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Motivating Factors for Physician Ordering of Factor V Leiden Genetic Tests
Lucia A. Hindorff, PhD, MPH;
Wylie Burke, MD, PhD;
Anne-Marie Laberge, MD, MPH;
Kenneth M. Rice, PhD;
Thomas Lumley, PhD;
Kathleen Leppig, MD;
Frits R. Rosendaal, MD, PhD;
Eric B. Larson, MD, MPH;
Bruce M. Psaty, MD, PhD
Arch Intern Med. 2009;169(1):68-74.
Background The factor V Leiden (FVL) genetic test is used by many physicians despite its uncertain clinical utility.
Methods We investigate whether self-reported motivations and behaviors concerning FVL genetic testing differ between 2 groups of primary care physicians defined by frequency of previous FVL test use. In January 2007, 112 physicians (60 frequent and 52 infrequent FVL test users) at Group Health, a large health care delivery system, were surveyed. Survey content areas included primary reasons and motivating factors for ordering the FVL test, the likelihood of ordering the FVL test for hypothetical patients, potential barriers to genetic testing, and practices and skills regarding FVL test ordering.
Results Responses between groups agreed concerning most clinical- and patient-related factors. Frequent-FVL physicians were more likely than infrequent-FVL physicians to report ordering the FVL test for hypothetical patients with mesenteric venous thrombosis (adjusted odds ratio, 4.57; 95% confidence interval, 1.55-13.53) or venous thrombosis after hospital discharge (adjusted odds ratio, 3.42; 95% confidence interval, 1.30-8.95). Frequent-FVL physicians were also less likely to identify several items on the survey as barriers to genetic testing and were more likely to report high confidence in interpreting and explaining FVL test results.
Conclusions Generally, both physician groups reported similar motivating factors for ordering FVL tests, and reported behaviors were consistent with existing guidelines. More striking differences were observed for measures such as barriers to and confidence in using genetic tests. Although additional research is necessary to evaluate the impact of these results, they inform several knowledge-to-practice translation issues that are important for the successful integration of genetic testing into primary care.
Author Affiliations: Departments of Epidemiology (Drs Hindorff and Psaty), Medical History and Ethics (Dr Burke), Biostatistics (Drs Rice and Lumley), Health Services (Dr Psaty), and Medicine (Dr Psaty) and the Institute for Public Health Genetics (Dr Laberge), University of Washington, Seattle; Medical Genetics (Dr Leppig) and Center for Health Studies (Drs Larson and Psaty), Group Health, Seattle; and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands (Dr Rosendaal). Dr Hindorff is now with the National Institutes of Health, Bethesda, Maryland.
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