The AAFP's 2005 Annual Clinical Focus on genomics takes a cue from the adage, "It's not what you know; it's whom you know." In the case of this year's ACF, however, the saying reads more like "It's not always what you do, it's often whom you're born to."
'It's a Family Affair'
First ACF 2005 Program on Genomics Highlights Family History
By Cindy Borgmeyer
2/1/2005
The first program in the AAFP's all-Web-based 2005 ACF, launched late last month, focuses on how family physicians can uncover, explore and use patients' family histories to help predict and manage health conditions that include a genetic component.
Seven more video programs on various genetically influenced health conditions will be released throughout the ACF year.
Seven more video programs on various genetically influenced health conditions will be released throughout the ACF year.
Getting Started
FPs begin the educational process by visiting the ACF Genomics CME Video Series. From there, they can link to the family history program page containing links to an online CME video and other resources. RealOne Player is required to view the roughly 30-minute video program. A link provided at the site allows participants to download that software free.
This story first appeared in the February 2005 FP Report.
In the video, Norman Kahn, M.D., AAFP vice president for science and education, explains why genomics was chosen for this year's ACF initiative. "First," Kahn says, "there have been rapid recent advances in genomics, centered around the mapping of the human genome. And second, we believe that this new information needs to find its way into our practices sooner rather than later."
He offers two relevant clinical scenarios participants are likely to have encountered in their practices and outlines some issues they raise. How does family history help clinicians decide what screening interventions are appropriate for their patients? What are the implications of a positive or negative screening result on preventive management? What are the relevant costs and likely benefits of such tests? These are the sorts of questions the 2005 ACF is designed to answer, says Kahn.
He offers two relevant clinical scenarios participants are likely to have encountered in their practices and outlines some issues they raise. How does family history help clinicians decide what screening interventions are appropriate for their patients? What are the implications of a positive or negative screening result on preventive management? What are the relevant costs and likely benefits of such tests? These are the sorts of questions the 2005 ACF is designed to answer, says Kahn.
"Face of genomics"
Family physician Nancy Stevens, M.D., associate professor of family medicine at the University of Washington, Seattle, and medical director for the 2005 ACF, will serve as "the face of genomics" for the entire yearlong ACF video series.
"We've chosen to begin with family history because this is the foundation on which we will build our knowledge," Stevens explains. "This program will focus on three approaches to family history: tools developed for primary care practice, tools developed for patients and the pedigree genetics professionals use to record family history."
Francis Collins, M.D., Ph.D., director of NIH's National Human Genome Research Institute and keynoter at the 2004 AAFP Scientific Assembly, appears briefly in the video. Collins led the Human Genome Project that in April 2003 successfully completed mapping the entire human genome. The findings from that project, he says, will transform many aspects of how physicians practice medicine.
"We will learn the individual genetic glitches that each of us carries around," Collins says, "and that will give us a chance to make predictions about who's at risk for what."
Collins' Scientific Assembly presentation may be accessed through a link on the family history program home page. It is also included in a "Web tour" of resources that accompanies the video program. The tour may be accessed through a link on the program's home page.
"We've chosen to begin with family history because this is the foundation on which we will build our knowledge," Stevens explains. "This program will focus on three approaches to family history: tools developed for primary care practice, tools developed for patients and the pedigree genetics professionals use to record family history."
Francis Collins, M.D., Ph.D., director of NIH's National Human Genome Research Institute and keynoter at the 2004 AAFP Scientific Assembly, appears briefly in the video. Collins led the Human Genome Project that in April 2003 successfully completed mapping the entire human genome. The findings from that project, he says, will transform many aspects of how physicians practice medicine.
"We will learn the individual genetic glitches that each of us carries around," Collins says, "and that will give us a chance to make predictions about who's at risk for what."
Collins' Scientific Assembly presentation may be accessed through a link on the family history program home page. It is also included in a "Web tour" of resources that accompanies the video program. The tour may be accessed through a link on the program's home page.
Genomics toolbox
Incorporated into the family history video program are tools physicians and patients can use to provide background for discussions about family history and specific genetics concerns. Two such tools featured in the video were developed as part of Genetics in Primary Care: A Faculty Development Initiative, a multi-year project that brought together representatives from the specialties of family medicine, internal medicine, pediatrics and genetics.
Family medicine leaders were instrumental in creating the GPC initiative, with support from the Maternal and Child Health Bureau and Bureau of Health Professions of the Health Resources and Services Administration, NHGRI, and the Agency on Healthcare Resources and Quality.
