Pharmacogenomic Testing to Support Prescribing in Primary Care: a Structured Review of Implementation Models

Abstract

The application of pharmacogenomics could meaningfully contribute toward medicines optimization within primary care. This review identified 13 studies describing eight implementation models utilizing a multi-gene pharmacogenomic panel within a primary care or community setting. These were small feasibility studies (n <200). They demonstrated importance and feasibility of pre-test counseling, the role of the pharmacist, data integration into the electronic medical record and point-of-care clinical decision support systems (CDSS). Findings were considered alongside existing primary care prescribing practices and implementation frameworks to demonstrate how issues may be addressed by existing nationalized healthcare and primary care infrastructure. Development of point-of-care CDSS should be prioritized; establishing clinical leadership, education programs, defining practitioner roles and responsibilities and addressing commissioning issues will also be crucial.

Keywords::

• community
• implementation
• medicines optimization
• pharmacogenomics
• prescribing
• primary care

Author contributions

J Hayward and N Qureshi conceived the article. J Hayward drafted the article with input from JH McDermott and WG Newman. JH McDermott and WG Newman offered critical input and reviewed all drafts. N Qureshi reviewed the final draft. All authors reviewed and agreed upon the final draft for submission.

Financial & competing interests disclosure

J Hayward was supported by University of Manchester and Health Education England Genomics Education Programme. The work of WG Newman is supported by the Manchester NIHR BRC (IS-BRC-1215-20007). J Hayward has a non-remunerated role with Congenica. The authors would like to thank North West Genomics Medicine Service Alliance for supporting this work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

J Hayward was supported by University of Manchester and Health Education England Genomics Education Programme. The work of WG Newman is supported by the Manchester NIHR BRC (IS-BRC-1215-20007). J Hayward has a non-remunerated role with Congenica. The authors would like to thank North West Genomics Medicine Service Alliance for supporting this work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.