Genomic medicine in primary care: views of Ontario family physicians. S. Morrison1, J. Allanson1,3, F. A. Miller4, J. A. Permaul5, B. J. Wilson6, J. C. Carroll2 1) Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; 2) Department of Family & Community Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada; 3) Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada; 4) Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; 5) Mount Sinai Hospital, Toronto, ON, Canada; 6) Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada.
Context: Primary care providers (PCPs) will be critical to the effective and appropriate implementation of genomic medicine (GM), which is expected to profoundly affect medical practice. Little is known about what role family physicians (FPs) see for themselves, including attitudes toward genomics and resources required. Objective: To determine FPs current involvement in GM, attitudes regarding its importance, confidence in knowledge, and beliefs about resources needed to deliver GM. Design: Mailed self-complete questionnaire. Setting and Participants: Random sample of 2000 Ontario (Canada) FPs from Scotts Directory. Eligibility included practicing family medicine in Ontario. Intervention: Questionnaire including current practice, confidence in genetic competencies, attitudes to GM, knowledge, education, resource needs and demographics. Modified Dillman Method used. Outcomes: Role, confidence, attitudes, educational resources needed. Results: Adjusted response rate: 358/1363 eligible FPs (26%). Mean age 51 years, 53% male. FPs reported high involvement in some aspects of genetics (e.g., eliciting family history, 92%; deciding to whom to offer genetic counseling, 91%), and a majority expected that advances in genomic medicine would improve patient health outcomes (59%). Yet involvement in emerging genetic practices was more limited (e.g., evaluating usefulness of genetic tests, 51%; discussing pharmacogenetics, 29%), and FPs expressed reduced enthusiasm regarding newer developments (e.g., incorporating GM into practice, 36%; importance of learning about personalized medicine based on targeted or whole genome sequencing, 44%). FPs valued educational resources in genetics (e.g., genetic disorder summaries, 86%; care pathways for common genetic disorders, 81%; genetic testing guidelines, 96%; website 59%), and preferred access to a local genetic counselor (66%) to aid in integrating GM. Conclusion: FPs have an established role in genomic medicine, but are cautious about newer developments. They have limited confidence in genomic medicine competencies but high interest in educational resources to enable practice. These results can be used to guide both residency and continuing education.
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