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Maruf AA, Aziz MA. The Potential Roles of Pharmacists in the Clinical Implementation of Pharmacogenomics. PHARMACY 2023; 11:180. [PMID: 37987390 PMCID: PMC10661263 DOI: 10.3390/pharmacy11060180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023] Open
Abstract
The field of pharmacogenomics is at the forefront of a healthcare revolution, promising to usher in a new era of precision medicine [...].
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Affiliation(s)
- Abdullah Al Maruf
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E OT5, Canada;
- Bangladesh Pharmacogenomics Research Network (BdPGRN), Dhaka 1219, Bangladesh
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4Z6, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Md. Abdul Aziz
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E OT5, Canada;
- Bangladesh Pharmacogenomics Research Network (BdPGRN), Dhaka 1219, Bangladesh
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2
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Dopheide JA, Werremeyer A, Haight RJ, Gutierrez CA, Williams AM. Positioning psychiatric pharmacists to improve mental health care. Ment Health Clin 2022; 12:77-85. [PMID: 35582321 PMCID: PMC9009818 DOI: 10.9740/mhc.2022.04.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/25/2022] [Indexed: 12/02/2022] Open
Abstract
Psychiatric pharmacy continues to grow and look to the future with a focus on helping individuals recover from mental health and substance use disorders. The American Association of Psychiatric Pharmacists (AAPP) considers Board Certified Psychiatric Pharmacist (BCPP) the gold standard credential that all psychiatric pharmacists should attain to demonstrate specialized knowledge and expertise in psychiatry. BCPPs are part of collaborative interprofessional teams and practice in hospitals, clinics, and diverse health systems. Two out of 3 BCPPs practicing in clinics have prescriptive authority. BCPPs improve access, safety, medication adherence, and therapeutic outcomes. Every person with a mental health and substance use disorder should have access to a BCPP providing comprehensive medication management (CMM) and psychotropic stewardship aimed at improving population health. BCPPs are in demand owing to their expertise. AAPP envisions growth and expansion of the BCPP role in many areas including coordinating psychiatric transitions of care and telehealth services, managing long-acting injectable medication clinics, providing pharmacogenomic consultation, conducting clozapine and lithium monitoring, managing medications for substance use disorders, leading medication groups, CNS drug development, research, and provider education. To prepare the workforce, colleges and schools of pharmacy should hire BCPPs for optimal curriculum development, and each student pharmacist should have an opportunity to develop a therapeutic alliance with a person recovering from psychiatric illness. Postgraduate year (PGY) 1 residencies should offer learning experiences in psychiatric pharmacy to prepare residents to enter an expanded number of PGY2 psychiatric pharmacy residencies, ultimately earning their BCPP and being well positioned to improve mental health care.
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Affiliation(s)
| | - Amy Werremeyer
- Professor and Chair, North Dakota State University, Fargo, North Dakota
| | - Robert J. Haight
- Clinicial Pharmacist, Saint Peter Regional Treatment Center and Southern Cities Clinic, Minnesota Department of Human Services, Saint Peter, Minnesota
| | | | - Andrew M. Williams
- Supervising Clinical Pharmacist, Riverside University Health System, Riverside, California
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3
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Del Toro-Pagán NM, Matos A, Bardolia C, Michaud V, Turgeon J, Amin NS. Pharmacist assessment of drug-gene interactions and drug-induced phenoconversion in major depressive disorder: a case report. BMC Psychiatry 2022; 22:46. [PMID: 35057765 PMCID: PMC8772164 DOI: 10.1186/s12888-021-03659-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Response to antidepressant therapy is highly variable among individuals. Pharmacogenomic (PGx) testing presents an opportunity to guide drug selection while optimizing therapy outcomes and/or decreasing the risk for toxicity. CASE PRESENTATION A patient with multiple comorbidities, including severe major depressive disorder (MDD), experienced adverse drug events and undesirable response to multiple antidepressant medications (i.e., bupropion, escitalopram, and venlafaxine). A clinical pharmacist assessed significant drug-gene, drug-drug, and drug-drug-gene interactions as well as other clinical factors to provide recommendations for antidepressant therapy optimization. CONCLUSION This case highlights the importance of PGx testing and the key role of pharmacists in identifying and mitigating drug-related problems and optimizing drug therapy in patients with MDD.
