Primary care providers feel unprepared for wholeheartedly entering the age of genetic medicine, according to a meta-analysis published in Genetics in Medicine.

"Barriers most frequently mentioned by primary care providers included a lack of knowledge about genetics and genetic risk assessment, concern for patient anxiety, a lack of access to genetics, and a lack of time," the authors found.

The researchers, from the American Academy of Pediatrics, the University of Michigan, and The Children's Mercy Hospitals and Clinics in Kansas City, Mo., systematically searched PubMed and ERIC using key and Boolean term combinations for articles published from 2001 to 2012 that met inclusion/exclusion criteria. Specific barriers were identified and aggregated into categories based on topic similarity. These categories were then grouped into themes.

Of the 4,174 citations identified by the search, 38 publications met inclusion criteria. The researchers discovered 311 unique barriers that were classified into 38 categories across four themes: knowledge and skills; ethical, legal, and social implications; health care systems; and scientific evidence.

The authors recommended that more effort be made to include pertinent tools and information for primary care providers. Among possible initiatives, they mentioned promotion of practical guidelines, point-of-care risk assessment tools, tailored educational tools, and "other systems-level strategies" to assist primary-care providers in providing genetics services for their patients.

“Genetics is not just about rare diseases and specialists. PCPs rely on genetics frequently during preventive care visits--especially when taking family histories and assessing a patient’s risk of more common, but chronic, diseases. So the fact that PCPs report many barriers to embracing and performing these tasks is concerning, ” said senior author Beth Tarini, M.D., assistant professor of pediatrics at the University of Michigan Medical School and C.S. Mott Children’s Hospital.

“Advances in genetic technology and the discovery of new genetic mechanisms seem to occur almost daily," she continued. "A PCP’s genetics training may be decades old and rusty from lack of use. Genetics has historically been viewed as a discipline focused on rare conditions, but recent genomic advances have highlighted that genetics has a role in common conditions encountered in primary care medicine.”

The study is available here.

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