We summarise a recent pilot study, published as preprint in medRxiv, that explored the practical barriers and facilitators experienced by patients, pharmacists and physicians to the implementation of pharmacogenomic screening in a Dutch outpatient hospital.
Pharmacogenomics (PGx) can help predict which medication will be most effective and safe for individual patients. This has the potential to significantly reduce healthcare costs and improve patient care. Ideally, an individual’s PGx profile would be known before drug prescription (pre-emptive PGx testing or PGx screening). There are several potential benefits of introducing PGx screening into routine healthcare including reduced hospitalisations and costs, and improved, safety, adherence and efficacy. Nevertheless, PGx is rarely applied in current clinical practice.
Several barriers to PGx implementation have previously been identified. These include unclear procedures, insufficient evidence, inefficient infrastructure, lack of a standardised format for reporting results, lack of IT support tools and lack of knowledge training and experience among healthcare practitioners. In this study, researchers undertook an explorative pilot study to identify barriers and facilitators from the perspective of all relevant stakeholders in an actual implementation setting. They also offered PGx screening within two outpatient clinics.
Barriers and facilitators
The study included 165 patients, 21 physicians, 13 hospital pharmacists and 48 community pharmacists and explored various themes around practical barriers and facilitators.
The team confirmed that actionable PGx variants were present within the majority of the patient population from the outpatient clinics. This finding is important and it further supports the value of screening for PGx variants.
Literature reports that recognition of clinical utility of PGx is a facilitator for implementation and that disbelief is a barrier. In this study, the team observed a positive attitude toward PGx among all the stakeholders. This was also found among patients and was independent of the occurrence of drug-gene interactions during their treatment.
Nonetheless, their results show that current practical experience with PGx is limited. The community and hospital pharmacists reported wanting more education about PGx. In addition, some patients wanted physicians to be better informed as they felt they were unable to provide sufficient explanation. A new barrier was also identified in their study – the unclear allocation of responsibilities among healthcare practitioners. It was unclear to both healthcare practitioners and patients who is ultimately responsible for the application of PGx screening results in different patient care situations.
This study highlights the practical barriers and facilitators to the implementation of PGx screening. These insights demonstrate which facilitators can be leveraged and which barriers must be overcome to successfully implement PGx screening. It also provides a foundation for more detailed research that will aid PGx implementation and help unlock the full potential of genome-guided drug prescription. This will enable more personalised medication schemes with optimised treatment tolerance and response.
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