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Mitchell S, Jaccard E, Schmitz FM, von Känel E, Collombet P, Cornuz J, Waeber G, Guessous I, Guttormsen S. Investigating acceptability of a training programme in precision medicine for frontline healthcare professionals: a mixed methods study. BMC MEDICAL EDUCATION 2022; 22:556. [PMID: 35850770 PMCID: PMC9294840 DOI: 10.1186/s12909-022-03613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Precision Medicine offers tailored prevention, diagnosis, treatment and management to patients that considers genomics, lifestyle and environmental factors. If implementation of Precision Medicine is to advance, effective, focused upskilling of frontline healthcare professionals through quality continuing professional development is needed. This study reports on an evidence-based approach to needs assessment to investigate the current level of knowledge of Precision Medicine, acceptable content for training, the perceived potential of a more precision approach to patient care and motivation to participate in a training programme among pharmacists, advanced practice nurses and general practitioners. Investigating perceived needs can avoid a top-down approach and support a design that is fit for purpose to targeted professions. METHODS This study reports on 2 focus groups (n = 12) delivered in French and German with equal professional participation of the targeted professions. The research objectives were investigated in two phases. During the first phase, a literature review and expert consultations were conducted to develop a definition of PM, patient cases and content for training. In a second phase, these investigations were further explored using focus groups to investigate acceptable learning objectives, the potential of PM to relevant professions and motivation of participants. Quantitative investigations using rating scales and visual analogues were incorporated. The focus groups were audio recorded, transcribed by intelligent verbatim and translated to English. NVivo was used for data analysis and interpretation following a hybrid approach using the Framework Method and thematic analysis. The analytical framework, Implementation Science, was applied to organise and present research data. RESULTS Precision Medicine is considered a new topic area, largely unfamiliar to frontline healthcare professionals.. There was acceptance of a more precision approach to care among all participants with perceived positive implications for patients. Valuable insight was gathered on acceptable content and form for training. All participants expressed concerns on readiness within their professions which included an insufficient system infrastructure, a lack of time to attend needed training, a lack of clarity for use in practice and the time needed to build a support network. CONCLUSIONS A precision approach to patient care is on the horizon for health care professionals not only in hospital settings but also at the community level. Our results conclude that an adaptable and flexible training programme in PM is timely, contextually relevant and conducive to the needs of targeted health professions for successful implementation. A training programme in PM will require support across sectors and stakeholders, supporting insurance models, educated patients and integrated care supported by innovative technology. Implementation Science outcomes are a useful strategy towards design of an effective training programme that can have measurable impact in practice.
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Affiliation(s)
- Sharon Mitchell
- Institute of Medical Education (IML), University of Bern, 3201, Bern, Switzerland.
| | - Evrim Jaccard
- Department of Medicine, University Hospital CHUV, Lausanne, 1011, CH, Switzerland
| | | | - Elianne von Känel
- Institute of Psychology, University of Bern, Fabrikstrasse 8, Bern, 3012, CH, Switzerland
| | - Prune Collombet
- Primary Care Medicine, Faculty of Medicine, Geneva University Hospital (HUG), Geneva, 1205, CH, Switzerland
| | - Jacques Cornuz
- Faculty of Biology and Medicine, Unisanté, University of Lausanne, Lausanne, 1011, CH, Switzerland
| | - Gérard Waeber
- Department of Medicine, University Hospital CHUV, Lausanne, 1011, CH, Switzerland
| | - Idris Guessous
- Primary Care Medicine, Faculty of Medicine, Geneva University Hospital (HUG), Geneva, 1205, CH, Switzerland
| | - Sissel Guttormsen
- Institute of Medical Education (IML), University of Bern, 3201, Bern, Switzerland
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Arwood MJ, Dietrich EA, Duong BQ, Smith DM, Cook K, Elchynski A, Rosenberg EI, Huber KN, Nagoshi YL, Wright A, Budd JT, Holland NP, Maska E, Panna D, Elsey AR, Cavallari LH, Wiisanen K, Johnson JA, Gums JG. Design and Early Implementation Successes and Challenges of a Pharmacogenetics Consult Clinic. J Clin Med 2020; 9:E2274. [PMID: 32708920 PMCID: PMC7408871 DOI: 10.3390/jcm9072274] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 12/13/2022] Open
Abstract
Pharmacogenetic testing (PGT) is increasingly being used as a tool to guide clinical decisions. This article describes the development of an outpatient, pharmacist-led, pharmacogenetics consult clinic within internal medicine, its workflow, and early results, along with successes and challenges. A pharmacogenetics-trained pharmacist encouraged primary care physicians (PCPs) to refer patients who were experiencing side effects/ineffectiveness from certain antidepressants, opioids, and/or proton pump inhibitors. In clinic, the pharmacist confirmed the need for and ordered CYP2C19 and/or CYP2D6 testing, provided evidence-based pharmacogenetic recommendations to PCPs, and educated PCPs and patients on the results. Operational and clinical metrics were analyzed. In two years, 91 referred patients were seen in clinic (mean age 57, 67% women, 91% European-American). Of patients who received PGT, 77% had at least one CYP2C19 and/or CYP2D6 phenotype that would make conventional prescribing unfavorable. Recommendations suggested that physicians change a medication/dose for 59% of patients; excluding two patients lost to follow-up, 87% of recommendations were accepted. Challenges included PGT reimbursement and referral maintenance. High frequency of actionable results suggests physician education on who to refer was successful and illustrates the potential to reduce trial-and-error prescribing. High recommendation acceptance rate demonstrates the pharmacist's effectiveness in providing genotype-guided recommendations, emphasizing a successful pharmacist-physician collaboration.
