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.

Discussion

Pharmacists have long been thought of as the medication experts in the healthcare field. It has become evident over the past decade that pharmacogenetics is evolving into an essential tool to ensure optimal medication use in a growing number of medications and disease states. Therefore, it is imperative that pharmacists are prepared to use pharmacogenetic information to appropriately individualize medication therapy for patients now and in the future. The pharmacist serves many roles in the implementation of pharmacogenetics in the healthcare setting.^[15] These include serving as a clinician who ensures that all proper information is incorporated into medication decisions, including pharmacogenetics. Pharmacists also serve as educators for patients and healthcare professionals alike to raise awareness of pharmacogenetics principles and clinical utilization strategies. Finally, pharmacists are in the optimal role to investigate and advance the science of pharmacogenetics through pilot and comparative–effectiveness research.

A survey on attitudes towards pharmacogenetics was recently reported for the US public.^[16] This survey was conducted by telephone to over 2000 randomly identified participants throughout the US. The study achieved a 42% response rate and demonstrated a high rate of interest in pharmacogenetic testing, which could predict side effects, guide dosing, or assist with medication selection. Most were not willing to undergo testing, though, if there was a risk that their information could be shared without their permission. To date, there has been no formal analysis of practicing pharmacists' knowledge and attitudes of pharmacogenetics information. Our report is the first such survey that examines not only the pharmacists' perceived knowledge but attempts to measure actual knowledge through several questions related to pertinent genetic and pharmacogenetic information. We also explored attitudes towards pharmacogenetic information being used in clinical practice as well as thoughts on how pharmacists could best obtain further pharmacogenetics education.

Not surprisingly, over half of practicing pharmacists have received some formal training in genetics. Approximately a half of those who did respond as having formal genetics education, had genetics as part of their undergraduate curriculum, which presumably did not contain any content on pharmacogenetics. It was not until 2007, that the American Council on Pharmacy Accreditation set pharmacogenetics as a required component of the pharmacy curriculum.^[103] The majority of participants in this survey have been in practice for over 10 years so the likelihood of receiving pharmacogenetics as part of the pharmacy curriculum is unlikely. Providing continuing education opportunities in pharmacogenetics has been a major focus of many colleges of pharmacy as well as many national pharmacy organizations. Only 14% of respondents had received any pharmacogenetics training through continuing education programs.

With a lack in formalized education in pharmacogenetics, it is not surprising that the majority of respondents reported their understanding of pharmacogenetics as fair or poor (83%). Only 17% of respondents rated their understanding of pharmacogenetics as excellent, very good or good. Those participants who rated their knowledge as either excellent or very good were associated with the highest mean scores on knowledge assessment, which helps validate this perception as being accurate. One encouraging statistic was that those with less than 10 years of practice experience demonstrated the highest scores on pharmacogenetic knowledge assessment, which may represent the increased focus of pharmacogenetics in the pharmacy curricula across the nation, as well as the increased amount of information on pharmacogenetics over the past decade. Of note, this group of practitioners with less than 10 years of experience also had the highest level of interest in further pharmacogenetics education.

In a similar survey of pharmacists that practice at three sites for the Mayo Clinic (in Arizona [AZ, USA], Florida [FL, USA] and Minnesota [MN, USA]), the authors conclude that pharmacists are interested to know about pharmacogenetics, feel pharmacogenetics contributes to the practice of pharmacy, but they feel ill-prepared to act on the results of pharmacogenetic tests. The survey responses suggest that practicing pharmacists need additional educational offerings to teach them about the application of pharmacogenetics.^[17]

There are several limitations of our survey that may have impacted the type and validity of the results. First, the sample size is relatively small compared with the number of pharmacists practicing in the state of NC and throughout the USA. This is evidenced and compounded by our low response rate of 7.7%. With nearly 10,000 pharmacists with an active NC license, our survey population may not be reflective of the average pharmacist licensed in NC nor the USA.

1 2 3 4 5

Next Section

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.

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.