Pharmacists can play a vital role in testing to improve medication outcomes in different practice settings.
Pharmacogenomics examines how genes affect the way individuals respond to medications, which can help in selecting the most effective therapy and optimal drug dosage.1
Pharmacogenomics also ties into precision medicine, which is treating each patient individually.1 The FDA provides pharmacogenomics information in the labeling of various medications that includes drug exposure and clinical response variability, genetic factors involved in drug metabolism, genotype-specific dosing, mechanisms of drug action, risk for adverse events, and trial design characteristics.2 Pharmacists can play an important role in pharmacogenomics testing to improve outcomes through medication therapy management (MTM) services.
The American Society of Health-System Pharmacists (ASHP) issued a statement emphasizing the importance of pharmacogenomics in improving medication-related outcomes in patient care across all health system practice settings.3 Improvements in outcomes include better selection of appropriate medication therapies, enhanced medication adherence, decreased length of treatment, and improved patient safety. Pharmacists can also work as part of an interdisciplinary team with genetic counselors, laboratory professionals, and physicians to implement pharmacogenomics into all their practices.3
Clinical pharmacogenomics activities may include designing patient-specific drug and dosage regimens based on genetic profile, documenting clinical recommendations, educating pharmacists and other health care professionals, and recommending testing (see figure).3,4 Those looking to expand their professional development can receive an ASHP Pharmacogenomics Certificate, which is a self-guided online program that provides 18.25 hours of Accreditation Council for Pharmacy Education continuing education (CE) for pharmacists.5 After completing the coursework, participants must analyze a pharmacogenomics case study and submit it for expert review to earn a professional certificate.5
Advanced training in pharmacogenomics may open up more practice opportunities for pharmacists, such as developing clinical decision support tools in electronic health record systems that guide prescribers on appropriate drug therapy regimens based on genetic profiles.3 Additionally, pharmacists can develop institutional guidelines and processes for implementing clinical pharmacogenomics services into various practice settings.3 Pharmacists can also develop patient education materials to explain the significance of the tests and serve as expert consultants in a pharmacogenomics service.3 Developing training opportunities, such as certificate programs and CE, on pharmacogenomics for health care professionals and publishing research can highlight this innovative service.3
Evidence shows that pharmacist-led MTM programs improve health outcomes.4 The results of 1 study evaluated the implementation of a pharmacist-led MTM program within a primary care setting that involved pharmacogenomics testing.4 Patients were eligible to participate in the study if they were Medicare beneficiaries prescribed at least 7 medications or if their physicians referred them to the pharmacist.4 For the 50 patients enrolled in the study, the pharmacist assessed for medication adherence and reconciliation, performing a buccal swab for DNA collection using a pharmacogenomics testing kit.4 The result showed that patients used an average of 12 prescription medications, and the pharmacist identified 138 medication-related problems (MRPs).4 Additionally, the most common MRPs were drug-drug interactions (29%) and drug-gene interactions (24.6%). All patients had at least 1 genetic variant, and the majority (66%) had at least 5.4
As part of the MTM consult, the pharmacist created a gene card summarizing the pharmacogenomics results for patients, and the information was also provided to the primary care physicians.4
Most (90.9%) of the recommendations were accepted by the primary care physicians.4 This study highlights the unique role pharmacists can play in integrating MTM and pharmacogenomics services with personalized medicine initiatives in a primary care setting.4
TAKING A CLOSER LOOK
Ahzam Afzal, PharmD, chief executive officer of Frontizo, a health consulting firm in Bingham Farms, Michigan, discussed the pharmacist's role in MTM and pharmacogenomics. "Frontizo's care coordination and MTM programs are designed to positively impact patient outcomes and reduce overall systemic costs to the health care system," he said.
Innovation that leverages an outside-the-box approach to deliver valuable results is a driving force for an effective MTM program. "Pharmacists are uniquely positioned to provide education on the importance of proper prescribing and the risks involved if a patient is on pharmacological therapy that their body does not metabolize properly," Afzal said. "A big piece of the incorporation of pharmacogenomic testing into an MTM program centers around provider education."
Pharmacists can play an important role in promoting pharmacogenomics testing by educating physicians about the implications to drug therapy and the importance of becoming early adopters of the technology.
"With this enhanced knowledge of the pharmacogenomics, our pharmacists have an opportunity to apply individualized genetic data into everyday practice to drive clinical efficacy and safely improve pharmacological outcomes," he said.
1. Pharmacogenomics. National Institutes of Health. Updated July 13, 2020. Accessed February 7, 2021. https://www.nigms.nih.gov/education/fact-sheets/Pages/pharmacogenomics.aspx[RP1]
2. Table of pharmacogenomic biomarkers in drug labeling. FDA. March 23, 2021. Accessed February 7, 2021. https://www.fda.gov/drugs/science-and-research-drugs/table-pharmacogenomic-biomarkers-drug-labeling[RP2]
3. ASHP statement on the pharmacist’s role in clinical pharmacogenomics. Am J Health Syst Pharm. 2015;72(7):579-581. doi:10.2146/sp150003
4. Schwartz EJ, Turgeon J, Patel J, et al. Implementation of a standardized medication therapy management plus approach within primary care. J Am Board Fam Med. 2017;30(6):701-714. doi:10.3122/jabfm.2017.06.170145
5. Pharmacogenomics certificate. American Society of Health-System Pharmacists. Accessed February 9, 2021. http://elearning.ashp.org/products/6673/pharmacogenomics-certificate-program[RP3]
ABOUT THE AUTHOR
Jennifer Gershman, PharmD, CPh, is a drug information pharmacist and Pharmacy Times contributor who resides in South Florida.