A primary care specialist genetics service: a cluster-randomised factorial trial.

Westwood G, Pickering R, Latter S, Little P, Gerard K, Lucassen A, Temple IK.

Source

Academic Unit of Primary Care and Population Sciences, Southampton General Hospital, Southampton, UK.

Abstract

BACKGROUND:

GPs do not have the confidence to identify patients at increased genetic risk. A specialist primary care clinical genetics service could support GPs with referral and provide local clinics for their patients.

AIM:

To test whether primary care genetic-led genetics education improves both non-cancer and cancer referral rates, and primary care-led genetics clinics improve the patient pathway.

DESIGN AND SETTING:

Cluster-randomised factorial trial in 73 general practices in the south of England.

METHOD:

Practices randomised to receive case scenario based seminar (intervention) or not (control), and referred patients a primary (intervention) or secondary (control) care genetic counsellor (GC)-led appointment.

OUTCOME MEASURES:

GP referral and clinic attendance rates (primary), appropriate cancer and case scenario referral rates, patient satisfaction, clinic costs, and case management (secondary).

RESULTS:

Eighty-nine and 68 referrals made by 36 intervention and 37 control practices respectively. There was a trend towards an overall higher referral rate among educated GPs (referral rate ratio [RRR] 1.34, 95% confidence interval [CI] = 0.89 to 2.02; P = 0.161), and they made more appropriate cancer referrals (RRR 2.36, 95% CI = 1.07 to 5.24; P = 0.035). No indication of difference in clinic attendance rates (odds ratio 0.91, 95% CI = 0.43 to 1.95; P = 0.802) or patient satisfaction (P = 0.189). Patients spent 49% less travelling (£3.60 versus £6.62; P<0.001) and took 33% less time (39.7 versus 57.7 minutes; P<0.001) to attend a primary than secondary care appointment; 83% of GC-managed appointments met the 18-week referral to treatment, NHS target.

CONCLUSION:

An integrated primary care genetics service both supports GPs in appropriate cancer referral and provides care in the right place by the right person.