Late last month the health insurer Bupa began offering customers free pharmacogenomic testing kits – as well as selling them to the general public at a discounted rate — with the results being sent to the person’s nominated GP. But are GPs ready?
The ‘at-home’ test looks at 11 genes that affect how the body responds to more than 100 medicines for therapeutic areas such as psychiatry, cardiology, pain management and gastroenterology.
Bupa is promoting pharmacogenomic tests as a way to help GPs “make an informed decision if prescribing a new medication or guide them in making changes to an existing treatment. This could include increasing or lowering dosages or switching to an alternate medication or treatment.”
“The results of an individual’s pharmacogenetic testing need to be discussed with their GP as part of their ongoing treatment plan,” Bupa Clinical Innovation and Genomics Director Dr Simon Benson said.
A national Healthed survey of over 1300 GPs found that more than three quarters of GPs are not particularly confident in their ability to order and interpret pharmacogenomic tests – 58% said they were not at all confident, while 28% were “slightly confident.” Just 14% described themselves as either very or moderately confident.
In the survey which opened 30 September, a week after Bupa launched the initiative, one in 10 GPs said they had a patient ask about pharmacogenomic testing. Just 8% had one patient ask about it in the previous fortnight, and 3% had two patients ask within that timeframe. Even fewer GPs (7%) had themselves initiated a pharmacogenomic test in the preceding two weeks.
While experience was limited, most GPs (63%) who did have at least one patient who’d had pharmacogenomic testing tended to view it positively.
Of the 465 GPs with patients who’ve had pharmacogenomic testing:
“In certain patients who have got a lot of drug side effects, or have tried or been on a lot of other medications, not tolerating many of these, this test can be very worthwhile. I have one patient who cannot tolerate almost any statin cholesterol lowering medications, but this testing said we could try one or two more with less likely side-effects,” one GP commented.
“I have found the results helpful for guiding treatments that are more personalised. Very helpful to have results to explain poor responses or unpleasant adverse events to meds. Really helpful for patients who have had multiple negative experiences,” another said.
The biggest concern, cited by 48% of 1312 GPs, was their lack of education about the tests. Forty-three percent were concerned about cost/benefit, while 41% said that lack of clinical guidelines concerned them– although the Royal College of Pathologists of Australia released the first national indications for pharmacogenomic testing last year.
Risk of misinterpretation was next on the list, cited by 32%.
One in five GPs (22%) were concerned about the impact on cost and coverage of health insurance; Bupa says pharmacogenetic testing “will have no impact on an individual’s health insurance premium and results will not be shared with Bupa Health Insurance.”
Just 16% of GPs said data being exploited by commercial entities was a top concern, and even fewer worried about privacy or data security (14% and 13%, respectively).
The RCPA’s pharmacogenomic indications cover 35 commonly used medications, and aim to help clinicians decide when testing is appropriate, both before prescribing or following adverse reactions to a medicine.
The Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines are another useful resource. CPIC is an international organisation, with guidelines aimed at optimising drug therapy based on genetic test results – you can look up various classes of medications and the genes associated with them.
MyDNA, also has information for health professionals on its site.
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