Abstract
Pharmacogenomics describes interpatient genetic variability in drug responses. Information based on whole genome sequencing will soon open up the field of pharmacogenomics and facilitate the use of genomic information relating to drug metabolism and drug responses. We undertook a qualitative study, aiming to explore the potential barriers, opportunities and challenges facing the implementation of pharmacogenomics into primary care. Semi-structured interviews were undertaken with 18 clinical participants (16 GPs and 2 other clinicians). All interviews were recorded and transcribed verbatim. Using a thematic analysis approach, data items were coded, ordered and themes constructed. Most participants were aged 55–60 years and worked as part-time clinical GPs with other clearly defined roles. The emerging themes covered several areas of concern, including the following: the utility of pharmacogenomics and the value of introducing such testing into primary care; how to educate the primary care workforce and ‘mainstream’ pharmacogenomics; the ethical, legal and social aspects of pharmacogenomics and its impact on patients; and potential impacts on the healthcare system particularly around economics and informatics. Most participants had concerns about pharmacogenomics and felt that there were a number of barriers and challenges to its implementation into routine primary care. Most striking were their concerns around the cost-effectiveness of using pharmacogenomics in primary care. At the same time most recognised the increasing availability of direct-to-consumer testing, and felt that this would drive the need to understand the ethical and social implications of using genomic information in primary care. This study has raised important issues that need to be considered when planning the implementation of pharmacogenomics into clinical practice. Prior to the implementation of genomic testing into day-to-day practice in UK primary care, it is important that considerations around education, cost-effectiveness and informatics are addressed, as well as the impact on patients.
Highlights
The 100,000 Genome project is a translational research project (Genomics England n.d.) which is stimulating NHSVancouver, Canada 3 University of Birmingham, Birmingham, UK 4 Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK 5 The Primary Care Unit, Department of Public Health & PrimaryCare, University of Cambridge, Cambridge, UK clinicians, researchers and policymakers to consider how genomic medicine will be mainstreamed across all specialties, including General Practice
Seven broad themes emerged from the analysis and are detailed as follows: 1. Pharmacogenomics: could it be useful in general practice?
‘I’ve not heard the term (Pharmacogenomics), it’s something new to me’ (R15, Locum General Practitioners (GPs)), and ‘I think those terms do make sense but even I don’t know the difference between genetics and genomics, so I wouldn’t know what pharmacogenetics is as opposed to pharmacogenomics’ (R11, academic GP)
Summary
University of Cambridge, Cambridge, UK clinicians, researchers and policymakers to consider how genomic medicine will be mainstreamed across all specialties, including General Practice. Health Education England (HEE) is addressing this concern by evaluating the genomics educational needs of General Practitioners (GPs) through surveys and feedbacks (HEE Genomics Programme: Engaging Primary Care n.d.). The use of genomic information at the time of drug prescribing is a potential application, but one that is not currently implemented in any systematic way in UK clinical practice. There is acceptance that while the future implementation of prescribing based on the use of genomic data is likely, we will need to consider key issues such as clinical effectiveness and cost-effectiveness (Hillman and Dale 2017; Hayward et al 2017; Walter et al 2014) before there is widespread adoption and clinical confidence in General Practice.
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