Analysis of referrals to a multi-disciplinary breast cancer genetics clinic: practical and economic considerations |
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Authors: | Marta M. Reis Dorothy Young Lorna McLeish David Goudie Alan Cook Frank Sullivan Helen Vysny Alison Fordyce Roger Black Manouche Tavakoli Michael Steel |
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Affiliation: | (1) Tayside Breast Cancer Family Clinic, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK;(2) Community Health Sciences Division, University of Dundee Medical School, McKenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK;(3) Bute Medical School, University of St Andrews, St Andrews, KY16 9TS, UK;(4) Information and Statistics Division (NHS Scotland), Gyle Square, Edinburgh, EH12 9EB, UK;(5) Department of Management, University of St Andrews, St Andrews, UK |
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Abstract: | Analysis of activity was undertaken in an established regional clinic providing risk assessment, counselling, screening and management for women with a family history of breast or ovarian cancer. The objectives were to determine: (1) how closely the route and pattern of referrals matched official guidelines (2) whether the previously recorded socio-economic imbalance among clinic clientele persisted and (3) the economic and practical consequences of committing resources to verification and extension of reported family histories. The findings were: (1) after some years of operation, the proportion of referrals direct from primary care had increased from less than 50% to over 75%, with a concomitant slight decrease in overall referral rate; (2) the socio-economic distribution of patients referred had become less selective and (3) extension and verification of reported family histories led to a redistributuion of risk categories, increasing the proportion of referrals judged to be in the “low risk” category, from 25% (based on referral letter alone) to 41% (at the end of the process). The costs associated with this approach are offset by the savings generated and it allows specialised counselling and screening services to be targeted more efficiently. |
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Keywords: | Breast cancer Familial Genetic Clinical services Risk Assessment Economics Primary care |
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