Knowledge, Attitudes and Education of Pharmacists Regarding Pharmacogenetic Testing

Mary W Roederer; Marcia Van Riper; John Valgus; George Knafl; Howard McLeod

Personalized Medicine. 2012;9(1):19-27.

Results

Seven hundred and thirty seven pharmacists began the survey yielding an overall response rate of 7.7%, with 728 completing the majority of the questions. In addition to being a pharmacist, one respondent was also a physician, another was a medical student and two were registered nurses.

Education

More than half of respondents achieved a doctor of pharmacy degree (51.8%), while 40.6% obtained a Bachelor of Science degree in pharmacy and 1.7% held an additional doctorate. Approximately 10% of the respondents were faculty members or educators. The respondents well represented pharmacists with varying years of experience: 19.3% out of 727 respondents practicing less than 5 years and 22.4% practicing more than 30 years (Figure 1). A total of 47.0% of the pharmacists did not have any genetics education. However, 26.1% of respondents took an undergraduate genetics course and 14.2% declared receiving genetics education via a continuing education course (Table 1).

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Figure 1.

Pharmacist years since graduation.

Knowledge

The survey contained five questions to assess knowledge of general genetics and five questions to assess the knowledge of general pharmacogenetics (Box 1). In assessing level of education as an influencing factor on knowledge, respondents with a PharmD had a significantly higher mean score on the total ten questions and the five genetics and five pharmacogenetics questions separately compared with respondents without an advanced degree or with a masters (all three p-values <0.001). Self-identified educators and those with prescribing privileges had higher scores on the ten knowledge assessment questions (p-values 0.003 and 0.029, respectively). Educators scored higher overall on the genetics and pharmacogenetics questions separately (p-values 0.022 and 0.002, respectively). However, the respondents with prescribing privileges scored higher on pharmacogenetics questions (p = 0.008) but not on the five genetics questions (p = 0.237).

New graduates with fewer than 5 years since matriculation scored statistically significantly higher on all ten questions and the five genetics and pharmacogenetics questions than the respondents out of school for 5 years or more (all p-values <0.001). Distant graduates out of school for 30 years or more scored significantly lower than all other respondents for all three assessments (all p-values <0.001) (Figure 2).

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Figure 2.

Mean scores for ten questions, five genetics questions, five pharmacogenetic questions by years since graduation. The number of correct responses out of ten are reported for the total number of knowledge questions. For the five individual genetics questions and five individual pharmacogenetics questions the correct response out of five are reported. The Cronbach's coefficient α value for the total ten knowledge questions was 0.793. For the individual genetics questions and the individual pharmacogenetics questions the Cronbach's coefficient α was 0.7.

Respondents were asked to assess their own knowledge of genetics and pharmacogenetics based on one of five categories: excellent, very good, good, fair and poor (Figure 3). Responses of excellent or very good were associated with the highest mean scores on the knowledge assessment questions for all three assessments of ten total questions and the five genetics and five pharmacogenetics questions (all p-values <0.001). Having no genetics education was associated with lower mean scores on all three sets of the knowledge assessment questions (all p-values <0.001). Exposure to more types of genetic education was associated with higher mean scores with mean scores increasing with the number of exposures to types of genetics education for all three assessments.

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Figure 3.

Pharmacist understanding.

Attitudes

Table 2 contains the eight questions related to attitudes regarding pharmacogenetic testing. There were five possible responses for each question ranging from 1: not likely to 5: very likely for questions 1, 3, 5, and 7, 1=not concerned to 5: very concerned for questions 2 and 4 and 1: not comfortable to 5: very comfortable for questions 6 and 8. The response to questions 2 and 4 were reverse coded so that larger values for all eight questions corresponded to more positive attitudes. A total positive attitude score was then computed as the average of the eight attitude questions. Cronbach's α for this attitude scale was acceptable at 0.71. PharmD and BSc in pharmacy degree recipients did not significantly differ in mean total positive attitude score or in mean values for each of the eight attitude questions. Similarly, when comparing pharmacists with prescribing privileges versus those without prescribing privileges, the mean positive attitude score and mean values for the eight questions did not differ significantly. Respondents serving as educators were not significantly different than noneducators in mean total positive attitude score but were significantly more comfortable having genetic information incorporated into the determination of their patient's initial warfarin dose (question 6). Mean total positive attitude increased with self-reported level of knowledge of genetics. For questions 2, 5, 6 and 8, the mean values for the individual questions increased with increased with self-reported knowledge. The mean total positive attitude score also increased with self-reported level of knowledge of pharmacogenetic testing. Similarly, for questions 1 and 5–8, the mean score increased with self-reported knowledge.

Educational Offerings

Ninety percent (90.5%) of respondents are interested in learning more about pharmacogenetic testing (see Figure 4 for the breakdown on types of educational offerings of interest). A total of 88.0% of pharmacists with a PharmD degree and 81.5% of BSc graduates want to receive education on pharmacogenetic testing. As a group, educators want education on pharmacogenetic testing more than noneducators (93.2 vs 84.6%; p = 0.05). Unlike level of education and serving as an educator, pharmacists with and without prescribing privileges do not differ in percentage wanting education on pharmacogenetic testing.

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Figure 4.

