Challenges to Integrating Pharmacogenetic Testing into Medication Therapy Management

Abstract

Background Some have proposed the integration of pharmacogenetic (PGx) testing into medication therapy management (MTM) to enable further refinement of treatment(s) to reduce risk of adverse responses and improve efficacy. PGx testing involves the analysis of genetic variants associated with therapeutic or adverse response and may be useful in enhancing the ability to identify ineffective and/or harmful drugs or drug combinations. This “enhanced” MTM might also reduce patient concerns about side effects and increase confidence that the medication is effective, addressing two key factors that impact patient adherence - concern and necessity. However, the feasibility and effectiveness of the integration of PGx testing into MTM in clinical practice has not yet been determined. Objectives In this paper, we consider some of the challenges to the integration and delivery of PGx testing in MTM services. What is already known about this subject While the addition of pharmacogenetic testing has been suggested, little literature exists exploring the challenges or feasibility of doing so.

<p>Medication Therapy Management: Current Challenges</p>

“…The barriers identified in this narrative review align with those noted in prior reviews and demonstrates that barriers to MTM implementation have persisted since Medicare Part D was implemented in 2006. 10,[15][16][17][18][19]21,22,25,26,[30][31][32][33][34][35][36]40,41,[43][44][45][46][47][48] More work is needed to overcome these challenges and produce consistently positive outcomes from MTM. 48 The literature points to considerations for potential solutions for overcoming each of the identified challenges to MTM delivery and these are summarized below.…”

“…While access to medical records has been noted as an important driver in the success of MTM, integrating the pharmacist into the health information technology (HIT) infrastructure has been difficult and adoption of shared electronic health record (EHR) systems in community pharmacies has been minimal. 22,[35][36][37] Specifically, interoperability and bi-directionality of health information, pharmacy informatics development, and burdensome documentation were cited as barriers for MTM delivery. 38 HIT has always posed challenges in healthcare simply due to the volume, velocity and variety of big data.…”

Implementation of Pharmacogenomics and Artificial Intelligence Tools for Chronic Disease Management in Primary Care Setting

“…Haga and colleagues have published rich commentary [ 34 , 35 , 36 ], and some primary research, on clinical outcomes in populations in which pharmacogenomic testing has been implemented. The chicken-and-egg paradox to further outcomes research is the dearth of patients for whom pharmacogenomic testing is ordered because of a limited reimbursement landscape [ 37 ], and the data linkage challenges posed by efforts to document the public health impact of medication choices.…”

Clinical Utility of Pharmacogenetic Testing and a Clinical Decision Support Tool to Enhance the Identification of Drug Therapy Problems Through Medication Therapy Management in Polypharmacy Patients

“…16 However, evaluation of MTM for outpatient polypharmacy patients that incorporates PGx has been limited, likely due to lack of reimbursement for PGx testing costs as well as the lack of PGx information in standard drug information tools traditionally used by MTM pharmacists. 17 Using the data collected from a randomized controlled study, this study demonstrates the usefulness of PGx in an MTM setting in that it identifies more serious drug therapy problems as compared to standard MTM programs.…”