Decision makers' perceptions of integrating genetic counselors into primary care.

BACKGROUND: Over the past decade, there have been rapid advancements in genomic medicine that have improved the clinical utility of genetic testing and counseling. Although theoretically, primary care is an ideal locations for the delivery of genomic medicine, physicians lack training, confidence, and time to implement these services. Though it has been suggested that genetic counselors could be integrated into the primary care setting to fill this gap in care, such integration has not yet been widely implemented. Decision makers' perceptions are foundational in the implementation of this model, but have yet to be explored. METHODS: We conducted a qualitative interview-based study with individuals holding key administrative roles in primary care systems to elicit opinions on a model of care that integrates genetic counselors into primary care. Interviews were analyzed using interpretive description involving thematic coding and iterative discussions among the research team to develop a comprehensive conceptual model. RESULTS: Barriers included team integration difficulties, a perceived lack of buy-in at the institutional, physician, and patient levels, and a lack of resources. Participants felt that integrating genetics into primary care is most feasible when one genetic counselor is contracted as a resource to multiple different clinics and is able to provide remote or hybrid care. CONCLUSION: Despite the growing evidence supporting the integration of genetic counselors into primary care settings, decision makers have concerns about how this integration will occur, and feel that more buy in is needed from patients, providers, and administration to make this model of care a reality.