Community pharmacists and their role in pharmacogenomics testing: an Australian perspective drawing on international evidence
Vijayaprakash Suppiah
A B C , Chiao Xin Lim A and Elizabeth Hotham A
+ Author Affiliations
- Author Affiliations
A School of Pharmacy and Medical Sciences, University of South Australia, City West Campus, Adelaide, SA 5000, Australia.
B Australian Centre for Precision Health, University of South Australia, City West Campus, Adelaide, SA 5000, Australia.
C Corresponding author. Email: vijay.suppiah@unisa.edu.au
Australian Journal of Primary Health 24(6) 441-447 https://doi.org/10.1071/PY18047
Submitted: 16 March 2018 Accepted: 19 August 2018 Published: 9 November 2018
Abstract
Patients obtaining a prescription from a pharmacy expect that the drug will be effective and have minimal side-effects. Unfortunately, drugs exhibit the desired effect in ~25–60% of people prescribed any medication. Adverse effects occur at a rate of 10% in patients taking a medication, and this rate increases during and after hospitalisation, with the transition of care back to the ambulatory setting posing a particular risk. Pharmacogenomics testing has been shown to optimise pharmacotherapy by increasing medication effectiveness and reducing drug-related toxicity, thus curtailing overall healthcare costs. Evidence from international studies have shown that community pharmacists would be able to offer this highly relevant professional service to their clients, given suitable training. This specific training complements pharmacists’ existing skills and expertise by educating them in an emerging scientific area of pharmacogenomics. However, in an increasingly tight financial climate, the provision of pharmacogenomics testing by Australian community pharmacists will only be viable with an appropriate reimbursement through the Medicare Benefits Schedule, currently accessible by other allied health practitioners but not by pharmacists.
References
Alexander KM, Divine HS, Hanna CR, Gokun Y, Freeman PR (2014) Implementation of personalized medicine services in community pharmacies: perceptions of independent community pharmacists. Journal of the American Pharmacists Association 54, 510–517.| Implementation of personalized medicine services in community pharmacies: perceptions of independent community pharmacists.Crossref | GoogleScholarGoogle Scholar |
Amara N, Blouin-Bougoe J, Bouthillier D, Simard J (2018) On the readiness of physicians for pharmacogenomics testing: an empirical assessment. The Pharmacogenomics Journal 18, 308–318.
| On the readiness of physicians for pharmacogenomics testing: an empirical assessment.Crossref | GoogleScholarGoogle Scholar |
American Society of Health-System Pharmacists (2015) ASHP statement on the pharmacist’s role in clinical pharmacogenomics. American Journal of Health-System Pharmacy 72, 579–581.
| ASHP statement on the pharmacist’s role in clinical pharmacogenomics.Crossref | GoogleScholarGoogle Scholar |
Australian Centre for Health Research (2008) Improving the quality use of medicines in Australia: realising the potential of pharmacogenomics (Deloitte Economics: Melbourne, Australia) Available at http://www.globalaccesspartners.org/Improving_the_Quality_Use_of_Medicines_in_Australia.pdf [Verified 9 February 2018]
Bartlett G, Zgheib N, Manamperi A, Wang W (2012) Pharmacogenomics in primary care : a crucial entry point for global personalized medicine? Current Pharmacogenomics and Personalized Medicine 10, 101–105.
| Pharmacogenomics in primary care : a crucial entry point for global personalized medicine?Crossref | GoogleScholarGoogle Scholar |
Berm EJJ, de Looff M, Wilffert B, Boersma C, Annemans L, Vegter S, van Boven JFM, Postma MJ (2016) Economic evaluations of pharmacogenetic screening tests: a systematic review. Second update of the literature. PLoS One 11, e0146262
| Economic evaluations of pharmacogenetic screening tests: a systematic review. Second update of the literature.Crossref | GoogleScholarGoogle Scholar |
Borse MS, Dong OM, Polasek MJ, Farley JF, Stouffer GA, Lee CR (2017) CYP2C19-guided antiplatelet therapy: a cost-effectiveness analysis of 30-day and 1-year outcomes following percutaneous coronary intervention. Pharmacogenomics 18, 1155–1166.
| CYP2C19-guided antiplatelet therapy: a cost-effectiveness analysis of 30-day and 1-year outcomes following percutaneous coronary intervention.Crossref | GoogleScholarGoogle Scholar |
Caraballo PJ, Hodge LS, Bielinski SJ, Stewart AK, Farrugia G, Schultz CG, Rohrer-Vitek CR, Olson JE, St Sauver JL, Roger VL, Parkulo MA, Kullo IJ, Nicholson WT, Elliott MA, Black JL, Weinshilboum RM (2017) Multidisciplinary model to implement pharmacogenomics at the point of care. Genetics in Medicine 19, 421–429.
