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Sharma V, McDermott J, Keen J, Foster S, Whelan P, Newman W. Pharmacogenetics Clinical Decision Support Systems for Primary Care in England: Co-Design Study. J Med Internet Res 2024; 26:e49230. [PMID: 39042886 PMCID: PMC11303890 DOI: 10.2196/49230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/22/2023] [Accepted: 05/13/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Pharmacogenetics can impact patient care and outcomes through personalizing the selection of medicines, resulting in improved efficacy and a reduction in harmful side effects. Despite the existence of compelling clinical evidence and international guidelines highlighting the benefits of pharmacogenetics in clinical practice, implementation within the National Health Service in the United Kingdom is limited. An important barrier to overcome is the development of IT solutions that support the integration of pharmacogenetic data into health care systems. This necessitates a better understanding of the role of electronic health records (EHRs) and the design of clinical decision support systems that are acceptable to clinicians, particularly those in primary care. OBJECTIVE Explore the needs and requirements of a pharmacogenetic service from the perspective of primary care clinicians with a view to co-design a prototype solution. METHODS We used ethnographic and think-aloud observations, user research workshops, and prototyping. The participants for this study included general practitioners and pharmacists. In total, we undertook 5 sessions of ethnographic observation to understand current practices and workflows. This was followed by 3 user research workshops, each with its own topic guide starting with personas and early ideation, through to exploring the potential of clinical decision support systems and prototype design. We subsequently analyzed workshop data using affinity diagramming and refined the key requirements for the solution collaboratively as a multidisciplinary project team. RESULTS User research results identified that pharmacogenetic data must be incorporated within existing EHRs rather than through a stand-alone portal. The information presented through clinical decision support systems must be clear, accessible, and user-friendly as the service will be used by a range of end users. Critically, the information should be displayed within the prescribing workflow, rather than discrete results stored statically in the EHR. Finally, the prescribing recommendations should be authoritative to provide confidence in the validity of the results. Based on these findings we co-designed an interactive prototype, demonstrating pharmacogenetic clinical decision support integrated within the prescribing workflow of an EHR. CONCLUSIONS This study marks a significant step forward in the design of systems that support pharmacogenetic-guided prescribing in primary care settings. Clinical decision support systems have the potential to enhance the personalization of medicines, provided they are effectively implemented within EHRs and present pharmacogenetic data in a user-friendly, actionable, and standardized format. Achieving this requires the development of a decoupled, standards-based architecture that allows for the separation of data from application, facilitating integration across various EHRs through the use of application programming interfaces (APIs). More globally, this study demonstrates the role of health informatics and user-centered design in realizing the potential of personalized medicine at scale and ensuring that the benefits of genomic innovation reach patients and populations effectively.
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Affiliation(s)
- Videha Sharma
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, United Kingdom
- Pankhurst Institute for Health Technology Research and Innovation, University of Manchester, Manchester, United Kingdom
| | - John McDermott
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Evolution, Infection and Genomics, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Jessica Keen
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Simon Foster
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, United Kingdom
| | - Pauline Whelan
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, United Kingdom
| | - William Newman
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Salas-Hernández A, Galleguillos M, Carrasco M, López-Cortés A, Redal MA, Fonseca-Mendoza D, Esperón P, González-Martínez F, Lares-Asseff I, Lazarowski A, Loera-Castañeda V, Remírez D, Martínez MF, Vargas R, Rios-Santos F, Macho A, Cayún JP, Perez GR, Gutierrez C, Cerpa LC, Leiva T, Calfunao S, Xajil L, Sandoval C, Suárez M, Gonzalez A, Echeverría-Garcés G, Sullón-Dextre L, Cordero-García E, Morales AR, Avendaño A, Sánchez E, Bastone LC, Lara C, Zuluaga-Arias P, Soler AM, Da Luz J, Burgueño-Rodríguez G, Vital M, Reyes-Reyes E, Huaccha A, Ariza YV, Tzul N, Rendón AL, Serrano R, Acosta L, Motta-Pardo A, Beltrán-Angarita L, Brand E, Jiménez MA, Hidalgo-Lozada GM, Romero-Prado MMJ, Escobar-Castro K, Umaña-Rivas M, Vivas JD, Lagos P, Martínez YB, Quesada S, Calfio