Toward Personalized Medicine Implementation: Survey of Military Medicine Providers in the Area of Pharmacogenomics

Abstract

Introduction Personalized medicine is the right treatment, to the right patient, at the right dose. Knowledge of genetic predisposition to variable metabolism and distribution of drugs within the body is currently available as pharmacogenomic testing and is one of the pillars of personalized medicine. Pharmacogenomic testing is growing. It has become part of guidelines for dosing on FDA labels and has been used by health care organizations to improve outcomes and reduce adverse events. Additionally, it has been FDA approved for direct-to-consumer purchase and has been cause of concern of patient self-dosing and medication changes. Presumably in the near future, pharmacogenomics will be impressed upon the military health system (MHS) provider from either a top-down, command requested, or from a bottom-up, patient requested, approach. To date, widespread implementation of pharmacogenomic testing does not seem to be established within the MHS. This survey sheds light on the knowledge, exposure, use, comfort, and interest among family medicine providers in the MHS. It compares similar results in other national and international surveys and compares results among a small subset of residents to staff. Materials and Methods The questions were part of a larger survey conducted by the Clinical Investigations Committee of the Uniformed Services Academy of Family Physicians (USAFP) at the USAFP 2019 annual meeting. The study received approval from the Uniformed Services University Institutional Review Board. Submitted questions were written using multiple choice, fill-in, five-point Likert scale, and best answer. Direct results are reported as well as chi-square statistics for categorical data with statistical significance to attain a P-value of < 0.05. Results Among the 532 USAFP-registered conference attendees eligible to complete the survey, 387 attendees responded to the survey, for a response rate of 72.7%. Some results included were a knowledge question in which 37% of respondents answered correctly. Less than half of respondents agreed that they could define pharmacogenomics, and resident respondents were more likely to have received teaching in graduate medical education. Additionally, 12% of providers responded to being exposed to direct-to-consumer results, and 28% of those exposed were influenced to change medications, while 14% were influenced to change medications on multiple occasions. Chi-square comparisons resulted in statistically significant direct relationships to exposure to direct to consumer testing, previous training, and confidence of those that answered the knowledge question correctly. Conclusions This survey establishes a baseline for the possible needs associated with implementation of a pharmacogenomic program, and it argues an actionable level for the use of pharmacogenomics among the patient population within the MHS.

Patients’ and professionals’ views related to ethical issues in precision medicine: a mixed research synthesis

“…Among the HCPs, many oncologists [ 24 – 32 ] participated in the included studies, but also other medical specialists are represented: nephrologists [ 33 , 34 ], cardiologists [ 27 ], infectiologists [ 24 ], psychiatrists and clinical psychologists [ 35 ], pathologists [ 31 , 32 ], gastroenterology specialty trainees [ 36 , 37 ], geneticists and genetic counsellors [ 31 , 32 , 38 – 42 ], laboratory medicine professionals [ 43 ], pharmacists [ 44 , 45 ], critical care intensivists [ 38 ], physician assistants [ 46 ] and nurses [ 30 , 38 , 46 – 48 ]. From the outpatient sector, primary care providers [ 46 , 49 – 51 ] or family medicine providers [ 27 , 52 ] participated in some studies. In many studies, researchers [ 42 , 47 , 53 ] were also represented.…”

Anesthesia providers as stakeholders to adoption of pharmacogenomic information in perioperative care

“…Another study among military family medicine physicians by Deluca et al . [36] revealed that 43% of providers had not received any education on pharmacogenomics (including self-education). Over half of respondents from the Deluca et al .…”

“…However, that study conversely found that a slightly higher rate of pediatricians who had been practicing for 0-4 years felt they were familiar with pharmacogenetics, compared to those with more years of experience (12% compared to ~8%, respectively). Another study among military family medicine physicians by Deluca et al [36] revealed that 43% of providers had not received any education on pharmacogenomics (including self-education). Over half of respondents from the Deluca et al study thought it is It is acknowledged that the majority of respondents in our study were physicians.…”

Personalizing Personalized Medicine: The Confluence of Pharmacogenomics, a Person’s Medication Experience and Ethics

“…Pharmacists bring a great deal of specific expertise to the discussion about PGx testing [ 48 ]. At the time of writing, relative to most other healthcare professionals, pharmacists possess an increased understanding of genetic factors that impact drug safety and efficacy [ 49 , 50 , 51 , 52 ]. They have enhanced education about the genetic etiology of drug responses, PGx instruction being required in all US pharmacy programs since 2016 [ 53 ].…”