Abstract
Introduction: Pharmacogenomics is using a patient’s genetic information to predict their likely response to a medicine. There is evidence that patients who receive pharmacogenomic-guided care benefit from a reduction in clinically significant adverse drug reactions. Therefore, pharmacogenomic testing can be used as a medicines optimisation tool to prevent adverse drug reactions in older people and reduce associated hospital admissions. This qualitative study aimed to identify the facilitators and barriers to implementing pharmacogenomic-guided prescribing in acute care for older patients by examining the views of patients, pharmacists and physicians.
Method: Following consent, patients (aged 65+), pharmacists and physicians across two hospital sites, participated in a semi-structured interview. The interviews were transcribed and analysed using the Framework approach to identify themes describing barriers or facilitators to implementing pharmacogenomic-guided care. Patient interviews were analysed separately from the healthcare professional interviews and supporting quotes were selected to illustrate each theme.
Results: Nine patients, six pharmacists and five physicians participated in the study. Framework analysis of the patient interview transcripts identified three themes: (1) Information delivery (2) Standard of care (3) Participation in pharmacogenomic-guided care. Framework analysis of the professional interviews produced the themes: (1) Level of interest (2) Workforce pressures (3) Support required for the workforce. Professionals do not have enough knowledge of pharmacogenomic-guided care to confidently apply it to their clinical practice. Patients want to be involved in pharmacogenomic-guided prescribing decisions so pharmacogenomics does not feel imposed on them.
Conclusion(s): Older patients view pharmacogenomic-guided care as therapeutically beneficial and would like to be involved in pharmacogenomic-guided prescribing decisions, with information about pharmacogenomic-guided care tailored to their information-seeking preferences. Professionals envisage pharmacogenomic-guided care as potentially useful in improving their prescribing and medicines reviews but are concerned that operational pressures could make its implementation impractical.