scholarly journals Physician Experience with Direct-To-Consumer Genetic Testing in Kaiser Permanente

2019 ◽  
Vol 9 (4) ◽  
pp. 47 ◽  
Author(s):  
M. Cabell Jonas ◽  
Pim Suwannarat ◽  
Andrea Burnett-Hartman ◽  
Nikki Carroll ◽  
Michelle Turner ◽  
...  
Keyword(s):  
Health Risk ◽  
Care Delivery ◽  
Clinical Information ◽  
Clinical Genetics ◽  
Kaiser Permanente ◽  
Direct To Consumer ◽  
Apply Genetic ◽  
Genetic Test Results ◽  
Adjusted Logistic Regression ◽  
Test Result

Health systems and physicians nationwide aspire to consistently and reliably apply genetic and genomic information to guide disease prevention, management, and treatment. However, clinical information, including genetics/genomics data from within and outside of the care delivery system, is expanding rapidly. Between November 2017 and April 2018, we surveyed 1502 Permanente Medical Group primary care and specialist physicians to assess the degree to which direct-to-consumer genetic test results were being presented to physicians and identify genetics educational needs among physicians (response rate 15%). Adjusted logistic regression (according to respondent characteristics) was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) comparing responses within groups. Results showed 35% and 12% of respondents reported receiving at least one direct-to-consumer health risk genetic result (DTC-health risk) or direct-to-consumer pharmacogenomic test result (DTC-PGx), respectively, from a patient in the past year. Of those receiving at least one test result, 40% (DTC-health risk) and 39% (DTC-PGx) of physicians reported 1+ referral(s); 78% (DTC-health risk) and 42% (DTC-PGx) of referrals were to clinical genetics. In total, 85% of physicians would spend ≥2 h/year on genetics/genomics education.

Patient recommendations for content and design for electronic return of genetic test results: An interview study among patients who accessed their genetic test results online (Preprint)

2021 ◽  
Author(s):  
Diane M Korngiebel ◽  
Kathleen McGlone West
Keyword(s):  
Patient Preferences ◽  
Genetic Test ◽  
Smartphone Application ◽  
Patient Portal ◽  
Genetic Test Result ◽  
Test Results ◽  
User Centered Design ◽  
Detailed Report ◽  
Genetic Test Results ◽  
Test Result

BACKGROUND Genetic test results will be increasingly made available electronically as more patient-facing tools are developed; however, little research has been done that collects patient preferences for content and design before creating results templates. OBJECTIVE This study identifies patient preferences for electronic return of genetic test results, including what considerations should be prioritized for content and design. METHODS Following User-Centered Design methods, 59 interviews were conducted using semi-structured protocols. The interviews explored content and design issues for patient portal results return for patients who received electronic results for specific types of genetic tests (pharmacogenomic, hereditary blood disorders, and positive and negative risk results for heritable cancers) or who had electronically received any type of genetic test result as well as a non-genetic test result. RESULTS In general, a majority of participants felt that there always needed to be some clinician involvement in electronic results return and that electronic coversheets with simple summaries would be helpful for facilitating that. Coversheet summaries could accompany, but not replace, the more detailed report. Participants had specific suggestions for those results summaries, such as only reporting the information that was most important for patients to understand, including next steps, and to do so using clear language free of medical jargon. Electronic results return should also include explicit encouragement for patients to contact providers with questions. Finally, many participants preferred to manage their care using their smartphones, particularly in instances where they needed to access health information on the go. CONCLUSIONS Participants recommended that a patient-friendly front section accompany the more detailed report and made suggestions for organization, content, and wording. Many used their smartphones regularly to access test results, therefore, health systems and patient portal software vendors should accommodate smartphone application design and web portal design concomitantly when developing results return platforms. CLINICALTRIAL N/A

Results from London Regional Clinical Genetics services over a 5-year period on germline TP53 testing in women diagnosed with breast cancer at <30 years

2021 ◽  
pp. jmedgenet-2021-107742
Author(s):  
Alice Garrett ◽  
Sabrina Talukdar ◽  
Louise Izatt ◽  
Angela F Brady ◽  
Sinead Whyte ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Pathogenic Variant ◽  
Her2 Status ◽  
Clinical Genetics ◽  
Premenopausal Breast Cancer ◽  
Genetic Test Results ◽  
Genetics Services ◽  
Clinical Genetics Services ◽  
The Impact

