PowerPoint Presentation

Integrating Genetics Into Your PracticeFamily Health Histories: More than Just Asking Questions and Getting Answers

-Opportunity for questions at end1Objectives Recognize how disorders and health risks are passed down through familiesDescribe the benefits and role of family health historyDescribe how to gather a family history from patientsShow techniques for talking with patients about sensitive issuesAcknowledgementsIllinois Department of Public HealthiNetThe Center for Jewish GeneticsAudience PollWhat type of health center do you work in?Local public health departmentState public health departmentHospitalFederally qualified health centerPrivate practiceOtherAudience PollWhat is your job position?NurseDoctorGenetic CounselorSocial WorkerOther health related positionOther non-health related positionAudience PollHow often do you gather a family health history from patients?AlwaysSometimes NeverPresentersErin TortiJosy Villarubia

Family Health History (FHH)Families share genetic, environmental, cultural and behavioral factors that influence their risk for many health conditionsCommon chronic diseaseMendelian & chromosome disorders

8Common Chronic DiseaseMultifactorial inheritanceFHH is an established risk factor for common chronic disease and is incorporated into screening guidelines1st degree relative: 2-5x riskMultiple relatives: >5x riskModifiable risk factors

Feero, W.G., Bigley, M.B., Brinner, K.M., The Family Health History Multi-Stakeholder Workgroup of the American Health Information Community. (2008). New Standards and Enhanced Utility for Family Health History Information in the Electronic Health Record: An Update From the American Health Information Communitys Family Health History Multi-Stakeholder Workgroup. J Am Med Inform Assoc, 15(6), 723-728.

9Mendelian & Chromosome DisordersPrevalence : 2-5%30 % hospitalized children5-15% cancer50% intellectual disability>14,000 conditionsSignificant health and/or developmental issuesRisk to relatives derived from inheritance patternRimoin, D., Connor, J.M., Pyeritz, R., eds. 1996. Emery and Rimoins Principles and Practices of Medical Genetics. Churchill Livingstone: New York.

10Chromosomes

Autosomal DominantAutosomal Recessive

X-Linked

FHH: A Powerful Public Health ToolGoals of FHH collection/assessment:Personalized interventionEducation and supportIdentification of at-risk family membersWidely accessible, inexpensive and accurate

Acheson, L.S., Wiesner, G.L., Zyanski, S.J., Goodwin, M.A., & Stange, K.C. (2000). Family history-taking in community family practice: implications for genetic screening. Genet Med, 2(3), 180-185. Summerton, N., & Garrood, P.V. (1997). The family history in family practice: A questionnaire study. Family Practice, 14(4), 285-288. Rich, E.C., Burke, W., Heaton, C.J., Haga, S., Pinsky, L., Short, M.P., & Acheson, L. (2004). Reconsidering the Family History in Primary Care. J Gen Intern Med, 19, 273-280. Sifri, R.D., Wender, R., & Paynter, N. (2002). Cancer risk assessment from family history: Gaps in primary care practice. J Fam Prac, 51(10), 856. The GapObtaining FHH is standard of care Most providers believe FHH is importantFHH is discussed in 51% of new visits and 22% of established visits; average discussion