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Cavanah LR, Goldhirsh JL, Huey LY, Piper BJ. National patterns of paroxetine use among US Medicare patients from 2015-2020. Front Psychiatry 2024; 15:1399493. [PMID: 39050917 PMCID: PMC11266311 DOI: 10.3389/fpsyt.2024.1399493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/12/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Paroxetine is an older "selective" serotonin reuptake inhibitor (SSRI) that is notable for its lack of selectivity, resulting in an anticholinergic adverse-effect profile, especially among older adults (65+). Methods Paroxetine prescription rates and costs per state were ascertained from the Medicare Specialty Utilization and Payment Data. States' annual prescription rate, corrected per thousand Part D enrollees, outside a 95% confidence interval were considered significantly different from the average. Results Nationally, there was a steady decrease in population-corrected paroxetine prescriptions (-34.52%) and spending (-29.55%) from 2015-2020 but a consistent, five-fold state-level difference. From 2015-2020, Kentucky (194.9, 195.3, 182.7, 165.1, 143.3, 132.5) showed significantly higher prescriptions rates relative to the national average, and Hawaii (42.1, 37.9, 34.3, 31.7, 27.7, 26.6) showed significantly lower prescription rates. North Dakota was often a frequently elevated prescriber of paroxetine (2016: 170.7, 2018: 143.3), relative to the average. Neuropsychiatry and geriatric medicine frequently prescribed the most paroxetine, relative to the number of providers in that specialty, from 2015-2020. Discussion Despite the American Geriatrics Society's prohibition against paroxetine use in older adults and many effective treatment alternatives, paroxetine was still commonly used in the US in this population, especially in Kentucky and North Dakota and by neuropsychiatry and geriatric medicine. These findings provide information on the specialty types and states where education and policy reform would likely have the greatest impact on improving adherence to the paroxetine prescription recommendations.
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Affiliation(s)
- Luke R. Cavanah
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | | | - Leighton Y. Huey
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
- Behavioral Health Initiative, Scranton, PA, United States
| | - Brian J. Piper
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
- Center for Pharmacy Innovation and Outcomes, Danville, PA, United States
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Laba TL, Worthington HC, Cheng L, Chan FKI, Bansback N, Law MR. The impact of the Choosing Wisely Canada campaign on the simultaneous use of angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers: interrupted time-series analysis. CMAJ Open 2022; 10:E1059-E1066. [PMID: 36735223 PMCID: PMC9828945 DOI: 10.9778/cmajo.20210185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Choosing Wisely is a high-profile campaign seeking to reduce the use of low-value care. We investigated the impact of a Choosing Wisely Canada recommendation against using a combination of angiotensin-converting-enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) for the management of hypertension, heart failure or diabetic nephropathy on population-level use of these medications in British Columbia, Canada. METHODS We identified all people (any age) who were continuously registered with BC's Medical Service Plan between 2010 and 2017 with the targeted conditions. Using prescription claims data and an interrupted time-series analysis, we estimated the number of people on combination therapy per month, the proportion of days covered (PDC) by combination therapy per month and proportion of all combination prescriptions started per month in the 2 years before and after the introduction of the recommendation on Oct. 29, 2014. RESULTS Of 1 104 593 people (mean age 65 yr, standard deviation 16 yr) in our study cohort, 4.6% were exposed to combination therapy, largely prescribed by family physicians (84%). The number of people on combination therapy and the PDC were declining before the recommendation, but the proportion of combination prescriptions started in the 2 years before the recommendation was increasing. After the recommendation, we observed no statistically significant changes in any outcome. The pre-existing downward trend of the monthly number of people decelerated (16.8, 95% confidence interval [CI] 14.0 to 19.5) and the proportion of prescriptions started increased (0.13%, 95% CI 0.08% to 0.18%). INTERPRETATION The Choosing Wisely Canada recommendation against using a combination of ACE inhibitors and ARBs was not associated with reduced combination therapy use in the targeted conditions. The observed pre-existing declines in this practice questions the process of selecting recommendations, and the optimal implementation and value of Choosing Wisely campaigns without other reinforcing interventions.
