 4 interventions altered health care outcomes in 1 or more measures. In 7 studies, sufficient data were available for effect sizes to be calculated; overall, no significant effect of these educational methods was detected (standardized effect size, 0.34; 95% confidence interval [CI], −0.22 to 0.97). However, interactive and mixed educational sessions were associated with a significant effect on practice (standardized effect size, 0.67; 95% CI, 0.01-1.45).ConclusionsOur data show some evidence that interactive CME sessions that enhance participant activity and provide the opportunity to practice skills can effect change in professional practice and, on occasion, health care outcomes. Based on a small number of well-conducted trials, didactic sessions do not appear to be effective in changing physician performance.

2,384 citations

Journal ArticleDOI
TL;DR: The physician's degree of resourcefulness, i.e., the ability to deal skillfully and promptly with new situations, is important for changing the health behaviors of patients within the constraints of a brief office visit, was in short supply among primary care physicians selected for their interest in preventive medicine.
Abstract: The physician's degree of resourcefulness, i.e., the ability to deal skillfully and promptly with new situations, is important for changing the health behaviors of patients within the constraints of a brief office visit. This quality, however, was in short supply among 15 primary care physicians selected for their interest in preventive medicine. The physicians tended to rely on a single approach for changing specific health behaviors of patients, restricted referrals to community services and other health specialists, relied almost exclusively on fear for motivating patients and expressed considerable pessimism about changing the health behaviors of older patients. The physicians uniformly reported that their inadequate education and the lack of reimbursement influenced how they counseled their patients. A good place to begin to rectify this situation is the required reading of the Guide to Clinical Preventive Services for medical students and residents, and continuing education opportunities for practic...

2,030 citations

Journal ArticleDOI
TL;DR: The risk factors for venous thrombosis differ from those for arterial vascular disease, particularly the role of coagulation abnormalities, and the resultant gene-gene and gene-environment interactions between risk factors are the key to the understanding of why a certain person develops thromBosis at a specific point in time.

1,502 citations

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TL;DR: YP2C9 genotyping may identify a subgroup of patients who have difficulty at induction of warfarin therapy and are potentially at a higher risk of bleeding complications.

1,235 citations