A practical first step using needs assessment and a survey approach to implementing a clinical pharmacogenomics consult service

Abstract

Introduction Genetic‐guided selection of nononcologic medications is not commonly practiced in general, and at University of California, San Francisco (UCSF) Health, specifically. Understanding the unique position of clinicians with respect to clinical pharmacogenetics (PG) at a specific institution or practice is fundamental for implementing a successful PG consult service. Objectives To assess clinicians' current practices, needs, and interests with respect to clinical PG at UCSF Health, a large tertiary academic medical center. Methods A list of 42 target medications with clinical PG recommendations was complied. Clinical specialties that routinely used the target medications were identified. A 12‐question survey focused on practice of PG for target medications was developed. Pharmacists and physicians were surveyed anonymously in several clinical specialties. Survey results were analyzed using descriptive statistics. Results Of the 396 clinicians surveyed, 76 physicians and 59 pharmacists participated, resulting in 27% and 50% average response rates, respectively. The current use of PG in clinical practice for physicians and pharmacists was 29% and 32%, respectively, however this number varied across clinical specialties from 0% to 80%. Of clinicians whom reported they do not currently apply PG, 63% of physicians and 54% of pharmacists expressed interest in integrating PG. However, the level of interest varied from 20% to 100% across specialties. Of the respondents, 64% of physicians and 56% of pharmacists elected to provide contact information to investigators to further discuss their interest related to clinical PG. Conclusions While PG is not uniformly practiced at UCSF Health, there is considerable interest in utilizing PG by the respondents. Our approach was successful at identifying clinicians and services interested in PG for specific drug‐gene pairs. This work has set a foundation for next steps to advance PG integration at UCSF Health. Clinicians can adopt our approach as preliminary work to build a clinical PG program at their institutions.

Pharmacogenomic testing: perception of clinical utility, enablers and barriers to adoption in Australian hospitals

“…Despite this, very few HCP reported incorporating pharmacogenomic testing into practice. This finding too aligns with previous research from other countries 4,5,7,8,21 . Although HCP believe pharmacogenomic testing is beneficial there are additional barriers to changing behaviour to order and use these results to inform clinical decisions.…”

“…This finding too aligns with previous research from other countries. 4,5,7,8,21 Although HCP believe pharmacogenomic testing is beneficial there are additional barriers to changing behaviour to order and use these results to inform clinical decisions. Consequently, the potential to improve patient safety and clinical outcomes is lost.…”

“…2,4,[8][9][10]20 Training in the clinical application of pharmacogenomic testing has been found to positively impact uptake by HCP. 4,5,10 Additional barriers to the adoption of pharmacogenomic testing include uncertainty about the value of testing, 3,5,8 a lack of clinical practice guidelines, 2,10,19,21 concerns about confidentiality and privacy 3,4,10,20 and cost of insurance cover. 2,[4][5][6]8,10,16,19,20 At an operational level, barriers include absence of supporting infrastructure and readiness of information systems to implement and integrate pharmacogenomic testing into clinical workflows.…”

Variability of pharmacogenomic information in drug labels approved by different agencies and its ethical implications

“…Moreover, a lack of clarity about the differences in pharmacogenomic research for discovering medical interventions and optimizing clinical care makes the provision of information to these patient groups particularly important [36]. The pharmacogenomics counseling skills for communicating with vulnerable populations and the knowledge and interest of healthcare providers in new-found PGx are variable and limited depending on their areas of expertise [37][38][39]. Hence well-written SmPCs may provide significant benefits and avoid harm among these vulnerable groups.…”

Healthcare professionals' and consumers' knowledge, attitudes, perspectives, and education needs in oncology pharmacogenomics: A systematic review

“…Cost, lack of insurance coverage, and resources A significant barrier to routine PGx implementation in oncology practice is the cost of testing, which was reported in eight studies. 21,24,27,31,35,[38][39][40][41] Both oncology HCPs and patients voiced their concerns about the cost and lack of health insurance coverage for PGx tests that impede the utilization of PGx screening in routine clinical care, despite high willingness for PGx-guided oncology treatment. Lack of PGx testing infrastructure to support integration of PGx into clinical oncology practice was also raised as a major barrier.…”