"The SCREEN mnemonic developed by the GPC initiative can be administered as part of a complete history and physical examination or can be used to quickly elicit concerns and/or risk factors regarding a patient's family history," Kahn explains in the video.
The letters of the SCREEN mnemonic represent various topics -- Some Concern; Reproduction; Early disease, death or disability; Ethnicity; and Nongenetic or Not necessarily genetic -- and remind physicians of questions they can ask to identify potential genetic "red flags." In this context, red flags are clinical findings revealed by the history, physical exam or laboratory testing that suggest the presence of genetically influenced disease and require further action such as intervention, counseling, referral, screening or follow-up.
A second GPC tool, represented by the mnemonic "Family GENES," consists of a small number of red-flag categories consistent with the family medicine approach to patient care. In this context, those red flags are: Family history -- multiple affected siblings or individuals in multiple generations; Groups of congenital anomalies; Extreme or Exceptional presentation of common conditions; Extreme or Exceptional pathology; Neurodevelopmental delay or degeneration; and Surprising laboratory values.
"Although red flags clearly aren't 100 percent sensitive or specific," Kahn says, "the presence of one should raise your suspicion regarding a genetic influence."
The video also points patients to a tool they can use to record their own family health history. The tool, "My Family Health Portrait," is part of the Family Health Initiative launched last November by Surgeon General Richard Carmona, M.D., M.P.H.
Via a link from the family history program home page, participants can view a separate video of the surgeon general discussing his initiative. "Family history can save your life," Carmona says in that video. "That information is critical and we don't use it enough."
This free online tool allows patients to record their family history at home and then bring the physician a printed copy to interpret. The tool, available in both English and Spanish, enables physicians to customize patients' care by focusing preventive strategies on areas most relevant to those patients.
Rounding out the family history program is a quality improvement project clinicians can complete for 20 CME credits.
The 2005 ACF program is supported by various governmental agencies, health professional associations and consumer health groups. Numerous other organizations also are partnering with the AAFP in the educational initiative. The family history program received financial and in-kind support from HRSA's Maternal and Child Health Bureau and NHGRI. A complete list of supporters and partners may be accessed from the 2005 ACF Web page.
Family medicine leaders were instrumental in creating the GPC initiative, with support from the Maternal and Child Health Bureau and Bureau of Health Professions of the Health Resources and Services Administration, NHGRI, and the Agency on Healthcare Resources and Quality.
"The SCREEN mnemonic developed by the GPC initiative can be administered as part of a complete history and physical examination or can be used to quickly elicit concerns and/or risk factors regarding a patient's family history," Kahn explains in the video.
The letters of the SCREEN mnemonic represent various topics -- Some Concern; Reproduction; Early disease, death or disability; Ethnicity; and Nongenetic or Not necessarily genetic -- and remind physicians of questions they can ask to identify potential genetic "red flags." In this context, red flags are clinical findings revealed by the history, physical exam or laboratory testing that suggest the presence of genetically influenced disease and require further action such as intervention, counseling, referral, screening or follow-up.
A second GPC tool, represented by the mnemonic "Family GENES," consists of a small number of red-flag categories consistent with the family medicine approach to patient care. In this context, those red flags are: Family history -- multiple affected siblings or individuals in multiple generations; Groups of congenital anomalies; Extreme or Exceptional presentation of common conditions; Extreme or Exceptional pathology; Neurodevelopmental delay or degeneration; and Surprising laboratory values.
"Although red flags clearly aren't 100 percent sensitive or specific," Kahn says, "the presence of one should raise your suspicion regarding a genetic influence."
The video also points patients to a tool they can use to record their own family health history. The tool, "My Family Health Portrait," is part of the Family Health Initiative launched last November by Surgeon General Richard Carmona, M.D., M.P.H.
Via a link from the family history program home page, participants can view a separate video of the surgeon general discussing his initiative. "Family history can save your life," Carmona says in that video. "That information is critical and we don't use it enough."
This free online tool allows patients to record their family history at home and then bring the physician a printed copy to interpret. The tool, available in both English and Spanish, enables physicians to customize patients' care by focusing preventive strategies on areas most relevant to those patients.
Rounding out the family history program is a quality improvement project clinicians can complete for 20 CME credits.
The 2005 ACF program is supported by various governmental agencies, health professional associations and consumer health groups. Numerous other organizations also are partnering with the AAFP in the educational initiative. The family history program received financial and in-kind support from HRSA's Maternal and Child Health Bureau and NHGRI. A complete list of supporters and partners may be accessed from the 2005 ACF Web page.