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Affiliation(s)
- N. M. Del Toro-Pagán
- Office of Translational Research and Residency Programs, Tabula Rasa HealthCare, 228 Strawbridge Drive, Moorestown, NJ 08057 USA
| | - A. Matos
- Office of Translational Research and Residency Programs, Tabula Rasa HealthCare, 228 Strawbridge Drive, Moorestown, NJ 08057 USA
| | - C. Bardolia
- Office of Translational Research and Residency Programs, Tabula Rasa HealthCare, 228 Strawbridge Drive, Moorestown, NJ 08057 USA
| | - V. Michaud
- Precision Pharmacotherapy Research & Development Institute, Tabula Rasa HealthCare, Lake Nona, FL USA ,grid.14848.310000 0001 2292 3357Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - J. Turgeon
- Precision Pharmacotherapy Research & Development Institute, Tabula Rasa HealthCare, Lake Nona, FL USA ,grid.14848.310000 0001 2292 3357Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - N. S. Amin
- Office of Translational Research and Residency Programs, Tabula Rasa HealthCare, 228 Strawbridge Drive, Moorestown, NJ 08057 USA
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Rahma AT, Elbarazi I, Ali BR, Patrinos GP, Ahmed LA, Elsheik M, Al-Maskari F. Development of the pharmacogenomics and genomics literacy framework for pharmacists. Hum Genomics 2021; 15:62. [PMID: 34656176 PMCID: PMC8520199 DOI: 10.1186/s40246-021-00361-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/05/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pharmacists play a unique role in integrating genomic medicine and pharmacogenomics into the clinical practice and to translate pharmacogenomics from bench to bedside. However, the literature suggests that the knowledge gap in pharmacogenomics is a major challenge; therefore, developing pharmacists' skills and literacy to achieve this anticipated role is highly important. We aim to conceptualize a personalized literacy framework for the adoption of genomic medicine and pharmacogenomics by pharmacists in the United Arab Emirates with possible regional and global relevance. RESULTS A qualitative approach using focus groups was used to design and to guide the development of a pharmacogenomics literacy framework. The Health Literacy Skills framework was used as a guide to conceptualize the pharmacogenomics literacy for pharmacists. The framework included six major components with specific suggested factors to improve pharmacists' pharmacogenomics literacy. Major components include individual inputs, demand, skills, knowledge, attitude and sociocultural factors. CONCLUSION This framework confirms a holistic bottom-up approach toward the implementation of pharmacogenomics. Personalized medicine entails personalized efforts and frameworks. Similar framework can be created for other healthcare providers, patients and stakeholders.
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Affiliation(s)
- Azhar T Rahma
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, Abu Dhabi, UAE
| | - Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, Abu Dhabi, UAE
| | - Bassam R Ali
- Department of Genetics and Genomics, College of Medicine and Health Science, United Arab Emirates University, P.O. Box 17666, Al Ain, Abu Dhabi, UAE.,Zayed Center for Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, Abu Dhabi, UAE
| | - George P Patrinos
- Department of Genetics and Genomics, College of Medicine and Health Science, United Arab Emirates University, P.O. Box 17666, Al Ain, Abu Dhabi, UAE.,Zayed Center for Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, Abu Dhabi, UAE.,Department of Pharmacy, School of Health Sciences, University of Patras, 26504, Patras, Greece
| | - Luai A Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, Abu Dhabi, UAE.,Zayed Center for Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, Abu Dhabi, UAE
| | - Mahanna Elsheik
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, Abu Dhabi, UAE.,Zayed Center for Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, Abu Dhabi, UAE
| | - Fatma Al-Maskari
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, Abu Dhabi, UAE. .,Zayed Center for Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, Abu Dhabi, UAE.
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5
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Goldstone LW, DiPaula BA, Werremeyer A, Botts S, Hepburn B, Liu HY, Duckworth K, Young AS, Kelly DL. The Role of Board-Certified Psychiatric Pharmacists in Expanding Access to Care and Improving Patient Outcomes. Psychiatr Serv 2021; 72:794-801. [PMID: 33940946 DOI: 10.1176/appi.ps.202000066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Although approximately 20% of adults in the United States experience a mental health condition annually, there continues to be a gap in the provision of care because of a shortage of behavioral health providers. The National Council for Behavioral Health Medical Director Institute has recommended that the number of board-certified psychiatric pharmacists (BCPPs), who are clinical pharmacists with advanced specialized training and experience in the treatment of patients with psychiatric and substance use disorders, be expanded to help meet this need. Although BCPPs currently assist in expanding care access, improving medication-related outcomes, and reducing health care costs by working collaboratively with physicians and other health care providers, BCPPs are often underutilized. This lack of utilization results in lost opportunity to better address the needs of persons with psychiatric or substance use disorders and to meet these needs in a timely manner. Here, the authors bring attention to five key areas-opioid use disorder, antipsychotic use among children, long-acting injectable antipsychotics, clozapine use, and transitions of care and care coordination-in which BCPPs, along with other pharmacists, provide evidence-based care and could be more extensively used as a collaborative solution to the mental health and substance use disorder crisis in the United States.
