Assessing the Implementation of Pharmacogenomic Panel-Testing in Primary Care in the Netherlands Utilizing a Theoretical Framework

Abstract

Despite overcoming many implementation barriers, pharmacogenomic (PGx) panel-testing is not routine practice in the Netherlands. Therefore, we aim to study pharmacists' perceived enablers and barriers for PGx panel-testing among pharmacists participating in a PGx implementation study. Here, pharmacists identify primary care patients, initiating one of 39 drugs with a Dutch Pharmacogenetic Working Group (DPWG) recommendation and subsequently utilizing the results of a 12 gene PGx panel test to guide dose and drug selection. Pharmacists were invited for a general survey and a semi-structured interview based on the Tailored Implementation for Chronic Diseases (TICD) framework, aiming to identify implementation enablers and barriers, if they had managed at least two patients with actionable PGx results. In total, 15 semi-structured interviews were performed before saturation point was reached. Of these, five barrier themes emerged: (1) unclear procedures, (2) undetermined reimbursement for PGx test and consult, (3) insufficient evidence of clinical utility for PGx panel-testing, (4) infrastructure inefficiencies, and (5) HCP PGx knowledge and awareness; and two enabler themes: (1) pharmacist perceived role in delivering PGx, and (2) believed clinical utility of PGx. Despite a strong belief in the beneficial effects of PGx, pharmacists' barriers remain, an these hinder implementation in primary care.

Keywords: framework; implementation; panel-testing; pharmacist; pharmacogenomics; qualitative.

Figure 1

Pharmacist journey per enrolled patient. Pharmacists invite patients who initiate one of the 39 drugs with a Dutch Pharmacogenetics Working Group (DPWG) recommendation. After informed consent, a DNA sample is collected and sent to the Leiden University Medical Center Pharmacogenetics Lab for a pharmacogenomics (PGx) panel test encompassing 12 pharmacogenes. Actionable test results for the drug of enrolment are directly communicated to the pharmacist by phone and email. Other PGx test results are communicated by email. The pharmacist is responsible for recording the PGx results in the electronic medical record (EMR). The pharmacist may choose whether to adhere to the DPWG recommendations. Approval of the treating physician is required before any changes to the drug treatment can be made. Following the report of an actionable PGx result, a PGx recommendation specific survey is performed. Pharmacists were invited for a semi-structured interview and general survey if they had managed at least two patients with actionable PGx results.