Educational offerings of interest. More than one response is allowed. Percentages are out of 728 respondents.
AHEC: Area health education center; CE: Continuing education; CME: Continuing medical education.

When evaluating the interest in pharmacogenetic testing by years of practice, the 5–10 years since graduation group had the highest overall percentage of respondents interested at 92.9% versus the group with the fewest interested in education, the more than 30 years since graduation group, with 77.3% (p = 0.008). The pharmacists that identified having taken a continuing education genetics course in the past were more likely to want an educational session on pharmacogenetic testing (94.2 vs 83.4%; p = 0.005) as were those who had taken an undergraduate course in the past (92.1 vs 82,3%; p = 0.001). Pharmacists who had not had any prior genetics education were significantly less likely to want an educational session on pharmacogenetic testing (80.6 vs 89.8%).

When reviewing the types of pharmacogenetics education that respondents want, the PharmDs prefer web-based continuing medical education more than BSc graduates (58.3 vs 42.5%; p < 0.001). The preference for web-based continuing medical education also significantly decreased with increased years in practice (61.4% for 0–4 years, 64.3% for 5–10 years, 51.6% with 10–19 years, 46.4% for 20–29 years and 38.7% for 30 or more years; p < 0.001).

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Table 1. Types of prior genetics education ^† (n = 728).
Type of genetics education	Respondents (%)
No genetics education	47.0
Undergraduate genetics course	26.1
Continuing education course	14.2
Seminar or workshop	8.7
Grand rounds	6.5
Other	9.6

^†More than one response allowed.

Table 2. Questions on attitudes about phamacogentic testing.
Question number	Mean value and standard deviation	Question assessing attitude regarding pharmacogenetic testing
1	Mean: 3.5; standard deviation: 1.0	In your opinion, how likely is it that pharmacogenetic testing will help to decrease the number of adverse drug reactions?
2	Mean: 3.0; standard deviation: 1.3	How concerned are you that unauthorized persons may gain access to the results of a patient's pharmacogenetic testing?
3	Mean: 2.4; standard deviation: 1.2	In your opinion, how likely is it that pharmacogenetic testing will help to decrease the cost of developing new drugs?
4	Mean: 2.6; standard deviation: 1.3	How concerned are you that pharmacogenetic testing may result in discrimination by employers and/or insurance companies?
5	Mean: 3.5; standard deviation: 1.0	In your opinion, how likely is it that pharmacogenetic testing will help to decrease the time it takes to find the optimal dose of warfarin for patients?
6	Mean: 3.7; standard deviation: 1.0	How comfortable would you be having genetic information incorporated into the determination of your patient's initial warfarin dose?
7	Mean: 3.5; standard deviation: 1.0	In your opinion, how likely is it that pharmacogenetic testing will help to decrease the adverse reactions experienced by patients on warfarin?
8	Mean: 3.9; standard deviation: 1.1	If you were the patient being started on warfarin, how comfortable would you be having genetic information incorporated into the determination of your initial dose of warfarin?

Contains the eight questions related to attitudes about pharmacogenetic testing. There were five possible responses for each question ranging from 1: not likely to 5: very likely for questions 1, 3, 5 and 7; 1: not concerned to 5: very concerned for questions 2 and 4; and 1: not comfortable to 5: very comfortable for questions 6 and 8. The response to questions 2 and 4 were reverse coded so that larger values for all eight questions corresponded to more positive attitudes. A total positive attitude score was then computed as the average of the eight attitude questions. Cronbach's a for this attitude scale was acceptable at 0.71. Within the table individual mean scores for each question are reported, along with standard deviation.

Box 1. True or false questions assessing knowledge.
*Questions assessing genetics knowledge*
Humans are over 99% identical at the DNA level ^† Mean: 0.5; standard deviation: 0.5 Most cells in the body contain 47 chromosomes ^‡ Mean: 0.6; standard deviation: 0.5 Every time the human body produces a sperm or an egg, approximately 3 billion nucleotides (bases) must be copied and packaged so they can be passed along to future offspring ^† Mean: 0.4; standard deviation: 0.5 The nucleotides (bases) in DNA, always match up the same way – 'A' always pairs with 'C' and 'G' always pairs with 'T' ^‡ Mean: 0.4; standard deviation: 0.5 A number of genetic conditions, such as sickle cell anemia, are caused by a mutation in a single gene ^† Mean: 0.7; standard deviation: 0.4
*Questions assessing pharmacogenetics knowledge*
Subtle differences in a person's genome can have a major impact on how the person responds to medications ^† Mean: 0.8; sstandard deviation: 0.4 Genetic determinants of drug response change over a person's lifetime ^‡ Mean: 0.4; standard deviation: 0.5 Genetic variations can account for as much as 95% of the variability in drug disposition and effects ^† Mean: 0.5; standard deviation: 0.5 The package insert for warfarin includes a warning about altered metabolism in individuals who have specific genetic variants ^† Mean: 0.5; standard deviation: 0.5 Pharmacogenetic diagnostic testing is currently available for most medications ^‡ Mean: 0.7; standard deviation: 0.5
^†The questions that are the true statements. ^‡The questions that are false statements. The means and standard deviations for the response to each question, where 1 point is awarded to correct responses, are reported for each question.

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