Pharmacogenomics (PGx) is the use of Deoxyribonucleic Acid (DNA) to predict an individuals’ response to a drug. Through the lower cost of DNA sequencing and advances in genomic medicine, PGx testing is a viable and valuable tool in improving medicines optimisation for patients.
Over recent years, the role of the community pharmacist in England has evolved from dispensing medicines to delivering increasingly complex pharmacy services. In addition, community pharmacy is accessible and convenient for patients, and therefore potentially an appropriate setting for this testing service. Whilst in some parts of the world, community pharmacists have begun offering PGx testing, there is no evidence of any activity in England.
There is therefore a research gap in knowledge to establish if this service could be implemented in the culture and context of the healthcare infrastructure and system in England, which differs somewhat from other countries.
The principles of co-design were deployed following three sequential phases using action-orientated frameworks and tools.
In Phase One, three focus groups were conducted with community pharmacists (n= 10), prescribers (General Practitioners) (n= 8) and patients (n=8) to identify the barriers and enablers to implementing a community pharmacy based PGx service in England. The focus groups were recorded, transcribed and thematically analysed. In Phase Two, barriers and enablers from Phase One were mapped onto the Theoretical Domains Framework (TDF) followed by use of the Theory and Techniques Tool (TATT) to link the identified TDF domain with corresponding Behaviour Change Techniques (BCTs). A consensus questionnaire followed by a Nominal Group Technique workshop were used to facilitate community pharmacists (n=11) selecting their preferred BCTs to include in a service specification. Finally, in Phase Three, a draft service specification was developed, and a joint participant (n=12) consensus panel was convened for critical comment. The service specification was refined based on the feedback.
Five barrier and enabler themes were developed in Phase One: (1) In-principle receptiveness, (2) Appreciation of the benefits, (3) Lack of implementation resources (4) Ambiguity about implications for implementation and (5) Interprofessional relationship challenges. In Phase Two, the qualitative data from the pharmacist focus group were mapped onto six TDF domains: Knowledge, Skills, Social/ professional role and identity, Optimism, Beliefs about Consequences, and Environmental context and resources. Forty-six BCTs were identified using the TATT, of which nine BCTs were selected by the target audience: Review outcome goal(s) (1.7), Information about emotional consequences (5.6), Pros and Cons (9.2), Social support (Practical) (3.2), Feedback on behaviour (2.2), Instruction on how to perform behaviour (4.1), Demonstration of the behaviour (6.1), Credible source (9.1) and Adding objects to the environment (12.5). Finally, in Phase Three, the draft service specification was produced, and progressed into the final version following critical feedback from the mixed participant consensus panel.
The co-design methodology using action-orientated frameworks and tools has resulted in the production of a novel service specification for implementation of a PGx community pharmacy testing service in England to fill a gap in research knowledge. This can now be used to implement the service and further research should be carried out to evaluate the service post implementation.
|Date of Award||2 Nov 2022|
|Supervisor||Julie Barnett (Supervisor) & David Wright (Supervisor)|
- behaviour change techniques
- community pharmacy
- consensus methods
- thematic analysis
- theoretical domains framework
- theory and techniques tool