Uniting Clinical Teams Around Pharmacogenomics to Advance Patient Care

Serious adverse drug reactions (ADRs) are the sixth leading cause of death across the globe and the fourth leading cause in North America. Additionally, the historical efficacy rates of drug therapy for many common conditions are only 40% to 60%.

Pharmacogenomics (PGx) has the potential to address these and other medication related concerns by improving the precision of drug therapy. Understanding PGx is essential for optimizing drug and dose selection and for reducing avoidable adverse reactions.

More than 90% of individuals carry at least 1 distinctive pharmacogenomic variation, and over a 5-year period, nearly two-thirds of patients receive at least 1 medication subject to clinically relevant genetic variation. By performing PGx testing, hospitals and care settings can better predict potential ADRs and optimize outcomes for everyone based on their individual situation and needs.

As the genetic basis of different drug responses becomes clearer, and as multi-gene testing is performed more often and earlier in life, there will be less of a reliance on race as a factor in PGx decision making. Currently, however, some labels and other guidelines include race-specific dosing or testing recommendations.

Although cost and other resource issues play a big role in the use of race-based recommendations, such recommendations often use classifications and terminology that are overly broad and imprecise. Many hospitals and health care teams are still working on integrating PGx testing into their diagnostic and treatment routines.

Broad adoption will depend on a team-based approach, involving an array of health care professionals, including prescribers, pharmacists, nurses, lab technicians, and more. When these teams collaborate and play their unique roles in applying PGx, they create a reliable system for harmonized care and positive patient outcomes.

Putting PGx into Practice

Awareness

The first step of integrating PGx into practice is engaging clinicians in how, when, and why to use it. Clinicians are aware of the impact of genetic factors on drug therapy, but don't always feel prepared to implement that information into their daily practice.

A recent US survey revealed that over 97% of physicians agreed on the importance of genetic variations when considering drug responses, but many do not know how to apply PGx findings to their daily practices. Less than 10% of these physicians felt well informed about PGx testing and less than half had recently ordered or anticipated ordering a test.

There is an increasing amount of available information to assist with the clinical incorporation of PGx knowledge. Published guidelines exist for approximately 100 separate drug-gene associations and information about many more is contained in drug labeling and other sources. Some drug information organizations have created clear clinical material to educate physicians on when PGx testing could be beneficial and how to implement PGx findings when available.

These materials often include information such as the prevalence of genomic variants in specific populations, interpretation of testing results, summaries of published research, and what recommendations are contained in published guidelines or labeling. With access to such information, clinicians have ready access to the information needed to understand drug-gene interactions and to use this knowledge to improve the precision of their patients' drug therapy.

Alerting

The next critical step is getting the right data into the hands of clinicians at the most appropriate time. Alerting clinicians of opportunities to apply PGx with accurate and updated data is essential. A United Kingdom study found that while practitioners found value in PGx, the path to implementing it into practice was not clear.

One of the largest obstacles for clinicians adopting PGx is incorporating genomic data and supportive tools into electronic health records they use daily. A survey of several sites in the Electronic Medical Records and Genomics (eMERGE) Network revealed that delays in the process were more related to health information technology and other logistical issues instead of with the PGx testing itself.

An alert system can be used as a proactive approach to preventing high-risk patients from being exposed to potentially harmful drugs or inappropriate doses. This can create awareness for prescribers regarding risky genetic variation and drug recommendations.

The key is to have this system in place before physicians decide on a treatment plan. Clinicians may want to consider additional screening, tests or drug treatment when presented with information about a patient’s specific genomic makeup.

Alignment

The final step to supporting the incorporation of PGx into daily practice is aligning all health care professionals around the processes of PGx testing. Through collaboration, communication, and knowledge of PGx resources, clinical implementation of PGx-guided therapy can become routine. Prescribers, lab technicians, pharmacists, and genetic counselors should all be aligned on their individual roles in the clinical use of PGx.

For example, a lab technician should be trained how to administer and advise specific genetic testing, while pharmacists can use that testing information to recommend the correct drug and dosage. Although these roles are separate, they both contribute to the patient’s understanding of how PGx testing works and can be integrated into the resulting treatment plan.

These roles can also be supported through IT/EMR setup and maintenance for PGx screening alerts and related outcomes. A system needs to be in place for reporting results that will help align all PGx testing personnel on potential treatment plans.

Conclusion

PGx is a critical component of improving the precision of drug therapy to optimize patient care and outcomes. When PGx testing is adopted into regular practice, clinicians and health care professionals can prevent ADRs in patients with known genetic variations.

Prescribers, pharmacists, nurses, lab technicians, and other health care professionals must work as a team to create awareness and understanding of PGx integration. Through awareness, proactive alerting, and alignment across these health care professionals, PGx can be used to both ensure drug treatments are safe and harmonize decision-making across a patient’s care team.

About the Author

Daniel Streetman, PharmD, MS is the manager of referential content in the Metabolism, Interactions, & Genomics group of Clinical Effectiveness, Wolters Kluwer, Health. He is also an adjunct faculty member with the University of Michigan College of Pharmacy and instructor at the University of Michigan-Flint; and the author of more than 25 publications.