| Multidisciplinary model to implement pharmacogenomics at the point of care.Crossref | GoogleScholarGoogle Scholar |
Castelino RL, Bajorek BV, Chen TF (2009) Targeting suboptimal prescribing in the elderly: a review of the impact of pharmacy services. The Annals of Pharmacotherapy 43, 1096–1106.
| Targeting suboptimal prescribing in the elderly: a review of the impact of pharmacy services.Crossref | GoogleScholarGoogle Scholar |
Crews KR, Cross SJ, Mccormick JN, Baker DK, Molinelli AR, Richard M, Relling MV, Hoffman JM (2011) Development and implementation of a pharmacist-managed clinical pharmacogenetics service. American Journal of Health-System Pharmacy 68, 143–150.
| Development and implementation of a pharmacist-managed clinical pharmacogenetics service.Crossref | GoogleScholarGoogle Scholar |
Dunnenberger HM, Biszewski M, Bell GC, Sereika A, May H, Johnson SG, Hulick PJ, Khandekar J (2016) Implementation of a multidisciplinary pharmacogenomics clinic in a community health system. American Journal of Health-System Pharmacy 73, 1956–1966.
| Implementation of a multidisciplinary pharmacogenomics clinic in a community health system.Crossref | GoogleScholarGoogle Scholar |
Farrugia G, Weinshilboum RM (2013) Challenges in implementing genomic medicine: the Mayo Clinic Center for individualized medicine. Clinical Pharmacology and Therapeutics 94, 204–206.
| Challenges in implementing genomic medicine: the Mayo Clinic Center for individualized medicine.Crossref | GoogleScholarGoogle Scholar |
Ferreri SP, Greco AJ, Michaels NM, O’Connor SK, Chater RW, Viera AJ, Faruki H, McLeod HL, Roederer MW (2014) Implementation of a pharmacogenomics service in a community pharmacy. Journal of the American Pharmacists Association 54, 172–180.
| Implementation of a pharmacogenomics service in a community pharmacy.Crossref | GoogleScholarGoogle Scholar |
Haga SB, Burke W, Ginsburg G, Mills R, Agans R (2012) Primary care physicians’ knowledge of and experience with pharmacogenetic testing. Clinical Genetics 82, 388–394.
| Primary care physicians’ knowledge of and experience with pharmacogenetic testing.Crossref | GoogleScholarGoogle Scholar |
Haga SB, Lapointe NMA, Moaddeb J (2015) Challenges to integrating pharmacogenetic testing into medication therapy management. Journal of Managed Care & Specialty Pharmacy 21, 346–352.
| Challenges to integrating pharmacogenetic testing into medication therapy management.Crossref | GoogleScholarGoogle Scholar |
Hattingh HL, Sim TF, Parsons R, Czarniak P, Vickery A, Ayadurai S (2016) Evaluation of the first pharmacist-administered vaccinations in Western Australia: a mixed-methods study. BMJ Open 6, e011948
| Evaluation of the first pharmacist-administered vaccinations in Western Australia: a mixed-methods study.Crossref | GoogleScholarGoogle Scholar |
Jiang M, You JH (2017) CYP2C19 LOF and GOF-guided antiplatelet therapy in patients with acute coronary syndrome: a cost effectiveness analysis. Cardiovascular Drugs and Therapy 31, 39–49.
| CYP2C19 LOF and GOF-guided antiplatelet therapy in patients with acute coronary syndrome: a cost effectiveness analysis.Crossref | GoogleScholarGoogle Scholar |
Jokanovic N, Tan ECK, Sudhakaran S, Kirkpatrick CM, Dooley MJ, Ryan-Atwood TE, Bell JS (2017) Pharmacist-led medication review in community settings: an overview of systematic reviews. Research in Social & Administrative Pharmacy 13, 661–685.
