Clinicians’ perceptions of pharmacogenomics use in psychiatry

Written by Chan CYW, Chua BY, Subramaniam M, Suen ELK, Lee J

Aim: This study aims to assess the attitudes and opinions of clinicians practicing in psychiatry toward pharmacogenomic testing, and in so doing elicits possible barriers and risks to employ this technology in patient care. Materials & methods: Doctors and pharmacists presently practicing in psychiatry were invited to participate in an anonymous web-based survey. Besides information on participant characteristics and experience in psychiatry, specific themes on pharmacogenomics including self-assessed competency, perceived usefulness in clinical situations, perceived risks and preferred mode of education were evaluated. Results: A total of 81% of respondents believed that pharmacogenomic testing would be useful for identifying suitable treatments and 71% believed that pharmacogenomic testing would be useful for medication intolerance. However, only 46.4% felt competent to order these tests. There were significant differences in responses for gender, doctors versus pharmacists and seniority in position. A total of 94.3% of respondents were concerned about costs and 84.5% were concerned about the lack of clear guidelines on its use. A total of 98.5% of respondents were keen on learning more about the applicability of pharmacogenomics, and the most preferred format of education was a lecture (44.5%). Conclusion: Most clinicians acknowledge the potential of pharmacogenomic testing in clinical practice. However, concerns with regard to its cost–effectiveness and the lack of clear guidelines are possible barriers to its clinical implementation.
Pharmacogenomics has the potential to guide effective drug therapy and reduce side effects [1], both of which would greatly benefit patients and their families. Despite these benefits, the adoption of pharmacogenomics in clinical practice has been suboptimal and perceptions of psychiatrists toward this technology have been cited as a significant barrier. A review of the literature identified only four studies [2–5] which examined the attitudes of psychiatrists toward pharmacogenomic testing. However, they were mostly done in locations where pharmacogenomic testing was already commonly used.

Hoop et al. [3] reported the responses of 75 psychiatrists and psychiatry residents from three centers in America, which were identified to be at the forefront of adoption of pharmacogenomic testing. The survey found that the clinicians had a positive perception of testing. However, there was a lack of consensus about the risks involved. Thompson et al. [2] surveyed 113 psychiatrists at the University of California and found that 94.6% of them indicated that genetic data would be useful in their clinical practice and 86% felt that pharmacogenomic testing would become standard of care. Dunbar et al. [4] utilized a series of open-ended questions to survey 37 senior medical officers and five registrars in New Zealand regarding their experience of using the AmpliChip CYP450 pharmacogenomic test. Results supported the use of the test as a clinical support tool with regard to dosing decisions. However, there were concerns about potential over-reliance on the tests and the length of time it took to receive the results. Shishko et al. [5] surveyed 107 psychiatric pharmacists from the College of Psychiatric and Neurologic Pharmacists, and found that there was a lack of availability and understanding regarding the use of pharmacogenomics.

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