BackgroundThe most common cancer diagnosed in germline TP53 pathogenic variant (PV) carriers is premenopausal breast cancer. An increased rate of breast tumour HER2 positivity has been reported in this group. Screening for breast/other cancers is recommended in PV carriers.Objectives1. To assess the frequency of germline TP53 PVs reported diagnostically in women with breast cancer at <30 years of age.2. To evaluate the impact of personal/family history and HER2 status on the likelihood of germline TP53 pathogenic/likely pathogenic variant (PV/LPV) identification.MethodsGenetic test results from patients undergoing diagnostic germline TP53 tests between 2012 and 2017 in the four London Regional Clinical Genetics Services were reviewed. Clinical/pathology data and family history were extracted from genetics files for women diagnosed with breast cancer at <30 years.ResultsThe overall germline TP53 PV/LPV variant detection rate was 9/270=3.3% in all women diagnosed with breast cancer at <30 years and 2/171=1.2% in those with no second/subsequent cancer diagnosis or family history of TP53-spectrum cancers. Breast cancers were significantly more likely to be HER2-positive in TP53 PV/LPV carriers than in non-carriers (p=0.00006).ConclusionsGermline TP53 PVs/LPVs are uncommon among women diagnosed with breast cancer aged <30 years without other relevant personal or family cancer history but have an important clinical impact when identified.

Engaging Housestaff as Informatics Collaborators: Educational and Operational Opportunities

2021 ◽  
Vol 12 (05) ◽  
pp. 1150-1156
Author(s):  
Jared A. Shenson ◽  
Ivana Jankovic ◽  
Hyo Jung Hong ◽  
Benjamin Weia ◽  
Lee White ◽  
...  
Keyword(s):  
Positive Impact ◽  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Information ◽  
Lessons Learned ◽  
First Year ◽  
Hospital Governance ◽  
Staff Members ◽  
It Systems

Abstract Background In academic hospitals, housestaff (interns, residents, and fellows) are a core user group of clinical information technology (IT) systems, yet are often relegated to being recipients of change, rather than active partners in system improvement. These information systems are an integral part of health care delivery and formal efforts to involve and educate housestaff are nascent. Objective This article develops a sustainable forum for effective engagement of housestaff in hospital informatics initiatives and creates opportunities for professional development. Methods A housestaff-led IT council was created within an academic medical center and integrated with informatics and graduate medical education leadership. The Council was designed to provide a venue for hands-on clinical informatics educational experiences to housestaff across all specialties. Results In the first year, five housestaff co-chairs and 50 members were recruited. More than 15 projects were completed with substantial improvements made to clinical systems impacting more than 1,300 housestaff and with touchpoints to nearly 3,000 staff members. Council leadership was integrally involved in hospital governance committees and became the go-to source for housestaff input on informatics efforts. Positive experiences informed members' career development toward informatics roles. Key lessons learned in building for success are discussed. Conclusion The council model has effectively engaged housestaff as learners, local champions, and key informatics collaborators, with positive impact for the participating members and the institution. Requiring few resources for implementation, the model should be replicable at other institutions.

scholarly journals Impact of direct-to-consumer genetic testing on Australian clinical genetics services

2020 ◽  
Vol 63 (9) ◽  
pp. 103968
Author(s):  
Michael Millward ◽  
Jane Tiller ◽  
Michael Bogwitz ◽  
Helen Kincaid ◽  
Shelby Taylor ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Clinical Genetics ◽  
Direct To Consumer ◽  
Genetics Services ◽  
Clinical Genetics Services

scholarly journals Cases in Precision Medicine: When Patients Present With Direct-to-Consumer Genetic Test Results

2019 ◽  
Vol 170 (9) ◽  
pp. 643 ◽  
Author(s):  
Michael G. Artin ◽  
Deborah Stiles ◽  
Krzysztof Kiryluk ◽  
Wendy K. Chung
Keyword(s):  
Precision Medicine ◽  
Genetic Test ◽  
Test Results ◽  
Direct To Consumer ◽  
Genetic Test Results

scholarly journals Novel Representation of Clinical Information in the ICU

2010 ◽  
Vol 01 (02) ◽  
pp. 116-131 ◽  
Author(s):  
V. Herasevich ◽  
A. Ahmed ◽  
O. Gajic ◽  
B.W. Pickering
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
User Interfaces ◽  
Information Overload ◽  
Care Delivery ◽  
Tertiary Care ◽  
Clinical Information ◽  
Care Providers ◽  
Effective Use ◽  
Physician Order Entry