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Affiliation(s)
- Meghan J. Arwood
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA; (E.A.D.); (B.Q.D.); (D.M.S.); (K.C.); (A.E.); (A.R.E.); (L.H.C.); (K.W.); (J.A.J.); (J.G.G.)
- Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA
| | - Eric A. Dietrich
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA; (E.A.D.); (B.Q.D.); (D.M.S.); (K.C.); (A.E.); (A.R.E.); (L.H.C.); (K.W.); (J.A.J.); (J.G.G.)
| | - Benjamin Q. Duong
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA; (E.A.D.); (B.Q.D.); (D.M.S.); (K.C.); (A.E.); (A.R.E.); (L.H.C.); (K.W.); (J.A.J.); (J.G.G.)
- Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA
| | - D. Max Smith
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA; (E.A.D.); (B.Q.D.); (D.M.S.); (K.C.); (A.E.); (A.R.E.); (L.H.C.); (K.W.); (J.A.J.); (J.G.G.)
- Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA
| | - Kelsey Cook
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA; (E.A.D.); (B.Q.D.); (D.M.S.); (K.C.); (A.E.); (A.R.E.); (L.H.C.); (K.W.); (J.A.J.); (J.G.G.)
- Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA
| | - Amanda Elchynski
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA; (E.A.D.); (B.Q.D.); (D.M.S.); (K.C.); (A.E.); (A.R.E.); (L.H.C.); (K.W.); (J.A.J.); (J.G.G.)
- Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA
| | - Eric I. Rosenberg
- Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA; (E.I.R.); (K.N.H.); (Y.L.N.); (A.W.); (J.T.B.); (N.P.H.); (E.M.); (D.P.)
| | - Katherine N. Huber
- Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA; (E.I.R.); (K.N.H.); (Y.L.N.); (A.W.); (J.T.B.); (N.P.H.); (E.M.); (D.P.)
| | - Ying L. Nagoshi
- Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA; (E.I.R.); (K.N.H.); (Y.L.N.); (A.W.); (J.T.B.); (N.P.H.); (E.M.); (D.P.)
| | - Ashleigh Wright
- Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA; (E.I.R.); (K.N.H.); (Y.L.N.); (A.W.); (J.T.B.); (N.P.H.); (E.M.); (D.P.)
| | - Jeffrey T. Budd
- Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA; (E.I.R.); (K.N.H.); (Y.L.N.); (A.W.); (J.T.B.); (N.P.H.); (E.M.); (D.P.)
| | - Neal P. Holland
- Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA; (E.I.R.); (K.N.H.); (Y.L.N.); (A.W.); (J.T.B.); (N.P.H.); (E.M.); (D.P.)
| | - Edlira Maska
- Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA; (E.I.R.); (K.N.H.); (Y.L.N.); (A.W.); (J.T.B.); (N.P.H.); (E.M.); (D.P.)
| | - Danielle Panna
- Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA; (E.I.R.); (K.N.H.); (Y.L.N.); (A.W.); (J.T.B.); (N.P.H.); (E.M.); (D.P.)
| | - Amanda R. Elsey
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA; (E.A.D.); (B.Q.D.); (D.M.S.); (K.C.); (A.E.); (A.R.E.); (L.H.C.); (K.W.); (J.A.J.); (J.G.G.)
- Clinical and Translational Science Institute, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, USA
| | - Larisa H. Cavallari
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA; (E.A.D.); (B.Q.D.); (D.M.S.); (K.C.); (A.E.); (A.R.E.); (L.H.C.); (K.W.); (J.A.J.); (J.G.G.)
- Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA
| | - Kristin Wiisanen
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA; (E.A.D.); (B.Q.D.); (D.M.S.); (K.C.); (A.E.); (A.R.E.); (L.H.C.); (K.W.); (J.A.J.); (J.G.G.)
- Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA
| | - Julie A. Johnson
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA; (E.A.D.); (B.Q.D.); (D.M.S.); (K.C.); (A.E.); (A.R.E.); (L.H.C.); (K.W.); (J.A.J.); (J.G.G.)
- Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA
| | - John G. Gums
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA; (E.A.D.); (B.Q.D.); (D.M.S.); (K.C.); (A.E.); (A.R.E.); (L.H.C.); (K.W.); (J.A.J.); (J.G.G.)
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