Collection of Family Health History for Assessment of Chronic Disease Risk in Primary Care

Abstract Background Risk assessment is a precision medicine technique that can be used to enhance population health when applied to prevention. Several barriers limit the uptake of risk assessment in health care systems; and little is known about the potential impact that adoption of systematic risk assessment for screening and prevention in the primary care population might have. Here we present results of a first of its kind multi-institutional study of a precision medicine tool for systematic risk assessment. Methods We undertook an implementation-effectiveness trial of systematic risk assessment of primary care patients in 19 primary care clinics at four geographically and culturally diverse healthcare systems. All adult English or Spanish speaking patients were invited to enter personal and family health history data into MeTree, a patient-facing family health history driven risk assessment program, for 27 medical conditions. Risk assessment recommendations followed evidence-based guidelines for identifying and managing those at increased disease risk. Results One thousand eight hundred eighty-nine participants completed MeTree, entering information on N = 25,967 individuals. Mean relatives entered = 13.7 (SD 7.9), range 7–74. N = 1443 (76.4%) participants received increased risk recommendations: 597 (31.6%) for monogenic hereditary conditions, 508 (26.9%) for familial-level risk, and 1056 (56.1%) for risk of a common chronic disease. There were 6617 recommendations given across the 1443 participants. In multivariate analysis, only the total number of relatives entered was significantly associated with receiving a recommendation. Conclusions A significant percentage of the general primary care population meet criteria for more intensive risk management. In particular 46% for monogenic hereditary and familial level disease risk. Adopting strategies to facilitate systematic risk assessment in primary care could have a significant impact on populations within the U.S. and even beyond. Trial registration Clinicaltrials.gov number NCT01956773, registered 10/8/2013.

Download Full-text

Comparing Electronic Health Record Portals to Obtain Patient-Entered Family Health History in Primary Care

Journal of General Internal Medicine ◽

10.1007/s11606-013-2442-0 ◽

2013 ◽

Vol 28 (12) ◽

pp. 1558-1564 ◽

Cited By ~ 22

Author(s):

Michael F. Murray ◽

Monica A. Giovanni ◽

Elissa Klinger ◽

Elise George ◽

Lucas Marinacci ◽

...

Keyword(s):

Primary Care ◽

Electronic Health Record ◽

Family Health ◽

Family Health History ◽

Health Record ◽

Health History ◽

Electronic Health

Download Full-text

The enduring importance of family health history in the era of genomic medicine and risk assessment

Personalized Medicine ◽

10.2217/pme-2019-0091 ◽

2020 ◽

Vol 17 (3) ◽

pp. 229-239 ◽

Cited By ~ 1

Author(s):

Susanne B Haga ◽

Lori A Orlando

Keyword(s):

Risk Assessment ◽

Assessment Tool ◽

Disease Risk ◽

Traditional Approach ◽

Genomic Medicine ◽

Family Health ◽

Family Health History ◽

Environmental Data ◽

Implementation Challenges ◽

Health History

Improving disease risk prediction and tailoring preventive interventions to patient risk factors is one of the primary goals of precision medicine. Family health history is the traditional approach to quickly gather genetic and environmental data relevant to the patient. While the utility of family health history is well-documented, its utilization is variable, in part due to lack of patient and provider knowledge and incomplete or inaccurate data. With the advances and reduced costs of sequencing technologies, comprehensive sequencing tests can be performed as a risk assessment tool. We provide an overview of each of these risk assessment approaches, the benefits and limitations and implementation challenges.

Download Full-text

Exploring the Role of Community Health Workers in Improving the Collection of Family Health History: A Pilot Study

Health Promotion Practice ◽

10.1177/15248399211019980 ◽

2021 ◽

pp. 152483992110199

Author(s):

Caitlin G. Allen ◽

Brittaney J. Bethea ◽

Lawrence P. McKinney ◽

Cam Escoffery ◽

Tabia Henry Akintobi ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Disease Risk ◽

Family Health ◽

Family Health History ◽

Active Involvement ◽

Health History ◽

Key Factor ◽

Screening And Prevention

Community health workers (CHWs) have been successful partners in addressing public health and health care challenges but have yet to be engaged in efforts to promote family health history (FHH) collection. FHH information is a key factor in determining disease risk and supporting screening and prevention across multiple diseases. The collection of FHH information could be facilitated by the existing cadre of CHWs already working alongside clients and families. In this qualitative study, we interviewed 30 CHWs from Georgia to better understand the current level of knowledge about FHH, perceptions of how FHH collection aligns with their role, and barriers and facilitators in order to support more active involvement of CHWs in FHH collection. Interviews were completed, transcribed, and double coded by three study team members. More than half of CHWs reported knowing their own FHH information. CHWs showed a strong interest and support for collecting FHH in their job, despite limited current engagement in this role. CHWs acknowledged the collection of FHH as being an opportunity to empower clients to have conversations with their providers. To better support this work, CHWs requested training in using and integrating FHH tools into their workflow and support in communicating about FHH with their clients. Our findings suggest that with support and training, CHWs are uniquely positioned to improve FHH collection among their client base. Ultimately, improving FHH collection skills among the population could allow for better integration of risk-stratified approaches that are informed by FHH information for the prevention, management, and treatment of disease.

Download Full-text