Pharmacist-Led PharmacogenomicsServices in Primary Care

WelcomeWe will begin shortly.

Pharmacy Research Webinar Series Hosted by:

Today’s SpeakersLisa McCarthy, RPh, BScPhm, PharmD, MSc, Clinician Scientist, Women’s College Research Institute, Leslie Dan Faculty of Pharmacy, Department of Family and Community Medicine, University of Toronto

and

Beth Sproule, RPh, BScPhm, PharmD, Clinician Scientist, Pharmacy, CAMH, Leslie Dan Faculty of Pharmacy, Department of Psychiatry, University of Toronto

Disclosure(s)

The presenters have no disclosures.

Note: we do not endorse a particular education training program or pharmacogenomics testing company.

Pharmacist‐Led Pharmacogenomics Services in Primary Care: Preliminary Findings from PRIME

Lisa McCarthy PharmD MSc, Beth A Sproule PharmD

Canadian Pharmacy Practice Research Group Webinar

Sept 14, 2017

Objectives

• To share experiences from the PRIME Study• Discuss study objectives, design, methods

• Highlight preliminary findings

• To discuss existing resources available to support pharmacists:• Learn more about pharmacogenomics

• How to obtain pharmacogenomic tests for their patients

Study Investigators

Beth Sproule1,2,4 (Study Co-Lead)Lisa McCarthy1,3,4 (Study Co-Lead)

Natalie Crown1,3

Micheline Piquette-Miller1

Daniel Mueller2,4

Affiliations:1Leslie Dan Faculty of Pharmacy, University of Toronto2Centre for Addiction and Mental Health3Women’s College Hospital4Faculty of Medicine, University of Toronto

Study Partners

Acknowledgements

• PRIME Pharmacists

• Coordinators• Josie

Chundamala

• Sara Karlsson

• Ryan Keay

• Research Trainees PRIME Training Program Nov 2015

Photo Credit: Michael Wong, WCH

• Melissa Baranski, Veeral Gohil, Thomas Boyang Huang, Meriam Hurmiz, Clara Korenvain, Nina Krupetsky, Jessica John, Jennifer Liu, Richard Procunier, Dana Wall-Bryce

Poll #1

• What is your primary place of practice?• Community

• Hospital

• Long-term care

• Primary care team

• Other

Poll #2

• Which of the following best describes your current role?• Clinician

• Manager or Director

• Owner

• Pharmacy practice researcher

• Educator

• Other

Poll #3

• Have you recommended a pharmacogenomic test for one of your patients? • Yes

• No, would like more training

• No, not sure how to get the testing

• No, not convinced of the clinical benefit

• Other

• Examples:• Pro-drug

• Toxic metabolite

• Number of metabolic routes

• Therapeutic ranges

Clinical consequences of altered metabolism

Pharmacists’ Role & PGxKnowledge of evidence-base

• Efficacy

• Harms

Knowledge of drugs

• Pharmacodynamics

• Pharmacokinetics

Knowledge of patient

Examples:

• Target symptoms

• Comorbidities

• Renal function, Liver function

• Pharmacogenomics

PRIME Study OverviewTo determine the feasibility and acceptability of pharmacist-led personalized medicine services in primary care settings.

Training Phase• To develop and evaluate a

PGx specialization training program directed to pharmacists

Clinical Phase• To determine if it is feasible for

trained pharmacists to provide meaningful recommendations that are accepted by patients and prescribers leading to improved outcomes for patients.

Resources for Practice

Education• University of Waterloo (launching Sept 15, 2017)

• Online learning, CCCEP accredited for 8.5 CEUs• https://uwaterloo.ca/pharmacy/degrees-and-professional-

development/distance-education-continuing-professional-development

• rxBriefCase• CCCEP accredited for 1.5 CEUs• http://www.rxbriefcase.com/

• RxGenomics Certificate Program• University of Manchester + RxGenomics, 16 hour online course• Accredited by American Pharmacists Association• http://www.rxgenomix.com/

Note: Beth Sproule and Lisa McCarthy do not endorse any of these programs in particular and have no financial involvement with any of these programs.

Testing

• PRIME Study – Assurex – GeneSight Psychotropic• Not commercially available in Canada at this time

• GeneYouIn – PillCheck• www.pillcheck.ca

• RxOme – myDNA• www.mydna.life/en-ca/

Note: Beth Sproule and Lisa McCarthy do not endorse any of these tests in particular and have no financial involvement with any of these companies.

PRIME Study Summary• Very positive examples of pharmacists integrating this into

their practice

• Very positive examples of patient benefit

• However, several pharmacists not able to incorporate into practice:• Out of 26 pharmacists who participated in training, 15

pharmacists recruited at least 1 patient

• Also, significant attrition in data from follow-ups• Practice issue or study documentation ‘burden’ issue or just

reality in a naturalistic study?

Questions

Next Pharmacy Practice Research Webinar

October 18, 2017 -Outcomes from pharmacist-managed travel clinic in Alberta (Sherilyn Houle)