Assessment of Two, Low-Tech, Genetic Health Care (GHC) Procedures Performed by Prenatal Care Providers (PCPs) in Washington State: Implications for Future Policy Development Activities
RM Fineman, TM Bell
Maternal and Child Health, Community and Family Health, Washington State Department of Health, Seattle, WA
Equity in health care demands that patients be treated fairly, impartially, and with justice. Health care professionals and others have long been aware of equity, and the many inequities that exist in our health care system. As part of the analysis of 1993-1996, post-partum, patient self-report, Washington PRAMS (Pregnancy Risk Assessment Monitoring System) data, we explored equity as it pertains to two, low-tech, prenatal genetic health care procedures: 1) whether or not PCPs asked their patients about a family history of birth defects/genetic conditions, and 2) whether or not PCPs talked to their patients about prenatal testing for birth defects/genetic conditions. Overall, about 80% of pregnant women said that they were asked about their family history of birth defects/genetic conditions, and 85% said that their PCPs talked to them about prenatal testing. Maternal characteristics associated with being significantly less likely to receive these two low-tech, genetic health care procedures were: young maternal age, and low education and income levels, regardless of where women with these attributes received their prenatal care (e.g., community, migrant, health department or military care clinics, private physicians, or health maintenance organizations). The data we will present suggest that Washington PCPs (and presumably PCPs elsewhere in the U.S.) are missing valuable opportunities to obtain and analyze potentially important family history/genetic testing information that could be used to improve health and reproductive outcomes in many women, especially those who are traditionally under-served. With regard to future policy development, every effort must be made in the future to ensure that equity is part of all genetic health care policy decisions, so that all residents of our country, and especially pregnant women, will benefit equally from research efforts like the Human Genome Project.
The Abstracts of the Second National Conference on Genetics and Disease Prevention, Baltimore, MD, December 6-8, 1999, will be published in COMMUNITY GENETICS. For more information please refer to the journal home page  . © 1999 S. Karger AG, Basel.
Primary Care Physicians’ Utilization and Perceptions of Genetics Services
SJ Hayflick, MP Eiff, L Carpenter, J Steinberger
Oregon Health Sciences University, Portland , OR and University of Washington, Seattle, WA
In managed health care plans, primary care physicians (PCPs) must authorize a referral in order for a patient to receive genetics services. To determine utilization of genetics services and perceptions about these services, we surveyed primary care physicians in the Pacific Northwest. Data were gathered on practice demographics, education and training, current referral patterns for genetics services, and perceptions about genetics services. 1642 PCPs (34%) responded. Over 90% of family physicians, obstetricians and pediatricians report that genetics consultation is available to them, whereas only 60% of internists do. One in four internists did not know if genetics consultation is available to them, yet only one in ten had additional genetics service needs, suggesting that 15% of internists surveyed know of no available services yet still perceive no need. Consistent with this, 78% of internists had obtained no genetics consultation in the past year, compared with 45% of family physicians, 9% of pediatricians and 5% of obstetricians. The strongest factor prompting a genetics referral was the patient’s/family’s interest, and the most common reason not to obtain a consultation was no perceived patient benefit (by the physician). Though consultation is often sought for individuals with dysmorphic features or a family history of a "genetic condition", it is rarely sought for a family history of cancer, for deafness, polycystic kidney disease or for congenital heart disease. Services provided by geneticists are perceived by PCPs to be of limited benefit and are probably never offered to many patients who might well benefit from them.
The Abstracts of the Second National Conference on Genetics and Disease Prevention, Baltimore, MD, December 6-8, 1999, will be published in COMMUNITY GENETICS. For more information please refer to the journal home page . © 1999 S. Karger AG, Basel.
Why Aren’t Women Utilizing Prenatal Genetic Services in Washington? —What Genetic Counselors Think
VS Murthy
University of Washington School of Public Health and Community Medicine, Public Health Genetics Program, Seattle, WA
Documented barriers to health services include financial and transportation issues, lack of education, lack of access to providers, cultural and religious insensitivities, and language differences between providers and clients. These factors also probably lead to under-utilization of prenatal genetic services. It is possible that women who may benefit from these services are being counseled by non-geneticist healthcare providers or are not referred for prenatal genetic services. Due to advances in the field of genetics, one would predict that there would be an increase in the use of prenatal genetic services. However, an evaluation of Washington State data between 1995-1997 showed that significantly fewer women received prenatal genetic services than expected. The average number of "potential clients," individuals who would potentially benefit from these services, was estimated to be 31,515. During the same time period, the number of clients who reportedly received prenatal genetic services through the regional genetic clinics was 5,933. To determine possible explanations for the low utilization rates, prenatal genetic counselors within the state were surveyed. These qualitative findings were consistent with other reports in the literature and identified potential barriers to receiving prenatal genetic services such as transportation, inadequate education of primary care providers about prenatal genetic needs, and lack of public awareness about genetic health care services. These data provide useful information for targeting resources and developing interventions to increase access and awareness for women to receive prenatal genetic services in Washington State.
The Abstracts of the Second National Conference on Genetics and Disease Prevention, Baltimore, MD, December 6-8, 1999, will be published in COMMUNITY GENETICS. For more information please refer to the journal home page . © 1999 S. Karger AG, Basel.
Multidisciplinary Training in Public Health Genetics: The University of Washington Experience
MA Austin
Public Health Genetics Program, University of Washington, Seattle, WA
The University of Washington has initiated a multidisciplinary academic program for "Public Health Genetics in the Context of Law, Ethics, and Policy," involving seven different schools and colleges within the UW, the Washington State Department of Health, and the Fred Hutchinson Cancer Research Center. The program offers a Master of Public Health degree in Public Health Genetics based on two years of course work, a public health practicum experience and a research thesis. In addition, students from other UW graduate programs can obtain a graduate certificate by taking core courses that include "Genetics Epidemiology," "Ethical, Legal and Social Issues in Public Health Genetics," and "Biotechnology, Bioinformatics and Ecogenetics," and by attending an interactive seminar series. A summer institute and a Ph.D. program in Public Health Genetics are under development. The UW also led the national "Genetics in Public Health Training Collaboration," that included seven different universities and had liaisons with CDC and HRSA. This collaboration developed common training competencies for public health genetics and conducted a workplace survey to identify employment opportunities for graduates of public health genetics programs.
The Abstracts of the Second National Conference on Genetics and Disease Prevention, Baltimore, MD, December 6-8, 1999, will be published in COMMUNITY GENETICS. For more information please refer to the journal home page . © 1999 S. Karger AG, Basel. |
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