Pharmacogenetic (PGx) testing can inform drug dosing and selection by assessing genetic variants known to impact risks of adverse response or non-effectiveness. Although multiple delivery models for PGx testing are currently being explored or used, it is not clear which models are most effective and can be implemented widely. Further, the availability and delivery of PGx testing, particularly in the outpatient settig, may vary considerably due in part to providers' knowledge and experience with testing. Pharmacists can play a key role in delivering PGx testing and interacting with both patients and providers. Through our previous research in this R01, we found having a pharmacist based in a primary care practice positively impacted physicians' use of PGx testing. In addition, PGx testing is beginning to be offered in community pharmacy settings. We propose to evaluate the impact of community pharmacist-delivered PGx testing as a stand-alone service or part of medication therapy management (or MTM). We intend to compare the effect of PGx alone and PGx with MTM from the pharmacy perspective (to assess impact on workflow/operations) and patient perspective (to assess acceptance of testing, understanding of results, medication adherence, and overall satisfaction with delivery model). We will gather data to assess the clinical utility o testing with respect to dosing or medication changes and medication adherence. A total of 20 North Carolina-based pharmacies will be recruited from the Community Pharmacist Pharmacogenetic Network (CPPN), a collection of community pharmacists who are interested in learning more about and utilizing PGx in their pharmacy. Using a cluster trial design, pharmacies will be randomized to the 'PGx+MTM Group' or the 'PGx-Only Group.' Since the proposed study will be implemented in a real-world setting, it will reflect the actual challenges faced by community pharmacists offering this new service. Eligible patients must have an active or new prescription for the select drugs for which PGx testing is available. All participating pharmacists will be required to complete a 2-part training module to be developed in Aim 1. In addition, all pharmacies will be provided with a patient educational toolkit and provider resources to facilitate both discussion about PGx testing with patients and interpretation of test results. Given the lack of evidence regarding the utility and feasibility of various approaches to delivering PGx testing, this study will provide valuable data regarding the feasibility of a pharmacist-delivered approach in a community pharmacy setting.

Public Health Relevance

With the expanding number of pharmacogenetic (PGx) tests that have been developed and the drug labels that have been revised to include information about PGx, it is essential to determine how best to deliver these tests to optimize patient acceptance, test utilization and clinical benefit. We will explore the feasibility and patient satisfaction with the provision of PGx testing in a community pharmacy setting, with the pharmacist playing a central role in the delivery of testing and patient counseling.

Agency
National Institute of Health (NIH)
Institute
National Institute of General Medical Sciences (NIGMS)
Type
Research Project (R01)
Project #
5R01GM081416-09
Application #
9315818
Study Section
Societal and Ethical Issues in Research Study Section (SEIR)
Program Officer
Long, Rochelle M
Project Start
2008-09-05
Project End
2019-07-31
Budget Start
2017-08-01
Budget End
2018-07-31
Support Year
9
Fiscal Year
2017
Total Cost
Indirect Cost
Name
Duke University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Haga, Susanne B; Kantor, Ariel (2018) Horizon Scan Of Clinical Laboratories Offering Pharmacogenetic Testing. Health Aff (Millwood) 37:717-723
Haga, Susanne B; Moaddeb, Jivan; Mills, Rachel et al. (2017) Assessing feasibility of delivering pharmacogenetic testing in a community pharmacy setting. Pharmacogenomics 18:327-335
Mills, Rachel; Ensinger, Megan; Callanan, Nancy et al. (2017) Development and Initial Assessment of a Patient Education Video about Pharmacogenetics. J Pers Med 7:
Haga, Susanne B (2017) Update: looking beyond the 100,000 Genome Project. Per Med 14:85-87
Haga, Susanne B; Mills, Rachel; Moaddeb, Jivan et al. (2017) Primary care providers' use of pharmacist support for delivery of pharmacogenetic testing. Pharmacogenomics 18:359-367
Haga, Susanne B (2017) Educating patients and providers through comprehensive pharmacogenetic test reports. Pharmacogenomics 18:1047-1050
Haga, Susanne B; Mills, Rachel (2016) A review of consent practices and perspectives for pharmacogenetic testing. Pharmacogenomics 17:1595-605
Haga, Susanne B; Mills, Rachel; Moaddeb, Jivan et al. (2016) Patient experiences with pharmacogenetic testing in a primary care setting. Pharmacogenomics 17:1629-1636
Haga, Susanne B; Moaddeb, Jivan (2016) Proposal for a pharmacogenetics certificate program for pharmacists. Pharmacogenomics 17:535-9
Haga, Susanne B; Mills, Rachel; Moaddeb, Jivan (2016) Evaluation of a pharmacogenetic educational toolkit for community pharmacists. Pharmacogenomics 17:1491-502

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