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Affiliation(s)
- Tracey-Lea Laba
- Pharmacy Program (Laba), Clinical and Health Sciences Unit, The University of South Australia, Adelaide, Australia; The Centre for Health Economics Research and Evaluation (Laba), University of Technology Sydney, Ultimo, Australia; Centre for Health Services and Policy Research (Worthington, Chen, Bansback, Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Epidemiology, Biostatistics, and Occupational Health (Chan), McGill University, Montréal, Que.
| | - Heather C Worthington
- Pharmacy Program (Laba), Clinical and Health Sciences Unit, The University of South Australia, Adelaide, Australia; The Centre for Health Economics Research and Evaluation (Laba), University of Technology Sydney, Ultimo, Australia; Centre for Health Services and Policy Research (Worthington, Chen, Bansback, Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Epidemiology, Biostatistics, and Occupational Health (Chan), McGill University, Montréal, Que
| | - Lucy Cheng
- Pharmacy Program (Laba), Clinical and Health Sciences Unit, The University of South Australia, Adelaide, Australia; The Centre for Health Economics Research and Evaluation (Laba), University of Technology Sydney, Ultimo, Australia; Centre for Health Services and Policy Research (Worthington, Chen, Bansback, Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Epidemiology, Biostatistics, and Occupational Health (Chan), McGill University, Montréal, Que
| | - Fiona K I Chan
- Pharmacy Program (Laba), Clinical and Health Sciences Unit, The University of South Australia, Adelaide, Australia; The Centre for Health Economics Research and Evaluation (Laba), University of Technology Sydney, Ultimo, Australia; Centre for Health Services and Policy Research (Worthington, Chen, Bansback, Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Epidemiology, Biostatistics, and Occupational Health (Chan), McGill University, Montréal, Que
| | - Nick Bansback
- Pharmacy Program (Laba), Clinical and Health Sciences Unit, The University of South Australia, Adelaide, Australia; The Centre for Health Economics Research and Evaluation (Laba), University of Technology Sydney, Ultimo, Australia; Centre for Health Services and Policy Research (Worthington, Chen, Bansback, Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Epidemiology, Biostatistics, and Occupational Health (Chan), McGill University, Montréal, Que
| | - Michael R Law
- Pharmacy Program (Laba), Clinical and Health Sciences Unit, The University of South Australia, Adelaide, Australia; The Centre for Health Economics Research and Evaluation (Laba), University of Technology Sydney, Ultimo, Australia; Centre for Health Services and Policy Research (Worthington, Chen, Bansback, Law), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Epidemiology, Biostatistics, and Occupational Health (Chan), McGill University, Montréal, Que
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Candon M, Xue L, Shen S, Cole ES, Donohue J, Rothbard A. The impact of opioid prescribing report cards in Medicaid. J Manag Care Spec Pharm 2022; 28:862-870. [PMID: 35876292 PMCID: PMC10373013 DOI: 10.18553/jmcp.2022.28.8.862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND: Performance feedback has been used for decades to improve health care quality and safety, with varying degrees of success. One example is the use of customized report cards that target inappropriate prescribing of high-risk medications, including opioids. Randomized controlled trials suggest that report cards are an effective tool to change opioid prescribing behavior, but their effectiveness in community settings is unclear. OBJECTIVE: To evaluate the impact of opioid prescribing report cards, which were mailed to Medicaid providers in Philadelphia, Pennsylvania. METHODS: Using a quasi-experimental approach, we compared trends in opioid prescribing by Medicaid providers in Philadelphia, who received a report card in late 2017, with Medicaid providers in surrounding counties, who did not receive report cards. First, we used propensity score matching to balance observed differences in the treatment and comparison groups; matching variables included provider specialty, sex, and selected characteristics of providers' Medicaid patient panels. We then estimated a difference-in-differences model to isolate the impact of report cards on opioid prescribing. RESULTS: The analytical sample included 1,598 providers in Philadelphia and 2,117 providers in surrounding counties, who prescribed opioids to 99,548 Medicaid patients during the study period. Although the number of Medicaid patients receiving opioids and the days supplied of opioids declined in both Philadelphia and surrounding counties during the study period, there was a larger reduction in Philadelphia Medicaid than in surrounding counties after the report cards were mailed. In the 6 months after the report cards were mailed (January 2018 to June 2018) compared with the 6 months before they were mailed (July 2017 to December 2017), we estimate that the reduction in opioid prescribing in Philadelphia Medicaid amounted to nearly 3 fewer Medicaid patients with an opioid prescription per month. CONCLUSIONS: After customized opioid prescribing report cards were mailed to Medicaid providers in Philadelphia, Pennsylvania, there was a statistically significant reduction in opioid prescribing to Medicaid patients relative to surrounding counties. Our findings suggest that opioid prescribing report cards with peer comparison are an effective way to influence opioid prescribing behavior among Medicaid providers. Report cards can complement other initiatives that target inappropriate opioid prescribing, such as prescription drug monitoring programs and prior authorization. DISCLOSURES: Drs Candon and Rothbard and Ms Shen received funding from Community Behavioral Health in Philadelphia, Pennsylvania. Drs Xue, Cole, and Donohue received funding from Pennsylvania Department of Human Services. Neither Community Behavioral Health nor the Pennsylvania Department of Human Services was involved in the study design; collection, analysis, and interpretation of data; writing of the report; or the decision to submit the report for publication.
