药物基因组学检测：澳大利亚医院对其临床应用价值的认知、采用的促进因素和阻碍因素。
Pharmacogenomic testing: perception of clinical utility, enablers and barriers to adoption in Australian hospitals.
机构信息
Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.
St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales.
出版信息
Intern Med J. 2022 Jul;52(7):1135-1143. doi: 10.1111/imj.15719. Epub 2022 Apr 5.
BACKGROUND
Despite healthcare professionals (HCP) endorsing the clinical utility of pharmacogenomics testing, use in clinical practice is limited.
AIMS
To assess HCP' perceptions of pharmacogenomic testing and identify barriers to implementation.
METHODS
HCP involved in prescribing decisions at three hospitals in Sydney, Australia, were invited to participate. The online survey assessed perceptions of pharmacogenomic testing, including: (i) demographic and practice variables; (ii) use, knowledge and confidence; (iii) perceived benefits; (iv) barriers to implementation; and (v) operational and/or system changes and personnel required to implement on site.
RESULTS
HCP were predominantly medical practitioners (75/107) and pharmacists (25/107). HCP perceived pharmacogenomic testing was beneficial to identify reasons for drug intolerance (85/95) and risk of side-effects (86/95). Although testing was considered relevant to their practice (79/100), few HCP (23/100) reported past or intended future use (26/100). Few HCP reported confidence in their ability to identify indications for pharmacogenomic testing (14/107), order tests (19/106) and communicate results with patients (16/107). Lack of clinical practice guidelines (62/79) and knowledge (54/77) were identified as major barriers to implementation of pharmacogenomics. Comprehensive reimbursement for testing and clinical practice guidelines, alongside models-of-care involving multidisciplinary teams and local clinical champions were suggested as strategies to facilitate implementation of pharmacogenomic testing into practice.
CONCLUSIONS
Pharmacogenomic testing was considered important to guide drug selection and dosing decisions. However, limited knowledge, low confidence and an absence of guidelines impede the use of pharmacogenomic testing. Establishment of local resources including multidisciplinary models-of-care was suggested to facilitate implementation of pharmacogenomics.
背景
尽管医疗保健专业人员（HCP）认可药物基因组学检测的临床实用性，但在临床实践中的应用仍然有限。
目的
评估 HCP 对药物基因组学检测的看法，并确定实施的障碍。
方法
邀请澳大利亚悉尼三家医院参与处方决策的 HCP 参与。在线调查评估了药物基因组学检测的看法，包括：（i）人口统计学和实践变量；（ii）使用、知识和信心；（iii）感知益处；（iv）实施障碍；以及（v）现场实施所需的运营和/或系统变更和人员。
结果
HCP 主要是医学从业者（75/107）和药剂师（25/107）。HCP 认为药物基因组学检测有助于确定药物不耐受的原因（85/95）和副作用风险（86/95）。尽管检测被认为与他们的实践相关（79/100），但很少有 HCP（23/100）报告过去或未来打算使用（26/100）。很少有 HCP 报告对自己识别药物基因组学检测适应症的能力有信心（14/107）、订购检测（19/106）和与患者沟通结果（16/107）。缺乏临床实践指南（62/79）和知识（54/77）被确定为实施药物基因组学的主要障碍。全面报销检测费用和临床实践指南，以及涉及多学科团队和当地临床冠军的护理模式，被建议作为促进药物基因组学检测纳入实践的策略。
结论
药物基因组学检测被认为对指导药物选择和剂量决策很重要。然而，有限的知识、低信心和缺乏指南阻碍了药物基因组学检测的使用。建议建立包括多学科护理模式在内的当地资源，以促进药物基因组学的实施。
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