Pharmacist survey raises questions as to what education and training is necessary for community, hospital, and health system pharmacists and other clinicians supporting pharmacogenomics
Pharmacogenomics and pharmacogenetics (PGx) may be growing exponentially as a field, but a recent survey shows that clinicians feel unprepared to participate in PGx programs for personalizing patients’ treatments. Hospital and community healthcare leaders interested in precision medicine programs and partnerships need to be aware that clinicians may feel undertrained in this area of modern healthcare.
A glimpse into perspectives finds an April 2022 article in The Pharmaceutical Journal. In this example, a two-month survey of over 600 pharmacists in the United Kingdom (UK) revealed that while 88% of respondents reported they expected to use pharmacogenomics to guide treatment for their patients, most said they were not prepared for this change. Only 10% of the pharmacists surveyed described themselves as being prepared “a great deal” or “a lot.” Almost half of pharmacists said that they were not prepared “at all” to use pharmacogenomics in clinical practice, even though most of them anticipated having to use it.
Pharmacogenomic Models in Practice Worldwide
The UK-based pharmacist survey comes at a time when a variety of pharmacogenomics and pharmacogenetics implementation models are either in practice or are testing in the US, UK, Australia, and other countries. Drug-gene testing is proving helpful for better treating breast cancer, colon cancer, and cardiovascular conditions, to name a few. As many healthcare leaders know, there is much to consider beyond the PGx testing itself.
“The Netherlands is one of the most advanced in this area, helped by a healthcare system setup around a single, central drug database (G-Standaard) that provides a supportive infrastructure for national testing programs,” stated a 2021 article in Pharmacy, titled, “Implementation of a Pharmacogenomic Testing Service through Community Pharmacy in the Netherlands: Results from an Early Service Evaluation.”
In nearby Scotland, the public health system NHS Scotland recently announced its intention to invest £66 million ($87.1 million USD) into developing an integrated pharmacogenomics and pharmaceutical clinical decision support service. The Scottish government already uses what it calls NHS Medicines Care and Review in community pharmacies to provide support to people who have a long-term condition and help get the best from their medicines, according to the government’s main information page.
“It is quite clear to see how community pharmacists would use pharmacogenomics-related information to build on this function—potentially using their independent prescribing skills to adjust therapy appropriately,” Community Pharmacy Scotland (CPS) policy and development pharmacist Adam Osprey, MPharm, told The Pharmaceutical Journal.
Role of Community Pharmacies in Pharmacogenomics Testing
Whether clear or not, approaches to implementing pharmacogenomics programs inclusive of community and other pharmacies bear watching for their impact on reducing hospital admissions from adverse drug reactions, improving health outcomes, and shaping pharmacogenomics training and education.
Many consider pharmacists to be among the most accessible of healthcare providers, with a central hub of treatment histories that can ultimately be linked to actionable clinical laboratory tests. This is because while most people may see different healthcare providers over time, they may only use one pharmacy for a long period of time.
“Many pharmacy staff do not need to be an expert in genomics but they do need to have a suitable level of knowledge and understanding in order to fulfill their day-to-day pharmacy role, which will be impacted by pharmacogenomics,” Sophie Harding, PharmD, told The Pharmaceutical Journal. Harding is the pharmacogenomics lead at the Royal Pharmaceutical Society, which publishes The Pharmaceutical Journal.
Harding suggested the pharmacists may be lacking important training when compared to other healthcare workers, explaining that there is “insufficient training available for pharmacy staff across all healthcare sectors.” She explained that it will be important to ensure all clinicians receive the same level of training in this area. “It needs to be equitable, and it needs to be in line with what other medics, nurses and colleagues are going to be getting,” she said.
Questions About Pharmacogenomics Training and Education Best for Pharmacists
One important survey question posed to the UK pharmacists found that two-thirds of respondents said that they have never received any training in the area of pharmacogenomics or genomic medicine. This raises big questions about the types of training and education needed for PGx programs and partnerships based on pharmacogenomic and pharmacogenetic testing not only in the UK but in the US and elsewhere.
Proper training and education in pharmacogenomics-related pharmacy practices will be key if the intent of September 2021 pharmacy policy statements issued by the American Society of Health-System Pharmacists (ASHP) is modeled to community pharmacists. Pharmacists have “a fundamental responsibility to ensure that pharmacogenomic testing is performed when needed and the results are utilized to optimize medication therapy,” stated the draft.
“Because test results will have implications throughout a patient’s lifetime, all pharmacists should serve as advocates for preemptive and reactive testing and have a basic understanding of pharmacogenomics in order to provide appropriate patient-care recommendations,” the ASHP added.
Some pharmacogenomics education and certification programs have been established but may not be widely available.
“One example is the embedded pharmacogenomics clinic in the Center for Geriatric Medicine which is a pharmacist-driven service that utilizes consult agreements to allow pharmacists to initiate pharmacogenomics testing, provide interpretations, and pharmacogenomics-based recommendations,” that is part of the Cleveland Clinic Pharmacy Residency Program.
Pharmacists Are Not Alone in Pharmacogenomics Education Needs
Feeling unprepared to use pharmacogenomic treatment may be a problem that is not unique to pharmacists. A study recently published in Nature found that many physicians receive little to no pharmacogenetic training.
Published in October 2021, a meta-analysis of available research on barriers to the clinical adoption of pharmacogenetic testing identified physician education as one of three key barriers, according to researchers at the University of Toronto.
“Lack of knowledge regarding PGx is a major barrier to clinical adoption and can be partially attributed to insufficient education on the subject,” the researchers, led by James Kennedy, MD, wrote. “Indeed, in medical pedagogy, the quality of PGx instruction varies greatly across schools.”
What may be more interesting is that a dedicated pharmacogenomics course was only available in two out of 90 schools included in one study, University of Toronto researchers found. The same study showed that over 70% of the schools surveyed spent four hours or less providing pharmacogenomic teaching.
Though PGx Is Available, Physician Confidence Is Also Lacking
The researchers also highlighted another study that surveyed physician confidence in providing pharmacogenetic treatments. “Just over half of respondents (51.4%; n = 306) felt inadequately informed about genetic testing; 22% (n = 131) stated that they had not previously received any form of PGx education; and 73% (n = 435) did not feel that their genetic training prepared them to use PGx tests or comprehend results,” the authors summarized.
“The overall lack of education in PGx is particularly problematic because, as previously mentioned, testing is already available to clients through industry stakeholders,” the authors concluded.
“Despite PGx evidence being strongest for use in specialties such as oncology, behavioral health, cardiology, organ transplant and pain, health systems are opting for system wide implementation as medications with PGx implications are pervasive across specialties and patient populations,” according to the ASHP which has designed a pharmacogenomics accelerator program with the University of Minnesota College of Pharmacy.
Hospital and health system leaders who plan to offer or are already offering services in pharmacogenetics, pharmacogenomics, and services that combine pharmacology with genomics should evaluate the training and education of their physicians, pharmacists, and other clinicians involved in these services.