Pharmacogenomics (sometimes abbreviated as PGx) is the study of genetic differences in enzymes, drug transporters and other proteins associated with drug metabolism, which can affect individual responses to drugs in terms of therapeutic and adverse effects. Pharmacogenomics testing is a DNA-based test of genetic variations of genes associated with risk of adverse response or drug response.
Community Pharmacists’ Experiences with Pharmacogenomics
The primary goal of the study was to characterize community pharmacists’ early experiences with PGx testing. Specifically we were interested in
- The amount of time required of pharmacists to provide PGx testing
- Patient interest in undergoing PGx testing
- Pharmacists’ perceptions of patients' understanding after testing was completed
- Pharmacist interactions with prescribing physicians regarding PGx test results
- Changes made to prescriptions based on PGx results
These objectives are all related to factors that would likely have a large impact on the decision to provide PGx testing alongside other pharmacy services and the practice of providing PGx testing in a community pharmacy. This study is significant because it demonstrates the feasibility of offering PGx testing in a community pharmacy setting, and it will inform other pharmacies that are considering offering PGx testing. [paper in press]
Pharmacogenomics Educational Tools for Pharmacists
Because of the novelty and lifetime implications of PGx testing, more effort may be required to educate patients and promote an understanding of results than for other types of clinical tests. Based on our experience from our prior studies on delivery of PGx testing, we applied principles for plain language and design to develop a suite of educational tools that may be used in the pharmacy setting. In this study, we sought feedback from pharmacists about the use of the components of this educational “toolkit” in order to determine pharmacists’ perspectives of utility of the toolkit and to improve components to increase likelihood of use.
Adding Pharmacogenomics to Medication Therapy Management
While evidence suggests that medication therapy management (MTM) may be clinically beneficial for some patients, there has been limited exploration of the feasibility or value of adding PGx testing to MTM. In this pilot study, we aimed to gather data on the feasibility and actual and perceived value of a pharmacist-delivered MTM plus PGx testing service in an outpatient setting. Specifically, we considered the practicality of offering a combined MTM plus PGx testing service, a component of feasibility studies defined as the “extent to which an intervention can be delivered when resources, time, commitment or some combination thereof are constrained in some way.” Outcome measures included patient recall of results and satisfaction, the duration of MTM sessions, changes in prescriptions based on PGx test results, and perceived value and satisfaction with PGx testing. Our data suggest patient receptiveness and feasibility of delivering PGx testing as part of MTM in a clinical office setting. [paper submitted]
Delivering Pharmacogenomics into Primary Care
The integration of pharmacogenetic (PGx) testing into primary care is rapidly evolving. Thus, to improve physician knowledge, address issues about how and when to integrate PGx testing into clinical care, and to facilitate integration of PGx testing into therapeutic decision-making, this project will focus on assessing delivery models of PGx testing. We will implement and evaluate two delivery models of PGx testing into primary care practices: physician-initiated testing and pharmacist-initiated testing. In the pharmacist-initiated group, a pharmacist based within the practice will identify prescribed drugs with available PGx testing through chart review and provide specific information and recommendations about PGx testing to the ordering physician. The proposed study aims to evaluate the delivery of PGx testing from three perspectives: practice setting, physician and patient. Effectiveness of the delivery models will be evaluated by the number of dosage adjustments and adverse responses for new and recent prescriptions (less than one month) of target drugs and number of office visits in each practice during the six-month intervention period compared to the six months prior to the intervention and the six months following the intervention in order to assess change and durability of any changes. These results will provide essential information on the uptake, impact, barriers and cost of two delivery models for integration of PGx testing in primary care practices.
Interdisciplinary Pharmacogenomics Workshops
This project aims to develop, implement and assess an interdisciplinary workshop series for educators (instructors and training program directors), providers (physicians and nurses), trainees and fellows, and students to promote knowledge and awareness of personalized medicine applications, understanding and practice of inter-disciplinary, team-based care for personalized medicine, patient-provider communication (pre/post-genomic testing), and interpretation and application of genomic information in a clinical setting.
The Community Pharmacist Pharmacogenetics Network (CPPN) aims to provide community pharmacists with the resources they need to deliver pharmacogenetic testing efficiently and effectively.