Barriers and strategies to integrate medical genetics and primary care in underserved populations: a scoping review

Abstract

Despite clinical and technological advances, serious gaps remain in delivering genetic services due to disparities in workforce distribution and lack of coverage for genetic testing and counseling. Genetic services delivery, particularly in medically underserved populations, may rely heavily on primary care providers (PCPs). This study aims to identify barriers to integrating genetic services and primary care, and strategies to support integration, by conducting a scoping review. Literature synthesis found barriers most frequently cited by PCPs including insufficient knowledge about genetics and risk assessment, lack of access to geneticists, and insufficient time to address these challenges. Telegenetics, patient-centered care, and learning communities are strategies to overcome these barriers. Telegenetics supplements face-to-face clinics by providing remote access to genetic services. It may also be used for physician consultations and education. Patient-centered care allows providers, families, and patients to coordinate services and resources. Access to expert information provides a critical resource for PCPs. Learning communities may represent a mechanism that facilitates information exchange and knowledge sharing among different providers. As PCPs often play a crucial role caring for patients with genetic disorders in underserved areas, barriers to primary care-medical genetics integration must be addressed to improve access. Strategies, such as telegenetics, promotion of evidence-based guidelines, point-of-care risk assessment tools, tailored education in genetics-related topics, and other system-level strategies, will facilitate better genetics and primary care integration, which in turn, may improve genetic service delivery to patients residing in underserved communities.

Evaluating Primary Care Providers’ Readiness for Delivering Genetic and Genomic Services to Underserved Populations

“…The survey was administered at a single FQHC and the views may not be representative of other providers practicing in FQHCs or providing care for minority patients. However, the integration of genetic services in primary care at FQHCs is relatively new [32], and many challenges exist, including provider knowledge [57]. Our participation in the AoURP provides an opportunity for both our providers and patients to increase their awareness of genomics and gain invaluable experience in discussing results with patients.…”

Current state and future directions of genomic medicine in aortic dissection: A path to prevention and personalized care

“…Although interested, primary care providers are hesitant to integrate genomics into their practice due to perceived knowledge gaps, lack of infrastructure, little incentive to coordinate, and concern for patient comprehension [ 34 ]. Providers have expressed a need for automated screening tools to signal which patients would benefit from genetic testing and modified management based on family history.…”

Profession of a Genetic Consultant: Formation and Modern Development Trends

“…К началу 2018 г. существовало уже почти 7000 генетических консультантов более чем в 28 странах [7]. Тем не менее дефицит генетических консультантов существует даже в таких странах, как США [8]. Генетическое консультирование наиболее развито как профессия в США, Канаде, Великобритании и Австралии.…”