The 3-I framework: a framework for developing public policies regarding pharmacogenomics (PGx) testing in Canada

Bashir, Naazish S.; Ungar, Wendy J.

doi:10.1139/gen-2015-0100

Cited by 4 publications

(4 citation statements)

References 79 publications

(85 reference statements)

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“…21 It has been suggested that, to affect the level of use of pharmacogenetic results, pharmacists can order pharmacogenetic tests and incorporate results into medication management. 22 We have shown that it is possible for both family physicians and pharmacists to obtain saliva samples from patients, send the samples to the laboratory, complete the biophysical and laboratory data needed for an MDSS and make decisions based on individualized medication options. In a pharmacybased study (n = 54) by Swen and colleagues, 23 9 saliva samples (16.7%) contained too little DNA, whereas we had 1 sample (0.5%) that contained too little DNA.…”

Section: Discussionmentioning

confidence: 99%

Introducing pharmacogenetic testing with clinical decision support into primary care: a feasibility study

et al. 2016

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Background: Inappropriate prescribing increases patient illness and death owing to adverse drug events. The inclusion of genetic information into primary care medication practices is one solution. Our aim was to assess the ability to obtain and genotype saliva samples and to determine the levels of use of a decision support tool that creates medication options adjusted for patient characteristics, drug-drug interactions and pharmacogenetics. Methods:We conducted a cohort study in 6 primary care settings (5 family practices and 1 pharmacy), enrolling 191 adults with at least 1 of 10 common diseases. Saliva samples were obtained in the physician's office or pharmacy and sent to our laboratory, where DNA was extracted and genotyped and reports were generated. The reports were sent directly to the family physician/pharmacist and linked to an evidence-based prescribing decision support system. The primary outcome was ability to obtain and genotype samples. The secondary outcomes were yield and purity of DNA samples, ability to link results to decision support software and use of the decision support software. Results:Genotyping resulted in linking of 189 patients (99%) with pharmacogenetic reports to the decision support program. A total of 96.8% of samples had at least 1 actionable genotype for medications included in the decision support system. The medication support system was used by the physicians and pharmacists 236 times over 3 months.Interpretation: Physicians and pharmacists can collect saliva samples of sufficient quantity and quality for DNA extraction, purification and genotyping. A clinical decision support system with integrated data from pharmacogenetic tests may enable personalized prescribing within primary care. Trial registration: ClinicalTrials.gov, NCT02383290. AbstractResearch Research CMAJ OPENCMAJ OPEN, 4(3) E529fective at changing prescribing decisions, 13 whereas information given within a physician's workflow has been found to be effective in reducing inappropriate orders for imaging. 14 A medication decision support system (MDSS) is a health information technology system that is designed to provide health care professionals with clinical decision support with medication decision-making tasks. These systems assess whether a drug is safe and effective for the patient, taking into account other medications, diseases and the patient's physical state. 15 We have developed a patient-centred MDSS that assesses the potential drug-drug, drug-condition, druggene and drug-drug-gene interactions and produces a list of drug options least likely to cause harm and most likely to be effective.We conducted a study to assess the DNA collection processes, investigate a panel of pharmacogenetic tests relevant to primary care patients and assess the use of an MDSS. The value of the MDSS will be assessed once feasibility of all processes has been shown. MethodsOver an 18-month period before the start of the trial, we developed a pharmacogenetic panel, a pharmacogenetic report and an MDSS for use in primary...

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Section: Discussionmentioning

confidence: 99%

Introducing pharmacogenetic testing with clinical decision support into primary care: a feasibility study

et al. 2016

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“…The political science model has been extrapolated to the analysis of healthy public policy and impacted the policy process in health issues (10). In healthcare, the framework has been used to aid analysis in studies of evidence-informed policies about health systems, pharmacogenomics policy development, and NCDs policy (11)(12)(13). For this study, this framework could illuminate the processes involved from the formulation to the implementation of NCD policies.…”

Section: Health Sector Policymentioning

confidence: 99%

Identifying key factors for successful formulation and implementation of healthcare policies on non-communicable diseases: a multinational analysis

