34 Effective Delivery Of Genetic Services In Primary Health Care

Diane Kirkland
Aims There is increasing call for the delivery of genetic services at primary health care level. However, the extent and nature of such services remain poorly defined.
This study aims to:
> explore the extent primary care practitioners currently use genetic information in their work and assess the level of genetic literacy they require
> explore the nature of the interface operating between specialist genetic services and primary care
with a view to making recommendations about genetic issues when integrated services are being planned.
Methods An ethnographic approach was utilised. Seventy primary care practitioners were recruited from 12 randomly selected primary care teams.
Data were collected by means of:
> Focus groups
> Ethnographic observation (of daily work)
Data were tape recorded where appropriate and detailed field notes maintained. Data were thematically analysed with the aid of NUD*IST 4.
Results Findings illustrate when and how genetic information is recorded and used in primary care. Genetics was perceived as an unfamiliar speciality. Practitioners defended their ‘generalist’ role, whilst acknowledging limited knowledge of what genetic services are available or referral criteria. Facilitators and barriers to the delivery of appropriate genetic services at primary care level are discussed. Once a genetic diagnosis/ assessment is made, the unique model of care utilised by genetic practitioners appears to exclude those working in primary care. Resulting implications for both workload and keeping abreast of genetic advances are discussed.
There is a need to achieve a consensus between primary care and genetics practitioners regarding what components of the genetic service should be delivered at primary care level, bearing in mind the facilitators and barriers identified.
34 Effective Delivery of Genetic Services in Primary Health Care