Literature Review Concerning the Challenges of Implementing Pharmacogenetics in Primary Care Practice

Abstract

Since President Obama signed the Precision Medicine Initiative in 2015, endeavors to integrate pharmacogenetics in clinical practice and psychiatric care have been evolving rapidly. The nature of general practice and psychiatric medicine, including psychopharmacotherapy and the long-term care necessary for chronic diseases, renders these fields in desperate need of the implementation of pharmacogenetics. This article presents some of the challenges facing pharmacogenetics implementation in family medicine and psychiatric care. Reputable research websites were used to extract papers, data, and lectures concerning this topic. The results reveal that three main challenges are facing this integration: the evaluation of pharmacogenetic testing in general and psychiatric practice, cost-effectiveness, and regulatory burdens. Although considerable advances are being made to address these issues, it is time to gather these efforts under one umbrella to create guidelines based on previous and upcoming research.

Decision making under uncertainty in the diagnosis and management of Alzheimer's Disease in primary care: A study protocol applying concepts from neuroeconomics

“…For example, most commonly clinicians initiate treatments (e.g., hypertension, mood disorders, dementia, migraine, etc.) without knowing how specific genes may alter the metabolism of a drug or the risk of serious side effects, ultimately affecting the therapeutic response (pharmacogenetics) ( 36 ). Decisions based on erroneous assessments may result in suboptimal medical care and outcomes, as well as unmet needs for patients and their families.…”

Revisiting Secondary Information Related to Pharmacogenetic Testing

“…Pharmacogenetic (PGx) testing has been implemented in a variety of clinical settings, including inpatient and outpatient settings (Cavallari et al, 2016;Schuh and Crosby, 2019;Smith et al, 2020;Dong et al, 2021), community pharmacies (Ferreri et al, 2014), academic medical centers (Hicks et al, 2012), executive health programs (Liko et al, 2021), and nursing homes (Dorfman et al, 2020). Despite the excitement for the field to improve therapeutic decision-making, the early adopters of PGx testing have highlighted some barriers, demonstrating the complexity of initiating a new type of testing with multiple types of delivery approaches, and limited provider awareness and clinical decision support (Klein et al, 2017;Moyer and Caraballo, 2017;Lanting et al, 2020;Omer, 2020;Chang et al, 2021;Luczak et al, 2021). The debate about the value of PGx testing continues as more evidence is gathered (Davis et al, 2021;Hicks et al, 2021), impacted by when and where testing is delivered, the type of test, and cost-effectiveness (Janssens and Deverka, 2014;Plumpton et al, 2019).…”