Abstract
Despite overcoming many implementation barriers, pharmacogenomic (PGx) panel-testing is not routine practice in the Netherlands. Therefore, we aim to study pharmacists’ perceived enablers and barriers for PGx panel-testing among pharmacists participating in a PGx implementation study. Here, pharmacists identify primary care patients, initiating one of 39 drugs with a Dutch Pharmacogenetic Working Group (DPWG) recommendation and subsequently utilizing the results of a 12 gene PGx panel test to guide dose and drug selection. Pharmacists were invited for a general survey and a semi-structured interview based on the Tailored Implementation for Chronic Diseases (TICD) framework, aiming to identify implementation enablers and barriers, if they had managed at least two patients with actionable PGx results. In total, 15 semi-structured interviews were performed before saturation point was reached. Of these, five barrier themes emerged: (1) unclear procedures, (2) undetermined reimbursement for PGx test and consult, (3) insufficient evidence of clinical utility for PGx panel-testing, (4) infrastructure inefficiencies, and (5) HCP PGx knowledge and awareness; and two enabler themes: (1) pharmacist perceived role in delivering PGx, and (2) believed clinical utility of PGx. Despite a strong belief in the beneficial effects of PGx, pharmacists’ barriers remain, an these hinder implementation in primary care.
Highlights
Pharmacogenomics (PGx) informed prescribing is one of the first applications of genomics in medicine [1,2]
Many barriers have been overcome, including the generation of evidence supporting the clinical utility of single gene-drug interactions [8,9,10,11], the development of clinical guidelines based on systematic review of literature [12,13,14], the selection of clinically relevant PGx tests [15] and the stimulation of healthcare professional’s (HCP) belief in PGx guided prescribing [16,17]
We studied pharmacists’ perceived remaining barriers, preventing and enablers facilitating implementation of pharmacist-initiated PGx panel-testing in primary care utilizing mixed-methods, including qualitative investigation using theoretical frameworks
Summary
Pharmacogenomics (PGx) informed prescribing is one of the first applications of genomics in medicine [1,2]. Lemke et al and Unertl et al investigated barriers experienced by physicians who had applied pre-emptive PGx-panel-testing in practice within study settings [24,25] These studies reported several challenges in implementation, including difficulties in interpreting the PGx test results despite the availability of guidelines, delays in receiving the results, lack of time to adequately inform their patients, and concerns about responsibility for the PGx results [24,25]
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