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Affiliation(s)
- Molly Candon
- Departments of Psychiatry and Health Care Management, Perelman School of Medicine and the Wharton School, University of Pennsylvania, Philadelphia
| | - Lingshu Xue
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pennsylvania
| | - Siyuan Shen
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Evan S Cole
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pennsylvania
| | - Julie Donohue
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pennsylvania
| | - Aileen Rothbard
- Department of Psychiatry, Perelman School of Medicine and School of Social Policy & Practice, University of Pennsylvania, Philadelphia
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Panickar R, Wo WK, Ali NM, Tang MM, Ramanathan GRL, Kamarulzaman A, Aziz Z. Allopurinol-induced severe cutaneous adverse drug reactions: Risk minimization measures in Malaysia. Pharmacoepidemiol Drug Saf 2021; 29:1254-1262. [PMID: 33084196 DOI: 10.1002/pds.5033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To describe risk minimization measures (RMMs) implemented in Malaysia for allopurinol-induced severe cutaneous adverse drug reactions (SCARs) and examine their impact using real-world data on allopurinol usage and adverse drug reaction (ADR) reports associated with allopurinol. METHODS Data on allopurinol ADR reports (2000-2018) were extracted from the Malaysian ADR database. We identified RMMs implemented between 2000 and 2018 from the minutes of relevant meetings and the national pharmacovigilance newsletter. We obtained allopurinol utilization data (2004-2018) from the Pharmaceutical Services Programme. To determine the impact of RMMs on ADR reporting, we considered ADR reports received within 1 year of RMM implementation. We used the Pearson χ2 test to examine the relation between the implementation of RMMs and allopurinol ADR reports. RESULTS The 16 RMMs for allopurinol-related SCARs implemented in Malaysia involved nine risk communications, four prescriber or patient educational material, and three health system innovations. Allopurinol utilization decreased by 21.5% from 2004 to 2018. ADR reporting rates for all drugs (n = 144 507) and allopurinol (n = 1747) increased. ADR reports involving off-label use decreased by 6% from 2011. SCARs cases remained between 20% and 50%. RMMs implemented showed statistically significant reduction in ADR reports involving off-label use for August 2014 [χ2 (1, N = 258) = 5.32, P = .021] and October 2016 [χ2 (1, N = 349) = 3.85, P = .0499]. CONCLUSIONS RMMs to promote the appropriate use of allopurinol and prescriber education have a positive impact. We need further measures to reduce the incidence and severity of allopurinol-induced SCARs, such as patient education and more research into pharmacogenetic screening.