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Affiliation(s)
- Lisa W Goldstone
- School of Pharmacy, University of Southern California, Los Angeles (Goldstone); School of Pharmacy (DiPaula) and School of Medicine (Kelly), University of Maryland, Baltimore; School of Pharmacy, North Dakota State University, Fargo (Werremeyer); Kaiser Permanente and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver (Botts); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); University of Nebraska Medical Center, Lincoln (Liu); National Alliance on Mental Illness, Arlington, Virginia (Duckworth); Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Young); Maryland Psychiatric Research Center, Baltimore (Kelly)
| | - Bethany A DiPaula
- School of Pharmacy, University of Southern California, Los Angeles (Goldstone); School of Pharmacy (DiPaula) and School of Medicine (Kelly), University of Maryland, Baltimore; School of Pharmacy, North Dakota State University, Fargo (Werremeyer); Kaiser Permanente and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver (Botts); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); University of Nebraska Medical Center, Lincoln (Liu); National Alliance on Mental Illness, Arlington, Virginia (Duckworth); Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Young); Maryland Psychiatric Research Center, Baltimore (Kelly)
| | - Amy Werremeyer
- School of Pharmacy, University of Southern California, Los Angeles (Goldstone); School of Pharmacy (DiPaula) and School of Medicine (Kelly), University of Maryland, Baltimore; School of Pharmacy, North Dakota State University, Fargo (Werremeyer); Kaiser Permanente and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver (Botts); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); University of Nebraska Medical Center, Lincoln (Liu); National Alliance on Mental Illness, Arlington, Virginia (Duckworth); Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Young); Maryland Psychiatric Research Center, Baltimore (Kelly)
| | - Sheila Botts
- School of Pharmacy, University of Southern California, Los Angeles (Goldstone); School of Pharmacy (DiPaula) and School of Medicine (Kelly), University of Maryland, Baltimore; School of Pharmacy, North Dakota State University, Fargo (Werremeyer); Kaiser Permanente and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver (Botts); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); University of Nebraska Medical Center, Lincoln (Liu); National Alliance on Mental Illness, Arlington, Virginia (Duckworth); Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Young); Maryland Psychiatric Research Center, Baltimore (Kelly)
| | - Brian Hepburn
- School of Pharmacy, University of Southern California, Los Angeles (Goldstone); School of Pharmacy (DiPaula) and School of Medicine (Kelly), University of Maryland, Baltimore; School of Pharmacy, North Dakota State University, Fargo (Werremeyer); Kaiser Permanente and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver (Botts); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); University of Nebraska Medical Center, Lincoln (Liu); National Alliance on Mental Illness, Arlington, Virginia (Duckworth); Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Young); Maryland Psychiatric Research Center, Baltimore (Kelly)
| | - Howard Y Liu
- School of Pharmacy, University of Southern California, Los Angeles (Goldstone); School of Pharmacy (DiPaula) and School of Medicine (Kelly), University of Maryland, Baltimore; School of Pharmacy, North Dakota State University, Fargo (Werremeyer); Kaiser Permanente and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver (Botts); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); University of Nebraska Medical Center, Lincoln (Liu); National Alliance on Mental Illness, Arlington, Virginia (Duckworth); Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Young); Maryland Psychiatric Research Center, Baltimore (Kelly)
| | - Ken Duckworth
- School of Pharmacy, University of Southern California, Los Angeles (Goldstone); School of Pharmacy (DiPaula) and School of Medicine (Kelly), University of Maryland, Baltimore; School of Pharmacy, North Dakota State University, Fargo (Werremeyer); Kaiser Permanente and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver (Botts); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); University of Nebraska Medical Center, Lincoln (Liu); National Alliance on Mental Illness, Arlington, Virginia (Duckworth); Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Young); Maryland Psychiatric Research Center, Baltimore (Kelly)
| | - Alexander S Young
- School of Pharmacy, University of Southern California, Los Angeles (Goldstone); School of Pharmacy (DiPaula) and School of Medicine (Kelly), University of Maryland, Baltimore; School of Pharmacy, North Dakota State University, Fargo (Werremeyer); Kaiser Permanente and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver (Botts); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); University of Nebraska Medical Center, Lincoln (Liu); National Alliance on Mental Illness, Arlington, Virginia (Duckworth); Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Young); Maryland Psychiatric Research Center, Baltimore (Kelly)
| | - Deanna L Kelly
