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What could a successful pharmacy pharmacogenomics service look like?

Community pharmacy-based pharmacogenomics (PGx) testing services should avoid holding pharmacy teams to certain targets, a study has recommended.

While “historically”, pharmacies have been given targets for the delivery of some services – such as medicine use reviews (MURs) – pharmacy-based PGx testing services should not pursue a “target number of tests”, according to the findings of a study published last week (April 9).

The research – which analysed the barriers and enablers to inform a service specification for the delivery of a community pharmacy-based PGx service – found that such a service would instead benefit from “having an outcome goal of optimising therapy and improving patient outcomes”.

What is pharmacogenomics?

The authors of the study – which include Day Lewis head of pharmacy Tim Rendell and David Wright, head of school of Allied Health Professions at the University of Leicester – explained PGx as a way of predicting “an individual’s response to drugs using DNA testing”.

While PGx testing services are often delivered via community pharmacies in other countries, no similar service has been set up in England, they found.

Under a pharmacy PGx testing service, the patient’s DNA would be collected via a cheek swab and sent to a laboratory. The community pharmacist would then use the results to review the patient’s medication and “make recommendations to their prescriber to amend their prescription”, the authors of the study indicated in March.

They believe that such a service would initially be privately funded, before being commissioned as an NHS service.

 

Remuneration on number of tests offers no incentives

 

One of the authors of the study, David Wright, told C+D today (April 14) that remunerating pharmacists’ work for the number of PGx tests completed would offer “no incentive to ensure that all results are acted upon or that we take full responsibility for the outcome”. 

 

Read more: ‘Super pharmacy’ CEO sets out plans for pharmacogenomics service

 

“This research identifies that for a PGx service to be valued by doctors and pharmacists, we need a remuneration model based on meaningful patient outcomes,” Professor Wright added.

However, the authors acknowledged that the study partially based its qualitative research on responses it had obtained from a “relatively small number of pharmacists”, who were consulted for the first stage of the study.

Another area of concern identified by the authors is that the “concept of genomics is a novel area of medicine and pharmacists may perceive that patients will be worried if they find out that medicines that they have been taking may have been inappropriate”.

The study also highlighted that pharmacists would welcome training materials and guidance “to overcome any actual or perceived skills gap in how to confidently offer and deliver the service to patients”.

 

Wright: PSNC should advocate for PGx service

 

Professor Wright told C+D that he believes the Pharmaceutical Services Negotiating Committee (PSNC) should be advocating for the introduction of this cost-effective service.

PSNC director of NHS services Alastair Buxton told C+D that “community pharmacy could be well placed to support the future use of this technology, where the NHS wishes to make it available via primary care”.

Professor Wright is hoping to apply for funding from the National Institute for Health and Care Research this year, “to set up the service on a small scale, so that we can properly learn from it and optimise its design before it becomes a national service”.

He believes that a pharmacy PGx service “could be located within the new medicine service” and could offer an opportunity to improve pharmaceutical care, while saving the NHS money.

“This service could be a real game changer for community pharmacy, as it has the potential to place them more centrally in the patient clinical pathway,” he added.

The Royal Pharmaceutical Society has also indicated in its submission for a review into primary care that pharmacy teams – and in particular those working within primary care settings, where most of the dispensing takes place – have a vital role to play in pharmacogenomics.

Meanwhile, in February, Alitam group CEO Feisal Nahaboo told C+D that around 70 of the chain's branches will start offering a “cutting edge” pharmacogenomics service later this year.

Scotland is also looking into pharmacogenomics. In November last year, NHS Scotland put out a contract worth £66 million for the development of “an integrated Pharmacogenomics and Pharmaceutical Clinical Decision Support Service for NHS Scotland”.

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