Kisor DF, Bright DR, Conaway M, Bouts BA, Gerschutz GP (2014) Pharmacogenetics in the community pharmacy: thienopyridine selection post–coronary artery stent placement. Journal of Pharmacy Practice 27, 416–419.
| Pharmacogenetics in the community pharmacy: thienopyridine selection post–coronary artery stent placement.Crossref | GoogleScholarGoogle Scholar |
Krass I, Hebing R, Mitchell B, Hughes J, Peterson G, Song YJC, Stewart K, Armour CL (2011) Diabetes management in an Australian primary care population. Journal of Clinical Pharmacy and Therapeutics 36, 664–672.
| Diabetes management in an Australian primary care population.Crossref | GoogleScholarGoogle Scholar |
Lesko LJ, Johnson JA (2012) Academia at the crossroads: education and training in pharmacogenomics. Personalized Medicine 9, 497–506.
| Academia at the crossroads: education and training in pharmacogenomics.Crossref | GoogleScholarGoogle Scholar |
Lunshof JE, Gurwitz D (2012) Pharmacogenomic testing: knowing more, doing better. Clinical Pharmacology and Therapeutics 91, 387–389.
| Pharmacogenomic testing: knowing more, doing better.Crossref | GoogleScholarGoogle Scholar |
McCullough KB, Formea CM, Berg KD, Burzynski JA, Cunningham JL, Ou NN, Rudis MI, Stollings JL, Nicholson WT (2011) Assessment of the pharmacogenomics educational needs of pharmacists. American Journal of Pharmaceutical Education 75, 51
| Assessment of the pharmacogenomics educational needs of pharmacists.Crossref | GoogleScholarGoogle Scholar |
McMahon T, Tucci J (2011) The perceptions of pharmacists in Victoria, Australia on pharmacogenetics and its implications. Pharmacy Practice 9, 141–147.
Moaddeb J, Mills R, Haga SB (2015) Community pharmacists’ experience with pharmacogenetic testing. Journal of the American Pharmacists Association 55, 587–594.
| Community pharmacists’ experience with pharmacogenetic testing.Crossref | GoogleScholarGoogle Scholar |
National Center for Health Statistics (2010) National ambulatory medical care survey: 2010 summary tables. (National Center for Health Statistics: Georgia, USA) Available at: http://cdc.gov/nchs/data/ahcd/namcs_summary/2010_namcs_web_tables.pdf [Verified 9 February 2018]
Owusu-Obeng A, Weitzel KW, Hatton RC, Staley BJ, Ashton J, Cooper-Dehoff RM, Johnson JA (2014) Emerging roles for pharmacists in clinical implementation of pharmacogenomics. Pharmacotherapy 34, 1102–1112.
| Emerging roles for pharmacists in clinical implementation of pharmacogenomics.Crossref | GoogleScholarGoogle Scholar |
Padgett L, O’Connor S, Roederer M, McLeod H, Ferreri S (2011) Pharmacogenomics in a community pharmacy: ACT now. Journal of the American Pharmacists Association 51, 189–193.
| Pharmacogenomics in a community pharmacy: ACT now.Crossref | GoogleScholarGoogle Scholar |
Paola S (2018) Review professional services: do you charge for your services? Australian Journal of Pharmacy 99, 16–20.
Pharmaceutical Society of Australia (2016) ‘National Competency Standards Framework for Pharmacists in Australia.’ (Pharmaceutical Society of Australia: Deakin West, ACT, Australia)
Pharmaceutical Society of Australia (2017) ‘Review of Pharmacy Remuneration and Regulation PSA’s Response to the Interim Report.’ (Pharmaceutical Society of Australia: Deakin West, ACT, Australia)
Plöthner M, Ribbentrop D, Hartman J-P, Frank M (2016) Cost-effectiveness of pharmacogenomic and pharmacogenetic test-guided personalized therapies: a systematic review of the approved active substances for personalized medicine in Germany. Advances in Therapy 33, 1461–1480.
| Cost-effectiveness of pharmacogenomic and pharmacogenetic test-guided personalized therapies: a systematic review of the approved active substances for personalized medicine in Germany.Crossref | GoogleScholarGoogle Scholar |
Plumpton CO, Roberts D, Pirmohamed M, Hughes DA (2016) A systematic review of economic evaluations of pharmacogenetic testing for prevention of adverse drug reactions. PharmacoEconomics 34, 771–793.
| A systematic review of economic evaluations of pharmacogenetic testing for prevention of adverse drug reactions.Crossref | GoogleScholarGoogle Scholar |
Relling MV, Evans WE (2015) Pharmacogenomics in the clinic. Nature 526, 343–350.
| Pharmacogenomics in the clinic.Crossref | GoogleScholarGoogle Scholar |
Royal Australian College of General Practitioners (2018) Genomics in general practice. (Royal Australian College of General Practitioners, Melbourne, Vic., Australia) Available at https://www.racgp.org.au/your-practice/guidelines/genomics/ [Verified 29 May 2018]
Sorich MJ, Horowitz JD, Sorich W, Wiese MD, Pekarsky B, Karnon JD (2013) Cost-effectiveness of using CYP2C19 genotype guide selection of clopidegrel or ticagrelor in Australia. Pharmacogenomics 14, 2013–2021.