- School of Pharmacy, University of Southern California, Los Angeles (Goldstone); School of Pharmacy (DiPaula) and School of Medicine (Kelly), University of Maryland, Baltimore; School of Pharmacy, North Dakota State University, Fargo (Werremeyer); Kaiser Permanente and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver (Botts); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); University of Nebraska Medical Center, Lincoln (Liu); National Alliance on Mental Illness, Arlington, Virginia (Duckworth); Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Young); Maryland Psychiatric Research Center, Baltimore (Kelly)
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Papastergiou J, Quilty LC, Li W, Thiruchselvam T, Jain E, Gove P, Mandlsohn L, van den Bemt B, Pojskic N. Pharmacogenomics guided versus standard antidepressant treatment in a community pharmacy setting: A randomized controlled trial. Clin Transl Sci 2021; 14:1359-1368. [PMID: 33641259 PMCID: PMC8301569 DOI: 10.1111/cts.12986] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 12/15/2022] Open
Abstract
The literature on pharmacogenomics as a tool to support antidepressant precision is burgeoning. Recently, a more active role has been argued for pharmacists in pharmacogenomic testing, with both pharmacists and family physicians perceiving pharmacist‐led testing as a valuable method by which to scale this innovation for depression treatment. In this prospective, single‐blind randomized controlled design, we evaluated the impact of pharmacogenomics guided versus standard antidepressant treatment of depression and anxiety, implemented in three large community pharmacies. Participants were 213 outpatients diagnosed with major depressive disorder and/or generalized anxiety disorder, randomized to receive pharmacogenomics guided (n = 105) or standard antidepressant treatment (n = 108); participants were blinded to the study. Patient reported outcomes of depression, anxiety, disability, and treatment satisfaction were assessed at months 0, 1, 3, and 6. Hypotheses were investigated using mixed effect models on the full data. All clinical outcomes improved significantly. The primary outcome (depression) and two secondary outcomes (generalized anxiety and disability) exhibited significant time by group interactions indicating that they improved for participants who received pharmacogenomics guided treatment more so than they did for participants who received standard treatment. Treatment satisfaction improved similarly for both groups. Results contribute to a growing body of work evaluating the impact of pharmacogenomics testing to inform antidepressant medication treatment for depression and anxiety, and provides important initial evidence for the role of pharmacists in care delivery. Pharmacogenomic testing may be a valuable tool to allow pharmacists to more effectively collaborate in facilitating clinical treatment decisions. ClinicalTrials.gov registration: (NCT03591224).
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Affiliation(s)
- John Papastergiou
- University of Toronto, Toronto, Ontario, Canada.,University of Waterloo, Kitchener, Ontario, Canada.,Shoppers Drug Mart, Toronto, Ontario, Canada
| | - Lena C Quilty
- University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Wilson Li
- Shoppers Drug Mart, Toronto, Ontario, Canada
| | - Thulasi Thiruchselvam
- University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Esha Jain
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Gove
- Green Shield Canada, Toronto, Ontario, Canada
| | | | - Bart van den Bemt
- Sint Maartenskliniek, Nijmegen, The Netherlands.,Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nedzad Pojskic
- University of Toronto, Toronto, Ontario, Canada.,Green Shield Canada, Toronto, Ontario, Canada
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7
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Genomics and Pharmacogenomics Knowledge, Attitude and Practice of Pharmacists Working in United Arab Emirates: Findings from Focus Group Discussions-A Qualitative Study. J Pers Med 2020; 10:jpm10030134. [PMID: 32962013 PMCID: PMC7563679 DOI: 10.3390/jpm10030134] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/29/2020] [Accepted: 09/15/2020] [Indexed: 02/05/2023] Open
Abstract
(1) Background: Genomics and pharmacogenomics are relatively new fields in medicine in the United Arab Emirates (UAE). Understanding the knowledge, attitudes and current practices among pharmacists is an important pillar to establish the roadmap for implementing genomic medicine and pharmacogenomics; (2) Methods: A qualitative method was used, with focus group discussions (FGDs) being conducted among pharmacists working in public and private hospitals in Abu Dhabi Emirate. Snowball sampling was used. Thematic inductive analysis was performed by two researchers independently. NVIVO software was used to establish the themes; (3) Results: Lack of knowledge of genomics and pharmacogenomics among pharmacists was one of the most prominent findings. Therefore, the role of pharmacist in making the right decisions was highlighted to be a barrier for pharmacogenomics implementation in the UAE. Pharmacists have a positive attitude toward pharmacogenomics, but they are preoccupied with concern of confidentiality. In addition, religion and culture shadowed their attitudes toward genetic testing; (4) Conclusions: It is highly recommended to introduce new courses and training workshops for healthcare providers to improve the opportunities for genomics and pharmacogenomics application in the UAE. Pharmacists agreed that the health authorities should take the lead for improving trust and confidence in the system for a better future in the era of genomics and pharmacogenomics.
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