Pharmacogenomic knowledge gaps and educational resource needs among physicians in selected specialties

Abstract

Background

The use of pharmacogenomic testing in the clinical setting has the potential to improve the safety and effectiveness of drug therapy, yet studies have revealed that physicians lack knowledge about the topic of pharmacogenomics, and are not prepared to implement it in the clinical setting. This study further explores the pharmacogenomic knowledge deficit and educational resource needs among physicians.

Materials and methods

Surveys of primary care physicians, cardiologists, and psychiatrists were conducted.

Results

Few physicians reported familiarity with the topic of pharmacogenomics, but more reported confidence in their knowledge about the influence of genetics on drug therapy. Only a small minority had undergone formal training in pharmacogenomics, and a majority reported being unsure what type of pharmacogenomic tests were appropriate to order for the clinical situation. Respondents indicated that an ideal pharmacogenomic educational resource should be electronic and include such components as how to interpret pharmacogenomic test results, recommendations for prescribing, population subgroups most likely to be affected, and contact information for laboratories offering pharmacogenomic testing.

Conclusion

Physicians continue to demonstrate pharmacogenomic knowledge gaps, and are unsure about how to use pharmacogenomic testing in clinical practice. Educational resources that are clinically oriented and easily accessible are preferred by physicians, and may best support appropriate clinical implementation of pharmacogenomics.

Keywords:

• pharmacogenomics
• knowledge gap
• drug response
• educational resource

Supplementary material

Survey of primary care physicians, cardiologists, and psychiatrists: pharmacogenomics knowledge, use of testing, and need for a pharmacogenomic resource

I. DEMOGRAPHICS

1	In what state do you currently practice medicine? (Fill-in text box)
2	Please select your gender. ○ Male ○ Female
3	Which of the following ranges contains your age? ○ 18–24 ○ 25–34 ○ 35–44 ○ 45–54 ○ 55–64 ○ 65 or over
4	How many years have you been in practice since you completed your residency or fellowship? (Fill-in text box)
5	How many hours of direct patient care do you provide during a typical week? (Fill-in text box)
6	Please indicate which of the following best describes your medical specialty: ○ Allergy and immunology ○ Anesthesiology ○ Cardiology ○ Colon and rectal surgery ○ Dermatology ○ Emergency medicine ○ Endocrinology ○ Family medicine ○ Gastroenterology ○ Geriatrics ○ General medicine ○ Internal medicine ○ Nephrology ○ Neurology ○ Neurological surgery ○ Obstetrics and gynecology ○ Ophthalmology ○ Orthopaedic surgery ○ Otolaryngology ○ Pathology ○ Pediatrics ○ Physical medicine and rehabilitation ○ Physiatry ○ Plastic surgery ○ Podiatry ○ Pulmonology ○ Preventive medicine ○ Psychiatry ○ Radiology ○ Rheumatology ○ Surgery ○ Thoracic surgery ○ Urology ○ Other (specify) If answer to question 6 was not cardiology, family medicine, general medicine, internal medicine, or psychiatry, the survey was terminated at this point.
7	Which of the following best describes your primary practice setting? ○ Physician’s office, solo practice ○ Physician’s office, single specialty group practice ○ Multi-specialty group practice or clinic ○ Hospital, teaching ○ Hospital, non-teaching ○ Skilled nursing facility ○ Hospice ○ Urgent care facility ○ Home health agency ○ Other (please specify)
8	Do you use an electronic medical record (EMR) in your office? ○ Yes ○ No
9	Which, if any, of the following devices do you use to access healthcare-related information? Please select all that apply. ○ Smartphone ○ Tablet computer (eg, iPad) ○ Laptop/notebook computer ○ Desktop computer ○ Other (please specify)

II. CURRENT KNOWLEDGE/USAGE OF PHARMACOGENOMICS INFORMATION

How important are each of the following issues when choosing appropriate drug therapy/dosing regimens for your patients?

