Implementation of Pharmacogenetics in Primary Care: A Multi-Stakeholder Perspective

Abstract

Introduction: Aberrant pharmacogenetic variants occur in a high proportion of people and might be relevant for the prescription of over 26 drugs in primary care. Early identification of patients who metabolize these drugs more rapidly or slowly than average could predict therapeutic effectivity and safety. Yet implementation of pharmacogenetics is progressing slowly. A high public health impact can potentially be achieved by increasing the proportion of people tested, when and where eligible according to clinical validity and utility. Discussion: Stakeholders together were able to formulate required actions to achieve true integration of pharmacogenetics in primary care, but no consensus could be achieved on the prioritization of the actions. Coordination of the current independent initiatives by the different stakeholders could facilitate effective and efficient implementation of useful pharmacogenetics in primary care.

Pharmacogenomics for Primary Care: An Overview

“…Potential pathways of how GPs may encounter PGx tests are shown in Figure 2 . Recent studies have identified that barriers to PGx implementation specifically within primary care include a perceived lack of evidence for clinical utility, unclear cost effectiveness and reimbursement strategies, how to educate the primary care workforce regarding PGx, unclear roles and responsibilities particularly between general practitioners and pharmacists, the need for informatics to support PGx-informed clinical prescribing decisions, and concerns over the principles of data sharing as well as other ethical, legal and social implications (ELSI) surrounding PGx [ 190 , 191 ].…”

Practical barriers and facilitators experienced by patients, pharmacists and physicians to the implementation of pharmacogenomic screening in Dutch outpatient hospital care – an explorative pilot study

“…In agreement with literature, our results show that current practical experience with PGx is limited, even though DPWG guidelines have been available nationwide since 2006. 2,4,7 A lack of knowledge and training amongst HCPs has previously been reported as a barrier to PGx implementation. 1,8,9,10,12,13 The community and hospital pharmacists in our study reported wanting more education about PGx for themselves and pharmacy staff.…”

“…6 Nevertheless, PGx is rarely applied in current clinical practice. 2,7 A number of barriers to PGx implementation have been identified so far. These include unclear procedures, insufficient evidence, inefficient infrastructure, lack of a standardized format for reporting results, lack of ICT support tools, and lack of knowledge, training and experience among healthcare practitioners (HCPs).…”

Assessing the knowledge, perceptions, and practices of primary care clinicians toward pharmacogenetics

“…Pharmacogenetic testing has gained popularity over the past two decades, allowing patients and providers access to information regarding potential increased or decreased efficacy of certain medications or propensity for adverse effects secondary to drug‐gene interactions 1 . Most well‐established PGx considerations have impacted specialty disciplines, such as oncology and infectious diseases, however there is increasing attention for PGx associations for medications commonly prescribed in primary care 2‐5 . Implementation of PGx in the primary care setting has lagged behind the original predictions of its widespread use 2,6 .…”

“…Most well‐established PGx considerations have impacted specialty disciplines, such as oncology and infectious diseases, however there is increasing attention for PGx associations for medications commonly prescribed in primary care 2‐5 . Implementation of PGx in the primary care setting has lagged behind the original predictions of its widespread use 2,6 . There are several proposed barriers to widespread use of PGx testing in primary care patients.…”