C, Arias ML, Lavanderos MA, Cáceres DD, Salazar-Granara A, Varela NM, Quiñones LA. An updated examination of the perception of barriers for pharmacogenomics implementation and the usefulness of drug/gene pairs in Latin America and the Caribbean. Front Pharmacol 2023; 14:1175737. [PMID: 37251329 PMCID: PMC10213898 DOI: 10.3389/fphar.2023.1175737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Pharmacogenomics (PGx) is considered an emergent field in developing countries. Research on PGx in the Latin American and the Caribbean (LAC) region remains scarce, with limited information in some populations. Thus, extrapolations are complicated, especially in mixed populations. In this paper, we reviewed and analyzed pharmacogenomic knowledge among the LAC scientific and clinical community and examined barriers to clinical application. We performed a search for publications and clinical trials in the field worldwide and evaluated the contribution of LAC. Next, we conducted a regional structured survey that evaluated a list of 14 potential barriers to the clinical implementation of biomarkers based on their importance. In addition, a paired list of 54 genes/drugs was analyzed to determine an association between biomarkers and response to genomic medicine. This survey was compared to a previous survey performed in 2014 to assess progress in the region. The search results indicated that Latin American and Caribbean countries have contributed 3.44% of the total publications and 2.45% of the PGx-related clinical trials worldwide thus far. A total of 106 professionals from 17 countries answered the survey. Six major groups of barriers were identified. Despite the region's continuous efforts in the last decade, the primary barrier to PGx implementation in LAC remains the same, the "need for guidelines, processes, and protocols for the clinical application of pharmacogenetics/pharmacogenomics". Cost-effectiveness issues are considered critical factors in the region. Items related to the reluctance of clinicians are currently less relevant. Based on the survey results, the highest ranked (96%-99%) gene/drug pairs perceived as important were CYP2D6/tamoxifen, CYP3A5/tacrolimus, CYP2D6/opioids, DPYD/fluoropyrimidines, TMPT/thiopurines, CYP2D6/tricyclic antidepressants, CYP2C19/tricyclic antidepressants, NUDT15/thiopurines, CYP2B6/efavirenz, and CYP2C19/clopidogrel. In conclusion, although the global contribution of LAC countries remains low in the PGx field, a relevant improvement has been observed in the region. The perception of the usefulness of PGx tests in biomedical community has drastically changed, raising awareness among physicians, which suggests a promising future in the clinical applications of PGx in LAC.
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Affiliation(s)
- Aimeé Salas-Hernández
- Department of Pharmacology, Toxicology and Pharmaco-Dependence, Faculty of Pharmacy, University of Costa Rica, San Jose, Costa Rica
| | - Macarena Galleguillos
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Matías Carrasco
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Andrés López-Cortés
- Cancer Research Group (CRG), Faculty of Medicine, Universidad de Las Américas, Quito, Ecuador
| | - María Ana Redal
- Molecular Diagnostic Laboratory, Genetics Division, Faculty of Medicine, Hospital de Clínicas José de San Martín, University of Buenos Aires, Buenos Aires, Argentina
| | - Dora Fonseca-Mendoza
- Universidad del Rosario, School of Medicine and Health Sciences, Center for Research in Genetics and Genomics (CIGGUR), Institute of Translational Medicine (IMT), Bogotá, Colombia
| | - Patricia Esperón
- Molecular Genetic Unit, School of Chemistry, Universidad de la República, General Flores, CP 1800 2124, Montevideo, Uruguay
| | - Farith González-Martínez
- Toxicology and Public Health Research Laboratory, Department of Research, Faculty of Dentistry, University of Cartagena, Cartagena, Colombia
| | - Ismael Lares-Asseff
- Academy of Genomics and Laboratory of Pharmacogenomics and Molecular Biomedicine, Instituto Politécnico Nacional, CIIDIR-Unidad Durango, Durango, Mexico
| | - Alberto Lazarowski
- Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires- Argentina, Buenos Aires, Argentina
| | - Verónica Loera-Castañeda
- Academy of Genomics and Laboratory of Pharmacogenomics and Molecular Biomedicine, Instituto Politécnico Nacional, CIIDIR-Unidad Durango, Durango, Mexico
| | | | - Matías F. Martínez
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Santiago, Chile
- Department of Pharmaceutical Sciences and Technology, Faculty of Chemical and Pharmaceutical Sciences, University of Chile, Santiago, Chile
| | - Rodrigo Vargas
- Department of Molecular Biology, Galileo University, Guatemala City, Guatemala
| | - Fabricio Rios-Santos
- Department of Health. Faculty of Medicine, Federal University of Mato Grosso (UFMT), Cuibá, Brazil
| | - Antonio Macho
- Morphology and Applied Immunology Research Center (NuPMIA), University of Brasilia (UnB), Brasília, Brazil
| | - Juan P. Cayún
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Germán R. Perez
- Department of Microbiology, Faculty of Biochemical and Pharmaceutical Sciences. National University of Rosario, Rosario, Argentina