| Cost-effectiveness of using CYP2C19 genotype guide selection of clopidegrel or ticagrelor in Australia.Crossref | GoogleScholarGoogle Scholar |
Stanek EJ, Sanders CL, Taber KAJ, Khalid M, Patel A, Verbrugge RR, Agatep BC, Aubert RE, Epstein RS, Frueh FW (2012) Adoption of pharmacogenomic testing by US physicians: results of a nationwide survey. Clinical Pharmacology and Therapeutics 91, 450–458.
| Adoption of pharmacogenomic testing by US physicians: results of a nationwide survey.Crossref | GoogleScholarGoogle Scholar |
Suppiah V, Khoo SN, Matti N, King C, Wiese M (2015) Teaching of pharmacogenomics in Australian pharmacy schools. Public Health Genomics 18, 47–48.
Swen JJ, Van Der Straaten T, Wessels JAM, Bouvy ML, Vlassak EEW, Assendelft WJJ, Guchelaar HJ (2012) Feasibility of pharmacy-initiated pharmacogenetic screening for CYP2D6 and CYP2C19. European Journal of Clinical Pharmacology 68, 363–370.
| Feasibility of pharmacy-initiated pharmacogenetic screening for CYP2D6 and CYP2C19.Crossref | GoogleScholarGoogle Scholar |
Tuteja S, Haynes K, Zayac C, Sprague JE, Bernhardt B, Pyeritz R (2013) Community pharmacists’ attitudes towards clinical utility and ethical implications of pharmacogenetic testing. Personalized Medicine 10, 793–800.
| Community pharmacists’ attitudes towards clinical utility and ethical implications of pharmacogenetic testing.Crossref | GoogleScholarGoogle Scholar |
van der Wouden CH, Cambon-Thomsen A, Cecchin E, Cheung KC, Dávila-Fajardo CL, Deneer VH, Dolžan V, Ingelman-Sundberg M, Jönsson S, Karlsson MO, Kriek M, Mitropoulou C, Patrinos GP, Pirmohamed M, Samwald M, Schaeffeler E, Schwab M, Steinberger D, Stingl J, Sunder-Plassmann G, Toffoli G, Turner RM, van Rhenen MH, Swen JJ, Guchelaar H-J, Ubiquitous Pharmacogenomics Consortium (2017) Implementing pharmacogenomics in Europe: design and implementation strategy of the ubiquitous pharmacogenomics consortium. Clinical Pharmacology and Therapeutics 101, 341–358.
| Implementing pharmacogenomics in Europe: design and implementation strategy of the ubiquitous pharmacogenomics consortium.Crossref | GoogleScholarGoogle Scholar |
van Wieren-de Wijer DBMA, Maitland-Van Der Zee AH, De Boer A, Stricker BHC, Kroon AA, De Leeuw PW, Bozkurt O, Klungel OH (2009) Recruitment of participants through community pharmacies for a pharmacogenetic study of antihypertensive drug treatment. Pharmacy World & Science 31, 158–164.
| Recruitment of participants through community pharmacies for a pharmacogenetic study of antihypertensive drug treatment.Crossref | GoogleScholarGoogle Scholar |
Verbelen M, Weale ME, Lewis CM (2017) Cost-effectiveness of pharmacogenetic-guided treatment: are we there yet? The Pharmacogenomics Journal 17, 395–402.
| Cost-effectiveness of pharmacogenetic-guided treatment: are we there yet?Crossref | GoogleScholarGoogle Scholar |
Weitzel KW, Elsey AR, Langaee TY, Burkley B, Nessl DR, Obeng AO, Staley BJ, Dong H-J, Allan RW, Liu JF, Cooper-DeHoff RM, Anderson RD, Conlon M, Clare-Salzler MJ, Nelson DR, Johnson JA (2014) Clinical pharmacogenetics implementation: approaches, successes, and challenges. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics 166C, 56–67.
| Clinical pharmacogenetics implementation: approaches, successes, and challenges.Crossref | GoogleScholarGoogle Scholar |
Williams MS (2014) Genomic medicine implementation: learning by example. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics 166C, 8–14.
| Genomic medicine implementation: learning by example.Crossref | GoogleScholarGoogle Scholar |
