Pharmacogenetic Testing in Primary Care Practice: Opinions of Physicians, Pharmacists and Patients

Abstract

Aim: Although health authorities have set pharmacogenetic (PGx) markers on labels of hundreds of drugs, the use of PGx in clinical care remains infrequent. The adoption of PGx will depend on the opinions of physicians, pharmacists and patients. Materials & methods: Qualitative focus group interviews were performed with 23 physicians, 11 pharmacists and 30 patients. Results: Majority of the participants showed enthusiasm toward the implementation of PGx in clinics. Lack of knowledge on PGx, roles of healthcare providers, factors in favor and challenges of PGx implementation, ethical and insurance issues, educational and tools needs were the key themes that emerged from the interviews. Conclusion: Several barriers impede the uptake of PGx in clinics, however, opinions of physicians, pharmacists and patients are mostly favorable.

Pharmacogenomic (PGx) Counseling: Exploring Participant Questions about PGx Test Results

“…These included requests for future results on drugs not yet included in the study (psychiatric medications), as well as interest in whether their PGx results impacted other drugs that were not specifically referenced on their result report (other statins, or other blood thinners). Other studies have also demonstrated that participants with exposure to PGx results have a strong receptiveness toward the use of pharmacogenomics and desire to see it used more routinely [3,[14][15][16].…”

“…Most participants requesting genetic counseling (54%) were seeking general assistance with understanding their PGx result reports, often alluding to uncertainty regarding whether they should or should not take a given medication in the future based on their results. The expectation for PGx test results to have the potential to inform physician prescribing decisions in a way that maximizes drug efficacy while limiting adverse reactions has been captured in several other studies, including studies of participants who have received PGx results [2,3,[14][15][16][17].…”

“…About 70% of participants in a study that surveyed patients who had PGx testing in either a PGx clinic or via a direct access in-home test reported feeling validated about their history of previous drug side effects or lack of efficacy following receipt of PGx test results [2]. Participants in a focus group study on patient, physician, and pharmacist opinions on PGx conducted by Frigon et al [15] commented on the potential for PGx test results to limit the experience of having a physician discount a patient's report of a drug side-effect as a "psychosomatic" event rather than a real drug side effect. The notion of PGx results potentially leading people to conclude that any and all adverse events from a drug was due to their genetic make-up was noted by Lee et al [16] in their focus group study comparing the attitudes and perceptions of individuals exposed to PGx-guided care versus those of individuals with traditional care.…”

“…For those who shared with doctors, 32% reported a positive or helpful response, 29% reported the doctor did not understand the result, and 14% were unsure of the doctor's response to their PGx result. Other studies capturing participant sharing of PGx test results with healthcare providers have also found that participants report that they are more likely to share results with their prescribing physician rather than a pharmacist [14][15][16]. The expectation among patients for prescribing physicians to be able to respond to PGx test results will have important implications for the broader implementation of PGx testing.…”

Pharmacogenetics in Practice: Estimating the Clinical Actionability of Pharmacogenetic Testing in Perioperative and Ambulatory Settings

“…6,7 A number of barriers have been identified, in cluding the lack of uptake in clinical guidelines. 8 Several institutions, often at academic medical centers, have overcome these barriers and clinical implementations are underway. [9][10][11] These institutions contribute to expanding ev idence supporting clinical utility of pharmacogenetics and provide lessons learned, which can facilitate additional clin ical implementations.…”