Computer support for genetic advice in primary care.

Abstract

General practitioners (GPs) are under increasing pressure to advise patients about genetic risk. Secondary care lacks the resources to deal with the increasing number of referrals for genetic counselling, and thus recommendations have been made to develop primary care genetics. But for most GPs, genetics is unfamiliar territory. Computers could help general practice to provide a genetics service by simplifying the construction and assessment of family trees and by implementing management guidelines. No programs have been written specifically for primary care genetics, but a range of software exists for secondary care. This paper discusses the types of program already available and how they relate to the needs of primary care. Currently available software offers only elements of the outlined 'ideal' program for primary care and may be too complex for a general practice setting. Most importantly, none provide decision support concerning management based on the level of risk, even though this may be the most valuable element. Genetics is an appropriate area for decision support software in general practice, but it would be wrong to assume that this alone is the key to developing primary care genetics. Additional educational strategies for GPs will be required, and the attitudes of patients to receiving expert advice from a computer must be considered. Current practice computer systems will have to develop so they can communicate with Windows-based expert systems, and changes in existing surgery hardware may be necessary. Existing genetics software provides a starting point from which to derive an appropriate system for general practice. A carefully developed decision-support system could empower GPs to meet the challenge of offering a high-quality genetics service in primary care.