SummaryThe introduction of electronic medical records (EMR) and computerized physician order entry (CPOE) into the intensive care unit (ICU) is transforming the way health care providers currently work. The challenge facing developers of EMR’s is to create products which add value to systems of health care delivery. As EMR’s become more prevalent, the potential impact they have on the quality and safety, both negative and positive, will be amplified. In this paper we outline the key barriers to effective use of EMR and describe the methodology, using a worked example of the output. AWARE (Ambient Warning and Response Evaluation), is a physician led, electronic-environment enhancement program in an academic, tertiary care institution’s ICU. The development process is focused on reducing information overload, improving efficiency and eliminating medical error in the ICU. Citation: Pickering BW, Herasevich V, Ahmed A, Gajic O. Novel representation of clinical information in the ICU – developing user interfaces which reduce information overload. Appl Clin Inf 2010; 1: 116–131 http://dx.doi.org/10.4338/ACI-2009-12-CR-0027

scholarly journals Impact of direct-to-consumer genetic testing on Australian clinical genetics services

2020 ◽  
Author(s):  
Michael Millward ◽  
Jane Tiller ◽  
Michael Bogwitz ◽  
Helen Kincaid ◽  
Shelby Taylor ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Genetic Risk ◽  
Online Survey ◽  
Third Party ◽  
Clinical Genetics ◽  
Direct To Consumer ◽  
Risk Estimates ◽  
Genetics Services ◽  
Clinical Genetics Services ◽  
The Impact

AbstractPurposeThe increasing popularity of direct-to-consumer genetic testing (DTCGT) is thought to be creating a burden on clinical genetic health services worldwide. However, no studies have collected recent evidence regarding the extent of this impact in Australia.MethodsWe administered an online survey to Australian clinical genetics services, asking questions related to DTCGT-related referrals received and outcomes over the past 10 years.ResultsEleven publicly-funded clinical genetics services completed the survey, reporting over 100 DTCGT-related referrals. Most referrals (83%) were made by general practitioners seeking interpretation of DTCGT results. More than 30% of referrals related to imputed genetic risk estimates generated from third-party web-based software tools. Services reported low validation rates for DTCGT results (<10%). Procedures for managing DTCGT referrals and granting appointments were variable between services, with most services (8/11) lacking specific procedures.ConclusionOur study helps quantify the impact of DTCGT on clinical genetics services, and highlights the impact of imputed genetic risk estimates generated from third-party software.

scholarly journals Implementation of Integrated Nursing Models toward Patient Satisfaction in Mitra Medika Amplas Hospital, Medan, North Sumatra

2020 ◽  
Author(s):  
◽  
Destanul Aulia ◽  
Heru Santosa ◽  
Ida Yustina ◽  
◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Nursing Care ◽  
Care Delivery ◽  
Intervention Group ◽  
Control Group ◽  
Consecutive Sampling ◽  
Level Of Satisfaction ◽  
North Sumatra ◽  
Delivery Models ◽  
Test Result

ABSTRACT Background: The patient’s statement of the nurse’s poor and needy performance reflects dissatisfaction. Communities need patient-focused services, and the success of nursing care is determined mainly by choice of nursing care delivery models. This study aimed to determine implementation of integrated nursing models toward patient satisfaction in Mitra Medika Amplas Hospital, Medan, North Sumatra. Subject dan Method: This was a quasi-experiment with two group comparison conducted at Mitra Medika Amplas Hospital, Medan, Indonesia. A sample of 77 patients was selected by consecutive sampling. The data were collected by questionnare and analyzed by t-test. Result: The results showed that the level of satisfaction in the intervention group stated that 60 people were satisfied (78%) while the control group stated that 4 people were satisfied (5%). It was statistically significant (p<0,05). Conclusion: The level of patient satisfaction based on the dimensions of tangible quality, empathy, reliability, responsiveness and assurance was higher in the intervention group than in the control group. Keywords: integrated model, patient focused services Correspondence: Deli, Universitas Sumatera Utara Medan. Jl. Dr. T. Mansur No.9, Padang Bulan, Medan, North Sumatra 20222. Email: [email protected]. Mobile: 085361880118 DOI: https://doi.org/10.26911/the7thicph.04.22

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