van der Wouden Cathelijne H, Paasman Ellen, Teichert Martina, Crone Matty R, Guchelaar Henk-Jan, Swen Jesse J
Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Leiden Network for Personalised Therapeutics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
J Clin Med. 2020 Mar 17;9(3):814. doi: 10.3390/jcm9030814.
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.
尽管克服了许多实施障碍，但药物基因组学（PGx）小组检测在荷兰并非常规做法。因此，我们旨在研究参与PGx实施研究的药剂师对PGx小组检测的促成因素和障碍的看法。在此，药剂师识别初级保健患者，开始使用荷兰药物遗传学工作组（DPWG）推荐的39种药物之一，随后利用12基因PGx小组检测的结果来指导剂量和药物选择。如果药剂师至少管理过两名有可采取行动的PGx结果的患者，他们会被邀请参加基于慢性病定制实施（TICD）框架的一般调查和半结构化访谈，旨在识别实施促成因素和障碍。总共进行了15次半结构化访谈，直至达到饱和点。其中，出现了五个障碍主题：（1）程序不明确，（2）PGx检测和咨询的报销未确定，（3）PGx小组检测临床效用的证据不足，（4）基础设施效率低下，以及（5）医疗保健人员对PGx的知识和认识；以及两个促成因素主题：（1）药剂师认为在提供PGx方面的作用，以及（2）相信PGx的临床效用。尽管坚信PGx的有益效果，但药剂师面临的障碍仍然存在，这些障碍阻碍了其在初级保健中的实施。