Babaita,

Jahan,

Nakamura

et al. 2024

Front. Public Health

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ObjectivesNon-communicable diseases (NCDs) are a major public health concern that accounts for 74% of global deaths each year. The increasing burden of NCDs exhausts public health resources and threatens the achievement of the 2030 agenda for sustainable development. The purpose of this study is to thematically analyze the contributory factors in the health policy process and reforms to strengthen the prevention of NCDs across borders, as well as the milestones achieved through the process of policy-making, change, and implementation.MethodThis study informs and draws on the findings of contributory factors in the health policy process for preventing NCDs across borders: United States, England, Sweden, Bangladesh, Singapore, South Korea, and Thailand. Ten experts from the seven countries were recruited purposively for a semi-structured interview (e-Interview) on the NCD policy-making process in their countries, either through health ministries or the authors’ network. This descriptive qualitative study design is guided by the “Three I’s” framework of public policy (institutions, ideas, and interests). In addition to the information obtained from the interviewee, data were also sourced from relevant documents and homepages suggested by the interviewee, as well as health homepages of the countries.ResultThe following themes were generated: (1) environmental policies and social determinants, (2) multistakeholder involvement, (3) interministerial collaboration, (4) independent evidence and review institution, (5) integrated health data, and (6) primary care system. There was a shift from individual-targeted policies to environmental policies and social determinants. Notably, national campaigns were developed through non-governmental organizations (NGOs) for the primary prevention of NCDs.ConclusionThe shift from behavioral modification and treatment to social determinants is important. NCDs are broad and require a multisector and multilevel approach. Establishing an organization or hierarchical body to overlook NCDs could result in increased awareness, focus, and surveillance and enhance the policy process.

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“…Following other health policy analysts (Lavis et al. 2002 ; Bashir and Ungar 2015 ; Shearer et al. 2016 ; Schram 2018 ), we propose that employing the 3-I framework can provide alcohol researchers with a more sophisticated understanding of how politics shapes the policy process.…”

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confidence: 97%

“…This is not the first analysis to suggest these factors matter or are interrelated (Heclo 1994;Hall 1997). Following other health policy analysts (Lavis et al 2002;Bashir and Ungar 2015;Shearer et al 2016;Schram 2018), we propose that employing the 3-I framework can provide alcohol researchers with a more sophisticated understanding of how politics shapes the policy process. To our knowledge, this is the first effort to apply this framework to alcohol policy.…”

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confidence: 99%

Reconceptualising the study of alcohol policy decision-making: the contribution of political science

Lesch

McCambridge

2020

Addiction Research & Theory

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In this article, we demonstrate the applicability of a 3-I (interests, institutions, and ideas) framework to alcohol policy research. The analysis uses literature from political science research to provide a core theoretical framework. To help illustrate the argument, we draw on relevant examples from alcohol policy in the UK as well as initial findings from an ongoing research study on minimum-unit pricing in Wales. The Welsh case study provides an opportunity to examine the value of the framework in generating testable hypotheses in alcohol policy research. We find that several interrelated factors promoted policy change in Wales, including the government's power to legislate on matters of public health (institutionally), a relatively weak alcohol industry (a key interest group), and a public health community with specific policy arguments on why and how to tackle alcohol-related harms (ideas). Our analysis has important implications for public health research and evidence-based policymaking. It suggests that the uptake of new ideas depends on the existing configuration of interests, institutions and ideas. This analysis provides alcohol policy researchers with a portable framework for analysing the policy context.

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The 3-I framework: a framework for developing public policies regarding pharmacogenomics (PGx) testing in Canada

Cited by 4 publications

References 79 publications

Introducing pharmacogenetic testing with clinical decision support into primary care: a feasibility study

Introducing pharmacogenetic testing with clinical decision support into primary care: a feasibility study

Identifying key factors for successful formulation and implementation of healthcare policies on non-communicable diseases: a multinational analysis

Reconceptualising the study of alcohol policy decision-making: the contribution of political science

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