by David F. Kisor, Pharm.D., Professor and Chair, Pharmaceutical Sciences, Director, Master of Science in Pharmacogenomics Program, Manchester University
The uptake of pharmacogenomics (PGx) in clinical practice is lagging, being related to a number of barriers including, largely, a lack of health professions student and practitioner education. Recent data illustrate the scope of the challenge in the pharmaceutical field.
A survey of practicing pharmacists (n=737; n=728 responding to most questions), across all education types (i.e. B.S./M.S./Pharm.D.), ages and years in practice regarding the use of genetic testing to guide drug therapy was reported in 2012. The study showed that only 18 percent of pharmacists believed they had a good, very good or excellent understanding of pharmacogenetic testing. Forty-one percent of the pharmacists believed they had a fair understanding of pharmacogenetic testing. Of the 728 pharmacists, 47 percent stated they had no genetics education. The remainder had some genetics education through undergraduate work (26 percent) or another avenue (39 percent), with some of the individuals receiving education via multiple settings.
This information demonstrates a clear need for PGx education in pharmacy. Fortunately, the field is rising to the challenge.
A survey of U.S. pharmacy colleges/schools showed the percentage of institutions with PGx in their Doctor of Pharmacy (Pharm.D.) curricula increased from 39 percent in 2005 to more than 89 percent in 2010. The latter information was provided by 75 of the then 109 colleges/schools of pharmacy in the U.S. that belong to the American Association of Colleges of Pharmacy (AACP). In the 2010 pharmacy college/schools report, just over 65 percent of respondents rated their institution’s PGx instruction as adequate, good or very good.
The increased focus on PGx education is now happening largely by design. Formal pharmacy education is now mandated by the 2016 Accreditation Council for Pharmacy Education (ACPE) standards to include PGx in the curricula of all pharmacy colleges/schools to ensure pharmacists entering practice are knowledgeable in the subject. In addition, numerous pharmacy programs, including The Ohio State University, Temple University, Presbyterian College and Manchester University, among others, have offered individual exercises incorporating student “pharmacogenotyping,” which have shown to increase students’ PGx knowledge. A shared PGx curriculum was offered through the PharmGenEdTM program out of the University of California San Diego. More recently, academic institutions have rolled out innovative ways to teach these concepts. These approaches include the University of Pittsburgh’s Test2LearnTM approach in the Pharm.D. core curriculum. Pharmacy colleges/schools are embracing PGx and are preparing graduates to incorporate PGx as a component of precision medicine in pharmacy practice.
Relative to educating practicing pharmacists, it was noted that in 2015 there were 35 knowledge or application programs related to pharmacogenetics/PGx. These self-study or live programs were associated with ACPE continuing education credits. Examples of more extensive practitioner-based PGx education have also been offered.
In 2015, a group of pharmacists completed a 20-hour certificate-training program that included 13 hours of home study and 7 hours of live education, including interaction with seven simulated patients. This program, offered by the Manchester University Pharmacy Program and the Indiana Pharmacists Alliance, was pointed at pharmacy practice, incorporating the pharmacist competencies in PGx from the Genetics/Genomics Competency Center (G2C2) website published by the National Human Genome Research Institute. The program will be offered again in the fall of 2016.
These kinds of programs are increasing in number. In March of 2016, the University of Florida College of Pharmacy and the University of Florida Health Personalized Medicine Program offered a certificate program for pharmacists as part of their inaugural conference on precision medicine. This effort included 15 hours of ACPE continuing education. The inaugural University of Florida conference was extremely well attended, which speaks to the rapidly growing interest in the pharmacy practice aspects of PGx. Additionally, a collaborative study is underway between academia and private industry to educate community pharmacists on how to provide PGx services. One of the components of the study is an online certificate-training program.
A commentary published in Pharmacogenomics in March 2016 from the Center for Applied Genomics & Precision Medicine at the Duke University School of Medicine noted that certificate training programs for pharmacists, such as those noted above, “could ensure the appropriate and safe use of PGx testing and optimize the lifetime benefits to patients.”
Other institutions are also playing an important role in moving the field forward. The AACP PGx special interest group recently published The DNA of Pharmacy Education: CAPE Outcomes and PGx online. This paper discusses educational approaches in pharmacy, combining G2C2 pharmacist competencies with the Center for the Advancement of Pharmacy Education (CAPE) outcomes, while considering the 2016 ACPE standards.
Optimally, inter-professional education in PGx with pharmacists, physicians, physician assistants, nurse practitioners, genetic counselors and other health care professionals would help to identify the specific roles that are needed in the health care team environment to optimally apply PGx as a component of precision medicine. These inter-professional education approaches are currently ongoing at various academic institutions.
The PGx education of pharmacy students and practicing pharmacists is now well underway, and further expansion of academic and professional education programs, such as expanded conference offerings and online certificate training programs, is likely. It is clear that the promise of personalized medicine is being fulfilled and the PGx component is advancing toward being the standard of patient care.