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Affiliation(s)
- Rema Panickar
- National Pharmaceutical Regulatory Agency, Ministry of Health, Petaling Jaya, Malaysia.,Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wee Kee Wo
- National Pharmaceutical Regulatory Agency, Ministry of Health, Petaling Jaya, Malaysia
| | - Norleen M Ali
- National Pharmaceutical Regulatory Agency, Ministry of Health, Petaling Jaya, Malaysia
| | - Min Moon Tang
- Department of Dermatology, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia
| | | | | | - Zoriah Aziz
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Faculty of Pharmacy, MAHSA University, Selangor, Malaysia
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Weitzel KW, Duong BQ, Arwood MJ, Owusu-Obeng A, Abul-Husn NS, Bernhardt BA, Decker B, Denny JC, Dietrich E, Gums J, Madden EB, Pollin TI, Wu RR, Haga SB, Horowitz CR. A stepwise approach to implementing pharmacogenetic testing in the primary care setting. Pharmacogenomics 2019; 20:1103-1112. [PMID: 31588877 PMCID: PMC6854439 DOI: 10.2217/pgs-2019-0053] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/29/2019] [Indexed: 01/12/2023] Open
Abstract
Pharmacogenetic testing can help identify primary care patients at increased risk for medication toxicity, poor response or treatment failure and inform drug therapy. While testing availability is increasing, providers are unprepared to routinely use pharmacogenetic testing for clinical decision-making. Practice-based resources are needed to overcome implementation barriers for pharmacogenetic testing in primary care.The NHGRI's IGNITE I Network (Implementing GeNomics In pracTicE; www.ignite-genomics.org) explored practice models, challenges and implementation barriers for clinical pharmacogenomics. Based on these experiences, we present a stepwise approach pharmacogenetic testing in primary care: patient identification; pharmacogenetic test ordering; interpretation and application of test results, and patient education. We present clinical factors to consider, test-ordering processes and resources, and provide guidance to apply test results and counsel patients. Practice-based resources such as this stepwise approach to clinical decision-making are important resources to equip primary care providers to use pharmacogenetic testing.
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Affiliation(s)
- Kristin Wiisanen Weitzel
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - Benjamin Q Duong
- Department of Pharmacy, Nemours/Alfred I DuPont Hospital for Children, Wilmington, DE 19803, USA
| | - Meghan J Arwood
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - Aniwaa Owusu-Obeng
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Noura S Abul-Husn
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Barbara A Bernhardt
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Brian Decker
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Joshua C Denny
- Department of Medicine & Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Eric Dietrich
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - John Gums
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - Ebony B Madden
- National Human Genome Research Institute, Division of Genomic Medicine, Bethesda, MD 20892, USA
| | - Toni I Pollin
- Department of Medicine & Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Rebekah Ryanne Wu
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27708, USA
| | - Susanne B Haga
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27708, USA
| | - Carol R Horowitz
- Department of Health Policy & Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Reducing inappropriate third-generation cephalosporin use for community-acquired pneumonia in a small Australian emergency department. Infect Dis Health 2018. [DOI: 10.1016/j.idh.2018.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Lim WY, HSS AS, Ng LM, John Jasudass SR, Sararaks S, Vengadasalam P, Hashim L, Praim Singh RK. The impact of a prescription review and prescriber feedback system on prescribing practices in primary care clinics: a cluster randomised trial. BMC FAMILY PRACTICE 2018; 19:120. [PMID: 30025534 PMCID: PMC6053727 DOI: 10.1186/s12875-018-0808-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 06/26/2018] [Indexed: 12/03/2022]
Abstract
BACKGROUND To evaluate the effectiveness of a structured prescription review and prescriber feedback program in reducing prescribing errors in government primary care clinics within an administrative region in Malaysia. METHODS This was a three group, pragmatic, cluster randomised trial. In phase 1, we randomised 51 clinics to a full intervention group (prescription review and league tables plus authorised feedback letter), a partial intervention group (prescription review and league tables), and a control group (prescription review only). Prescribers in these clinics were the target of our intervention. Prescription reviews were performed by pharmacists; 20 handwritten prescriptions per prescriber were consecutively screened on a random day each month, and errors identified were recorded in a standardised data collection form. Prescribing performance feedback was conducted at the completion of each prescription review cycle. League tables benchmark prescribing errors across clinics and individual prescribers, while the authorised feedback letter detailed prescribing performance based on a rating scale. In phase 2, all clinics received the full intervention. Pharmacists were trained on data collection, and all data were audited by researchers as an implementation fidelity strategy. The primary outcome, percentage of prescriptions with at least one error, was displayed in p-charts to enable group comparison. RESULTS A total of 32,200 prescriptions were reviewed. In the full intervention group, error reduction occurred gradually and was sustained throughout the 8-month study period. The process mean error rate of 40.7% (95% CI 27.4, 29.5%) in phase 1 reduced to 28.4% (95% CI 27.4, 29.5%) in phase 2. In the partial intervention group, error reduction was not well sustained and showed a seasonal pattern with larger process variability. The phase 1 error rate averaging 57.9% (95% CI 56.5, 59.3%) reduced to 44.8% (95% CI 43.3, 46.4%) in phase 2. There was no evidence of improvement in the control group, with phase 1 and phase 2 error rates averaging 41.1% (95% CI 39.6, 42.6%) and 39.3% (95% CI 37.8, 40.9%) respectively. CONCLUSIONS The rate of prescribing errors in primary care settings is high, and routine prescriber feedback comprising league tables and a feedback letter can effectively reduce prescribing errors. TRIAL REGISTRATION National Medical Research Register: NMRR-12-108-11,289 (5th March 2012).
