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The genomic medicine model: an integrated approach to implementation of family health history in primary care

    Lori A Orlando

    * Author for correspondence

    Duke Center for Personalized Medicine & Duke Institute for Genome Sciences & Policy, 3475 Erwin Road, Wallace Clinic Ste 204, Durham, NC 27705, USA.

    ,
    Vincent C Henrich

    Center for Biotechnology, Genomics & Health Research, University of North Carolina-Greensboro, 3701 MHRA Building, Greensboro, NC 27402, USA

    ,
    Elizabeth R Hauser

    Center for Human Genomics, Department of Medicine, Duke University, PO Box 3445, Durham, NC 27710, USA

    Epidemiological Research & Information Center, Durham VA Medical Center, Durham, NC 27705, USA

    ,
    Charles Wilson

    Cone Health, 1200 North Elm Street, Greensboro, NC 27401, USA

    &
    Geoffrey S Ginsburg

    Duke Center for Personalized Medicine & Duke Institute for Genome Sciences & Policy, 3475 Erwin Road, Wallace Clinic Ste 204, Durham, NC 27705, USA

    ;
    Published Online:https://doi.org/10.2217/pme.13.20

    As an essential tool for risk stratification, family health history (FHH) is a central component of personalized medicine; yet, despite its widespread acceptance among professional societies and its established place in the medical interview, its widespread adoption is hindered by three major barriers: quality of FHH collection, risk stratification capabilities and interpretation of risk stratification for clinical care. To overcome these barriers and bring FHH to the forefront of the personalized medicine effort, we developed the genomic medicine model (GMM) for primary care. The GMM, founded upon the principles of the Health Belief Model, Adult Learning Theory and the implementation sciences, shifts responsibility for FHH onto the patient, uses information technology (MeTree©) for risk stratification and interpretation, and provides education across multiple levels for each stakeholder, freeing up the clinical encounter for discussion around personalized preventive healthcare plans. The GMM has been implemented and optimized as part of an implementation-effectiveness hybrid pilot study for breast/ovarian cancer, colon cancer and thrombosis, and risk for hereditary cancer syndromes in two primary care clinics in NC, USA. This paper describes the conceptual development of the model and key findings relevant for broader uptake and sustainability in the primary care community.

    Papers of special note have been highlighted as: ▪ of interest ▪▪ of considerable interest

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