Assessing the Implementation of Pharmacogenomic Panel-Testing in Primary Care in the Netherlands Utilizing a Theoretical Framework

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.

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 the 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 among healthcare practitioners 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.…”

“…Literature reports that recognition of the clinical utility of PGx is a facilitator for implementation and that disbelief is a barrier [ 8 , 9 , 10 , 12 , 13 ]. In our study, patients were positive about PGx, including its expected clinical utility, regardless of the occurrence of DGIs during their treatment, whereas healthcare practitioners were generally positive about the clinical utility, although some did not feel ready to apply it in daily practice.…”

“…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. Reported facilitators include recognition of clinical utility, pharmacist’s feelings of responsibility for delivering PGx to patients, and the availability of professional guidelines for interpreting test results [ 1 , 8 , 9 , 10 , 11 , 12 , 13 ]. To the best of our knowledge, no study has identified barriers and facilitators from the perspective of all the relevant stakeholders in an actual implementation setting.…”

Global Frequencies of Clinically Important HLA Alleles and Their Implications For the Cost‐Effectiveness of Preemptive Pharmacogenetic Testing

“…However, when genetic testing is reimbursed or incorporated into biobank or neonatal screening programs, considerable economies of scale could be leveraged that reduce test costs well below $40. 34,35 We furthermore conducted a sensitivity analysis of our recommendations to test costs, in which we assumed the highest HLA genotyping costs found in the literature ($141; results provided in Table S9). As expected, increasing the genotyping costs lowered the incremental cost thresholds.…”

Clinical Relevance of a 16-Gene Pharmacogenetic Panel Test for Medication Management in a Cohort of 135 Patients

“…Not only does PGx testing promise to improve efficacy and safety outcomes for patients, it could also lead to overall savings in health care costs due to more efficient patient management strategies. Particularly preemptive PGx testing with multigene panels may be a promising approach for the identification of clinically relevant variants [ 8 ]. If they are used in a high number of subjects, costs of PGx testing may decrease considerably and therefore have a major impact on weighing costs vs. benefits.…”