Papastergiou John, Tolios Peter, Li Wilson, Li Jane
J Am Pharm Assoc (2003). 2017 Sep-Oct;57(5):624-629. doi: 10.1016/j.japh.2017.05.006. Epub 2017 Jul 6.
The safety and efficacy of medications can vary significantly between patients as a result of genetic variability. As genomic screening technologies become more widely available, pharmacists are ideally suited to use such tools to optimize medication therapy management. The objective of this study was to evaluate the feasibility of implementing personalized medication services into community pharmacy practice and to assess the number of drug therapy problems identified as a result of pharmacogenomic screening.
The study was conducted in 2 busy urban community pharmacies, operating under the brand Shoppers Drug Mart, in Toronto, Ontario.
Pharmacists offered pharmacogenomic screening as part of their professional services program. Eligible patients received a buccal swab followed by DNA analysis with the use of Pillcheck. Pillcheck is a genotyping assay that translates genomic data and generates a personalized evidence-based report that provides insight into patients' inherited drug metabolic profile. After receiving the report, pharmacists invited patients back to the clinic for interpretation of the results. Clinically significant drug therapy problems were identified and recommendations for medication optimization forwarded to the primary care physician.
One hundred patients were enrolled in the study. Average age was 56.7 years, and patients were taking a mean of 4.9 chronic medications. Pharmacists cited the most common reasons for testing as ineffective therapy (43.0%), to address an adverse reaction (32.6%), and to guide initiation of therapy (10.4%). An average of 1.3 drug therapy problems directly related to pharmacogenomic testing were identified per patient. Pharmacist recommendations included change in therapy (60.3%), dose adjustment (13.2%), discontinuation of a drug (4.4%), and increased monitoring (22.1%).
These results highlight the readiness of community pharmacists to adopt pharmacogenomic screening into practice and their ability to leverage this novel technology to positively affect medication therapy management. Community pharmacists are ideally suited to both offer personalized medication services and interpret genomic results.
由于基因变异性，药物的安全性和有效性在患者之间可能存在显著差异。随着基因组筛查技术的广泛应用，药剂师非常适合使用此类工具来优化药物治疗管理。本研究的目的是评估在社区药房实践中实施个性化药物服务的可行性，并评估基因检测筛查所发现的药物治疗问题的数量。
该研究在安大略省多伦多市两家繁忙的城市社区药房进行，药房以Shoppers Drug Mart品牌运营。
药剂师提供基因检测筛查作为其专业服务项目的一部分。符合条件的患者接受口腔拭子采样，随后使用Pillcheck进行DNA分析。Pillcheck是一种基因分型检测方法，可转化基因组数据并生成个性化的循证报告，提供患者遗传药物代谢谱的相关信息。收到报告后，药剂师邀请患者返回诊所解读结果。确定具有临床意义的药物治疗问题，并将药物优化建议转发给初级保健医生。
100名患者参与了该研究。平均年龄为56.7岁，患者平均服用4.9种慢性药物。药剂师列举的检测最常见原因是治疗无效（43.0%）、解决不良反应（32.6%）以及指导治疗开始（10.4%）。每位患者平均识别出1.3个与基因检测直接相关的药物治疗问题。药剂师的建议包括改变治疗方案（60.3%）、调整剂量（13.2%）、停药（4.4%）以及加强监测（22.1%）。
这些结果突出了社区药剂师将基因检测筛查纳入实践的意愿，以及他们利用这项新技术对药物治疗管理产生积极影响的能力。社区药剂师非常适合提供个性化药物服务并解读基因组结果。
