The American Society of Health-System Pharmacists (ASHP) released a statement emphasizing the importance of pharmacogenomics in improving drug-related patient care outcomes in all practice settings in the healthcare system.3 Improvements in outcomes include better selection of appropriate drug therapies, better medication adherence, shorter duration 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 in all of their practices.3
Clinical pharmacogenomics activities may include designing patient-specific drug and drug regimens based on the genetic profile, documenting clinical recommendations, training pharmacists and other healthcare professionals, and recommending tests (see figure ).3.4 Those looking to broaden their professional development can receive an ASHP Pharmacogenomics Certificate, which is a self-guided online program that offers 18.25 hours of continuing education (CE) in the Accreditation Council for Pharmacy Education for Pharmacists.5 After completing the course, participants are required to analyze a pharmacogenomics case study and submit it for expert review in order to obtain a professional certificate.5
Advanced training in pharmacogenomics can open up more practice opportunities for pharmacists, such as developing clinical decision support tools in electronic health record systems that guide prescribers on appropriate treatment regimens based on profiles. genetic.3 In addition, pharmacists can develop guidelines and institutional processes for the implementation of clinical pharmacogenomics services in various practice settings.3 Pharmacists can also develop patient education materials to explain the meaning of tests and serve as expert consultants in a pharmacogenomics department.3 Developing training opportunities, such as certificate and CE programs, on pharmacogenomics for healthcare professionals and publishing research can showcase this innovative service.3
Evidence shows that pharmacist-led MTM programs improve health outcomes.4 The results of a study evaluated the implementation of a pharmacist-led MTM program in a primary care setting that involved pharmacogenomic testing.4 Patients were eligible to participate in the study if they were Medicare beneficiaries who prescribed at least 7 medications or if their doctors referred them to the pharmacist.4 For the 50 patients included in the study, the pharmacist assessed drug adherence and reconciliation, taking a mouth swab for DNA collection using a pharmacogenomic test kit.4 The result showed that patients were using an average of 12 prescription drugs, and the pharmacist identified 138 drug-related problems (MRPs).4 Additionally, the most common MRPs were 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 consultation, the pharmacist created a genetic card summarizing the pharmacogenomic results for the patients, and the information was also provided to primary care physicians.4
Most (90.9%) of the recommendations were accepted by 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
TAKE A CLOSER LOOK
Ahzam Afzal, PharmD, CEO of Frontizo, a health consulting company in Bingham Farms, Michigan, discussed the role of the pharmacist 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 healthcare system,” he said.
Innovation that takes advantage of an outside the box approach to deliver valuable results is a driving force for an effective MTM program. “Pharmacists are in a unique position to provide education on the importance of proper prescribing and the risks involved if a patient is undergoing pharmacological treatment that their body does not metabolize properly,” Afzal said. “Much of the incorporation of pharmacogenomic testing into an MTM program centers around training providers.”
Pharmacists can play an important role in promoting pharmacogenomic testing by educating physicians about the implications of pharmacotherapy and the importance of becoming early users of the technology.
“With this improved knowledge of pharmacogenomics, our pharmacists have the opportunity to apply individualized genetic data in daily practice to boost 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 role of the pharmacist 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 approach to drug management and treatment in primary care. J Am Board Fam Med. 2017; 30 (6): 701-714. doi: 10.3122 / jabfm.2017.06.170145
5. Certificate of pharmacogenomics. 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 contributor to The Pharmacy Times who resides in South Florida.