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Affiliation(s)
- Wei Yin Lim
- Clinical Research Centre Perak, Ministry of Health Malaysia, Level 4, Ambulatory Care Centre, Raja Permaisuri Bainun Hospital, Jalan Raja Ashman Shah, 30450 Ipoh, Perak Malaysia
| | - Amar Singh HSS
- Clinical Research Centre Perak, Ministry of Health Malaysia, Level 4, Ambulatory Care Centre, Raja Permaisuri Bainun Hospital, Jalan Raja Ashman Shah, 30450 Ipoh, Perak Malaysia
- Department of Paediatrics, Raja Permaisuri Bainun Hospital, Ministry of Health Malaysia, Jalan Raja Ashman Shah, 30450 Ipoh, Perak Malaysia
| | - Li Meng Ng
- Manjung Health District Office, Ministry of Health Malaysia, Jalan Dato’ Ahmad Yunus, 32000 Sitiawan, Perak Malaysia
| | - Selva Rani John Jasudass
- Sg Chua Health Clinic, Ministry of Health Malaysia, Kaw Perindustrian Sg Chua, Sg Ramal Luar, 43000 Kajang, Selangor Malaysia
| | - Sondi Sararaks
- Institute for Health Systems Research, Ministry of Health Malaysia, No. 2 Jalan Setia Prima S U13/S, Seksyen U13 Setia Alam, ,40170 Shah Alam, Selangor Malaysia
| | | | - Lina Hashim
- Clinical Research Centre Perak, Ministry of Health Malaysia, Level 4, Ambulatory Care Centre, Raja Permaisuri Bainun Hospital, Jalan Raja Ashman Shah, 30450 Ipoh, Perak Malaysia
| | - Ranjit Kaur Praim Singh
- Perak State Health Department, Ministry of Health Malaysia, Jalan Panglima Bukit Gantang Wahab, 30590 Ipoh, Perak Malaysia
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Longo C, Rahimzadeh V, O'Doherty K, Bartlett G. Addressing ethical challenges at the intersection of pharmacogenomics and primary care using deliberative consultations. Pharmacogenomics 2016; 17:1795-1805. [PMID: 27767407 DOI: 10.2217/pgs-2016-0092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIM Primary care physicians will play a central role in the successful implementation of pharmacogenomics (PGx); however, important challenges remain. We explored the perspectives of stakeholders on key challenges of the PGx translation process in primary care using deliberative consultations. METHODS Primary care physicians, patients and policy-makers attended deliberations, where they discussed four ethical questions raised by PGx research and implementation in the primary care context. RESULTS Stakeholders voiced skepticism regarding PGx funding, commercialization, regulation, maintenance of an equal access healthcare system and restructuring of health research incentives and priorities in the public sector. CONCLUSION Deliberants developed governing principles for a PGx-specific charter of ethics, aiming to protect the interests of patients, and outlined recommendations for the future of PGx in primary care.
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Affiliation(s)
- Cristina Longo
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | | | - Kieran O'Doherty
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Gillian Bartlett
- Department of Family Medicine, McGill University, Montreal, QC, Canada
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