Bridging the pharmacogenomics knowledge gap: Study reveals current needs, strategies
Teresa Vo, PharmD
According to a recent survey of primary care physicians, cardiologists, and psychiatrists, nearly 20% of respondents reported ordering a pharmacogenetic test in the previous year. Respondents expressed a lack of familiarity with pharmacogenomics overall, and cited clinical factors such as not knowing which test to order or how to change drug therapy based on test results as negatively influencing their likelihood of ordering a test.
Information on the potential for differing patient responses based on genetic variability is included in FDA-approved labeling for over 100 medications. Many of these agents are routinely used without awareness of genetic factors that may influence drug response or adverse reactions. Physicians and pharmacists have expressed unfamiliarity with clinical use of pharmacogenomics data to inform drug therapy choices. Additional information is needed regarding educational needs and preferences of clinicians in this area.
Johansen Taber and colleagues conducted a survey of 300 primary care physicians, psychiatrists, and cardiologists practicing in the United States to investigate their knowledge and attitudes about pharmacogenomics. The 40-question survey was developed by American Medical Association staff; invitations were distributed through Epocrates (San Mateo, CA, USA) and the survey was administered online to 300 physicians between 25 and 64 years of age.
Approximately 60% of survey respondents were primary care physicians, 20% were psychiatrists, and 20% were cardiologists. When asked about the relative importance of several factors in choosing drug therapy regimens, genetic information was considered extremely or very important by only 27% of respondents. Conversely, over 90% of surveyed physicians considered medical history and adverse effects to be extremely or very important for this choice. Approximately 13% of respondents reported being extremely or very familiar with pharmacogenomics, with 11% of participants stating they had received formal training in pharmacogenomics.
Approximately 20% of physicians reported ordering a pharmacogenetic test in the past year, with significantly more cardiologists (32.2%) than psychiatrists (11.7%) having ordered a test (P < 0.05). Respondents most commonly cited not knowing what test to order (69.7%), lack of insurance coverage (52.7%), and uncertainty about the clinical value of the test (51.9%) as reasons why they had not ordered a test.
When asked about their preferences for an ideal pharmacogenomics resource, survey respondents indicated that this resource should provide information on interpreting test results, prescribing recommendations, effects on drug mechanism, and likely targeted patient populations. The majority of respondents expressed a preference for having this information available in either a web-based format or through a mobile application for smartphones or tablets.
Clinician knowledge regarding the effects of interindividual genetic variability on drug therapy choices is a critical element to successfully integrating this information into routine clinical practice. Study findings provided insight into the current standing of pharmacogenomic knowledge among physicians, barriers to use of such tests clinically, and perceived value of different educational approaches.
Notably, physicians consistently expressed a preference for information to support clinical decision making in an ideal pharmacogenomics educational resource. Authors pointed out that the existing Pharmacogenomics KnowledgeBase (PharmGKB) provides much of this information. “Efforts to increase awareness of currently available resources should be undertaken, and may partially address the pharmacogenomics knowledge gap,” study authors wrote. As frontline drug therapy experts, pharmacists are ideally poised to educate physicians about effects of genetic variability and increase awareness of useful clinical tools and resources.
Study limitations include a small sample size that was overrepresented by younger physicians and survey factors that may have supported selection of a physician population already somewhat familiar with genomics and/or pharmacogenomics.
Johansen Taber KA et al. Pharmacogenomic knowledge gaps and educational resource needs among physicians in selected specialties. Pharmgenomics Pers Med. 2014;7:145–62.