| | - Carolina Gutierrez
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Leslie C. Cerpa
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Tamara Leiva
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Susan Calfunao
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Santiago, Chile
- Laboratory Pathological Anatomy, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Lesly Xajil
- Department of Research in Pharmacogenomics, Faculty of Chemical Sciences and Pharmacy, University of San Carlos de Guatemala, Guatemala, Guatemala
| | - Christopher Sandoval
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Santiago, Chile
- Clinical Laboratory Blood Biochemistry and Immunoassay Section, Hospital Clínico Félix Bulnes Cerda, Santiago, Chile
| | - Marcelo Suárez
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Santiago, Chile
- Pharmacy Service, Hospital UC-Christus, Santiago, Chile
| | | | | | | | - Eugenia Cordero-García
- Department of Pharmacology, Toxicology and Pharmaco-Dependence, Faculty of Pharmacy, University of Costa Rica, San Jose, Costa Rica
| | - Alexis R. Morales
- Department of Toxicology and Pharmacology, Faculty of Pharmacy and Bioanalisis, University of Los Andes, Merida, Venezuela
| | - Andrea Avendaño
- Department of Pediatrics, Medical Genetics Unity, Faculty of Medicine, University of Los Andes, Mérida, Venezuela
| | | | - Laura C. Bastone
- Laboratorio de Medicina Genómica, Gammalab, Grupo Gamma, Rosario, Argentina
| | - Cesar Lara
- Betesda La Alternativa Natural, San José, Costa Rica
| | | | - Ana María Soler
- Laboratorio de Genética Molecular Humana, Departamento de Ciencias Biológicas, Universidad de La República, Montevideo, Uruguay
| | - Julio Da Luz
- Laboratorio de Genética Molecular Humana, Departamento de Ciencias Biológicas, Universidad de La República, Montevideo, Uruguay
| | - Gabriela Burgueño-Rodríguez
- Laboratorio de Genética Molecular Humana, Departamento de Ciencias Biológicas, Universidad de La República, Montevideo, Uruguay
| | - Marcelo Vital
- Molecular Genetic Unit, School of Chemistry, Universidad de la República, General Flores 2124, Montevideo, Uruguay
| | - Elizabeth Reyes-Reyes
- Clinical Experimental Pharmacology Section, Teaching and Research Department, Institute of Oncology and Radiobiology, Havana, Cuba
| | | | - Yeimy V. Ariza
- Pharmaceutical Chemistry Program, El Bosque University, Bogotá, Colombia
| | - Naomi Tzul
- Drug Inspectorate Unit, Ministry of Health and Wellness, Belmopan, Belize
| | - Ana L. Rendón
- Department of Pharmaceutical Technology, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | | | - Larissa Acosta
- Faculty of Biology, Chemistry and Pharmacy, Galileo University, Guatemala, Guatemala
| | - Angelo Motta-Pardo
- GENOBIDC, Faculty of Pharmacy and Biochemistry, Universidad Nacional Mayor de San Marcos (UNMSM), CIGBM, Faculty of Medicine, Universidad de San Martin de Porres (USMP), Lima, Peru
| | - Leonardo Beltrán-Angarita
- Faculty of Heath Sciences, Central Unit of Valle del Cauca, Tuluá, Colombia
- Chemistry School, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Erika Brand
- Postgraduate Department, Master’s Degree in Immunology, Universidad Cayetano Heredia, Lima, Perú
| | | | | | - Marina M. J. Romero-Prado
- Department of Physiology, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Karla Escobar-Castro
- Laboratory of Histocompatibility and Immunogenetics, Department of Nephrology and Transplant, Hospital General San Juan de Dios, Guatemala, Guatemala
| | - Mariel Umaña-Rivas
- Department of Tropical Medicine, Faculty of Medicine, University of Brasília, Brasília, Brazil
| | - Juan D. Vivas
- Department of Clinical Pharmacology, Faculty of Medicine, University of La Sabana, Chía, Colombia
| | - Paola Lagos
- Recombinant Biopharmaceutical Laboratory, Department of Pharmacology, Faculty of Biological Sciences, University of Concepción, Concepción, Chile
| | - Yineth Ballén Martínez
- Medical Specialist in Epidemiology Clinical Pharmacology Teacher; Medical Scientific and Pharmacovigilance Advisor in the Pharmaceutical Industry, Bogotá, Colombia
| | - Sharleth Quesada
- Faculty of Pharmacy, University of Costa Rica, San Jose, Costa Rica
| | - Camila Calfio
- International Center for Biomedicine ICC, Santiago, Chile
| | - Maria L. Arias
- Tropical Diseases Research Center and Microbiology Faculty, University of Costa Rica, San José, Costa Rica
| | - María A. Lavanderos
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Dante D. Cáceres
- Environmental Health Programme, School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Alberto Salazar-Granara
- Universidad de San Martín de Porres, Facultad de Medicina Humana, Centro de Investigación de Medicina Tradicional y Farmacología, Lima, Perú
| | - Nelson M. Varela
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Luis A. Quiñones
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Santiago, Chile
- Department of Pharmaceutical Sciences and Technology, Faculty of Chemical and Pharmaceutical Sciences, University of Chile, Santiago, Chile
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