Developing training in genetics/genomics for primary care health workers
Background
A project funded by the Netherlands Genomics Initiative (NGI). It is a contribution of the Centre for Medical Systems Biology (CMSB, Leiden, prof. GJ van Ommen) to the agenda of the Centre for Society and Genomics (CSG, Nijmegen, prof. H. Zwart).
1.1.2009-31.12.2012.
Researcher: Isa Houwink, MD
Project leader: prof. Martina Cornel, MD, PhD, professor of community genetics and public health genomics
Unlike in many other countries, General practice in the Netherlands is an open access full time service for every patient with any medical complaint, request, or question. The service includes a list system, implying that every person (with or without a disease) is on the list of one general practitioner (GP), thus guaranteeing optimal continuity of care. The GP handles more than 90% of all presented complaints and diseases. All referrals to secondary care and most referrals to other primary care services are managed by the GP. Therefore, the GP is the first to whom a patient will turn when he/she has questions on prevention and treatment of disease. They are highly involved in care for patients with a common complex disorder. It has been argued that the greatest public health benefit of advances in understanding the human genome may be realized for common chronic diseases such as cardiovascular disease, diabetes mellitus, and cancer (Scheuner, 2008). Attempts to integrate such knowledge into clinical practice are still in the early stages, and as a result, many questions surround the current state of this translation (Khoury 2007; Scheuner, 2008). Physicians lack knowledge of genetics relevant for daily practice (Baars et al, 2005), lack oversight of genetic testing and concerns about privacy and discrimination, and report inadequacy to deliver genetic services (Scheuner, 2008). For genomics to have an effect on clinical practice that is comparable to its impact on research will require advances in the genomic literacy of health-care providers (Guttmacher, 2007). In previous research we have studied the curricula of Dutch medical schools (Plass et al, 2006) and were involved in the identification of needs for training in several groups of health care workers. General practitioners mentioned “genetics of common disorders” as a first teaching priority (Julian-Reynier et al, 2008). Midwives reported a low confidence with genetic issues in clinical practice, and identified psychosocial, screening and risk assessment aspects of genetic education as being important to them, rather than technical aspects or genetic science (Benjamin et al, 2007). In the age of genomics both genetics of common disorders and large scale applications in screening will become increasingly important, and primary care health workers will have to be prepared to discuss these issues with their clients. For the assessment of possibilities for screening and its implementation in preventive check-ups also public health workers (well baby clinics, occupational health care, policy makers) need to increase their skills and knowledge. Genomics might change the roles of actors in the field. GPs might get more involved in preventive check-ups and develop a more flexible way to deal with patients requests for genetic tests, instead of just a gatekeeper function.
Opportunities to improve patient safety by pharmacogenomics and to improve quality of life by early detection in screening programs and to personalize treatment will not materialize unless translation into the primary care practice takes place.
In this project we will reflect on current genomics developments with primary care workers, and help them identify their learning priorities. Next we will develop a maximum of three training modules. Unfortunately training alone is often not effective (Davis et al, 2006; Guttmacher et al, 2007). We will also investigate the effectiveness of the modules in order to learn how to improve future education.