Table

17	How familiar are you with pharmacogenomics? ○ Extremely familiar ○ Very familiar ○ Somewhat familiar ○ Not very familiar ○ Not at all familiar Pharmacogenomics is the influence of genetic differences on the human variability in drug response. Please keep this definition in mind as you answer the following questions.
18	To what extent do you agree or disagree that you are confident in your knowledge about the influence of genetics on drug therapy? ○ Strongly agree ○ Somewhat agree ○ Neither agree nor disagree ○ Somewhat disagree ○ Strongly disagree
19	Have you had any type of formal training in pharmacogenomics? ○ Yes ○ No If answer to question 19 was “Yes”:
19a	In which of the following types of settings have you received formal training in pharmacogenomics? Please select all that apply. ○ Medical school ○ Residency training ○ Continuing medical education programs (CME) ○ Other (please specify)
20	Have you ordered a pharmacogenomic test within the last year (2011)? ○ Yes ○ No If answer to question 20 was “Yes”:
20a	What type of pharmacogenomic test(s) have you ordered in the last year (2011)? Please be specific in your response. (Fill-in text box) If answer to question 20 was “No”:
20b	Which of the following issues explain why you haven’t ordered a pharmacogenomic test for a patient in the last year (2011)? Please select all that apply. ○ Don’t know what test to order ○ Insurance doesn’t cover test ○ Uncertain about clinical value of test ○ Not applicable for my patients ○ Patient declined test ○ Privacy concerns ○ Other (please specify)
21	Do you anticipate ordering a pharmacogenomic test in the next year (2012)? ○ Yes ○ No If answer to question 21 was “Yes”:
21a	What type of pharmacogenomic test(s) do you anticipate ordering in the next year (2012)? Please be specific in your response. (Fill-in text box) If answer to question 21 was “No”:
21b	Which of the following issues explain why you don’t anticipate ordering a pharmacogenomic test in the next year (2012)? Please select all that apply. ○ Won’t know what test to order ○ Insurance won’t cover test ○ Uncertain about clinical value of test ○ Not applicable for my patients ○ Patient likely to decline test ○ Privacy concerns ○ Other (please specify)
22	Which, if any, of the following sources of information do you consult when you have questions about pharmacogenomics? Please select all that apply. ○ Scientific literature ○ Peer discussions ○ Medical association literature/guidelines/recommendations ○ Internet (eg, Google searches, WebMD, etc) ○ Drug labeling ○ Laboratory director/personnel ○ FDA website ○ Insurance company/payer ○ Other (please specify) ○ None of the above, have not consulted any sources
23	Do you feel that there are resources currently available that enable you to access the pharmacogenomics information you need or want to know? ○ Yes ○ No

III. PHARMACOGENOMICS KNOWLEDGE ASSESSMENT

24	To the best of your knowledge, which sections of the drug product labeling could contain pharmacogenomic information? Please select all that apply. ○ Black-box warning ○ Clinical pharmacology ○ Clinical studies ○ Indications and uses ○ Dosage and administration ○ Warnings or precautions ○ Adverse reactions ○ Drug interactions ○ Special populations ○ Other (please specify) ○ Don’t know
25	How helpful do you find the pharmacogenomics information typically included in drug labeling? ○ Extremely helpful ○ Very helpful ○ Somewhat helpful ○ Not very helpful ○ Not at all helpful
26	To the best of your knowledge, which of the following drugs elicit substantially variable population responses due to a patients’ genetic background? Please select all that apply. ○ Atomoxetine (Straterra®) ○ Atorvastatin (Lipitor®) ○ Captopril (Capoten®) ○ Carbamazaepine (Tegretol®) ○ Clopidrogel (Plavix®) ○ Fluconazole (Diflucan®) ○ Hydrochlorothiazide ○ Levo-thyroxine (Synthroid®) ○ Metoprolol (Lopressor®) ○ Quinidine ○ Warfarin ○ Don’t know
27	To the best of your knowledge, what is the most commonly recognized mechanism for pharmacogenomic differences in drug response? Is it mutations affecting …? ○ Drug metabolizing enzymes ○ Cellular receptors or drug targets ○ Membrane drug transporters ○ Human leukocyte antigens ○ Don’t know
28	Before today, were you aware of the abbreviation “CYP”? If yes, please explain. ○ Yes ○ No
29	To the best of your knowledge, approximately what percentage of the top 200 prescribed drugs is metabolized by an enzyme subject to pharmacogenomic variation? ○ <10% ○ 10%–25% ○ 26%–50% ○ 51%–75% ○ >75% ○ Don’t know

IV. CONCEPT OF IDEAL PHARMACOGENOMICS RESOURCE

30

Imagine an ideal resource that could be consulted when you have questions about pharmacogenomics or medications that may have pharmacogenomic properties. What type of content should be included in such a resource? Please select all that apply. ○ How to interpret pharmacogenomics test results ○ Description of pharmacogenomics information in drug labeling ○ Laboratories offering pharmacogenomic testing ○ Effect of genetic variation on mechanism of drug action ○ Recommendations (if any) for prescribing ○ Demographics of populations likely to carry genetic variations ○ References (scientific literature) ○ Other (please specify)

In which of the following types of formats would you prefer to use an ideal pharmacogenomics resource? Please rank each format by selecting a ‘1’ for your most preferred format, ‘2’ for your second most preferred format, and so on. A rank of ‘5’ represents your least preferred format. Use each number only once.

Table

36	Which of the following would be your preferred source for an ideal pharmacogenomic resource? ○ Professional/specialty society (please specify) ○ Health plans ○ Health care-related software company (eg, Epocrates) ○ Government ○ Other (please specify)

Acknowledgments

The authors wish to thank members of the AMA Market Research staff for their assistance in developing and fielding the survey. We also thank Modena Wilson, MD, MPH (AMA) for her helpful comments on the manuscript. The work presented in this paper was supported by the AMA.

Disclosure

The authors report no conflicts of interest in this work.