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Why precision medicine is important for pharmacists: Interview (Includes interview and first-hand account)

Pharmacists are beginning to use pharmacogenomics to guide patients to safer and more effective medications. Pharmacogenomics is a rapidly emerging field that analyzes an individual’s genes to predict his or her response to medications.

It’s argued that integrating pharmacogenomics into regular clinical care could shift the current medical paradigm from one that is reactive to one that is preventive.

OneOme’s RightMed aims to bring ‘pharmacogenomic solutions’ into medical clinics, health systems and pharmacies. The system integrates results into the patient’s medical record for years of more accurate, personalized prescriptions. To discover more Digital Journal spoke with Kathleen Bosse, who is a Clinical Development Pharmacist about the problems facing pharmacists today. A second article focuses on the technological solutions via the OneOme system.

Clinical Pharmacist at OneOme

Clinical Pharmacist at OneOme
Kathleen Bosse

Digital Journal: What are the major challenges for pharmacists today?

Kathleen Bosse: With the extensive medication expertise pharmacists offer, patients and other healthcare professionals are beginning to recognize pharmacists as a clinical resource. As a result, the role of the pharmacist is becoming increasingly valuable. This change may be met with resistance, and pharmacists must continually educate other providers on our knowledge, potential, and value.

Pharmacists are challenged to maintain dispensing activities while expanding clinical services offered. Healthcare utilization is increasing, which also increases the need for the pharmacist to spend time dispensing and providing clinical services.

However, there are ongoing efforts to update laws and regulations to redefine the role of the pharmacist and pharmacy technician in order to reduce the number of limitations of these roles, and to optimize safety and efficiency.

Many of the same challenges apply in the field of pharmacogenomics. The challenges include educating providers on it, defining its value, and deciding where, how, and by how it should be used within clinical practice.

Most providers will acknowledge the importance of genetics in drug response, but implementation into clinical settings may seem daunting due to the large amount of complex scientific information.

Pharmacists can work with patients and other healthcare providers to implement pharmacogenomic testing to improve medication therapy and guide prescription decisions. Pharmacists’ support of these initiatives can demonstrate both the valuable of the pharmacist as well as the clinical utility of pharmacogenomics.

DJ: Where is the drive for personalized prescriptions coming from?

Bosse: The drive for personalized prescriptions is coming from multiple places. The healthcare system as a whole is demanding more personalized prescriptions in an effort to improve care and reduce costs. There is also demand coming from health professionals who recognize the benefits that their patients could have as a result of PGx testing; these health professionals are calling for increased access for patients and integration into everyday practice. Patients also are driving adoption of pharmacogenomic testing.

Across all forms of healthcare, patients are advocating for themselves and becoming more engaged in their own healthcare. More and more patients who may have personal experience with “trial and error” to find the right medication or have suffered an adverse drug reaction are asking for pharmacogenomic testing.

DJ: How is healthcare changing?

Bosse: In broad terms, the world of healthcare is transitioning from medical treatments being designed for the average patient, or a one-size-fits-all approach, to one that takes into account individual differences, including at the genetic level. On January 20, 2015, President Obama announced the Precision Medicine Initiative (or PMI) to fund research in order to develop strategies for improved individualized care. The PMI Cohort program will enlist one million Americans and will generate use cases for precision medicine, including the use of pharmacogenomics.

The attention on precision medicine has increased awareness amongst physicians, administrators, and patients, as a means of improving patient care and reducing healthcare costs.

Prescription drug ineffectiveness is a serious, extensive problem. Today’s standard of care for prescribing medications is still largely using a “trial and error” approach despite the growing and compelling evidence that genetics influences how we react to drugs. Innovative health professionals are becoming “champions” of pharmacogenomics, recognizing where PGx could benefit their patients and driving integration into everyday practice.

Pharmacists drive personalized prescriptions by including pharmacogenomic test results into medication therapy management programs or services that they provide.

There is growing awareness that personalized prescriptions can guide patients to safer and more effective medications – and OneOme provides the tools to make that goal a reality.

DJ: What are the concerns with the efficacy of generalized prescriptions?

Bosse: More than four billion prescriptions are issued each year in the U.S. alone, and there is ample opportunity to improve the personalization of those medications. Studies show that the response rates for many drugs are only between 50-75 percent – meaning there are potentially millions or billions of people who are currently receiving prescriptions with little assurance that the drug will work effectively.

Scientific research supports the importance of pharmacogenomics in making prescriptions safer and more effective as well as reducing healthcare costs. Research found that genetic factors account for up to 95 percent of drug-response variability; a study done by the Mayo Clinic found that 99 percent of participants had a clinically actionable genetic variant.

This means that in nearly each subject, a genetic variation was found that impacts how the patient metabolizes a medication, and this variation should be reviewed prior to making a prescription decision.

DJ: Are there also issues with adverse drug events?

Bosse: Adverse drug reactions (ADRs) are a leading cause of hospitalizations and death. In the U.S., ADRs are the fourth leading cause of death and cost $136 billion annually, according to the FDA. Prescriptions not tailored to a patients’ unique genetic make-up may lead to treatment delays, re-hospitalizations, adverse events, and increased mortality.

DJ: A solution to this is ‘pharmacogenomics’ How would you define this?

Bosse: Pharmacogenomics is the study of how genes affect a person’s response to medications. Pharmacogenomics combines the study of how medications affect our bodies (pharmacology) with the study of our genes and their functions (genomics) to identify effective, safe medications and doses for patients. A pharmacogenomic test (also called a medication response test) may help to identify the medications that work best for an individual, based on their unique DNA.

In the second part of this article, Kathleen Bosse explains how OneOme’s RightMed pharmacogenomic solution works and the advantages it holds for pharmacists.

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Written By

Dr. Tim Sandle is Digital Journal's Editor-at-Large for science news. Tim specializes in science, technology, environmental, business, and health journalism. He is additionally a practising microbiologist; and an author. He is also interested in history, politics and current affairs.

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