April 20, 2016 - A new research initiative by the Centre for Addiction and Mental Health (CAMH), Women’s College Hospital (WCH) and the Leslie Dan Faculty of Pharmacy (LDFP) at the University of Toronto is training community pharmacists to be a key resource in delivering personalized medicine to individuals.
The new study is in the area of pharmacogenetics, a branch of personalized medicine that determines how a person’s genetic makeup affects the way he or she responds to medications. The study could enable pharmacists to help individuals with depression or other mental illnesses to identify the most effective medications and doses for their unique genetic profile.
“This study is positioning pharmacists as medication experts,” says Dr. Beth Sproule, a study lead and Clinician-Scientist at CAMH. “Pharmacists are well positioned to decide when pharmacogenetic testing may be worthwhile and to apply this knowledge to help patients. Pharmacists are already using an evidence-based approach and an understanding of pharmacology to offer care to patients. Pharmacogenetic testing is a new tool to finesse that even more.”
Beth, who is also Associate Professor in LDFP and the Department of Psychiatry at the University of Toronto, is leading this study with Dr. Lisa McCarthy, Clinician-Scientist at WCH and LDFP.
CAMH’s Dr. Beth Sproule
Testing a new model
The study includes 21 pharmacists from family health teams and community pharmacies throughout Ontario, and the researchers received more than 130 expressions of interest from pharmacists within two days of starting recruitment last fall.
Participating pharmacists will identify individuals who might benefit from pharmacogenetic testing; discuss testing with individuals and refer individuals for testing; interpret the test results, develop a care plan and make medication recommendations to the individuals and their prescribing doctor; and provide follow-up checks and care after four and eight weeks. “We’re hoping individuals and prescribers will welcome this, because it’s new to everybody,” says Beth.
“We’re pleased to welcome pharmacists in providing pharmacogenetic testing to individuals,” says Dr. Daniel Mueller, an investigator on the study and Head of the Pharmacogenetics Research Clinic at CAMH. “The goal is to optimize care for people taking antidepressant or antipsychotic medications by identifying the most effective medications and doses for each individual quickly.”
The participating pharmacists have completed the new personalized medicine training program, which involved online lectures, a two-day in-person session and completing sample case reviews.
The goal is to provide pharmacogenetic care to 250 individuals in total. Pharmacists will screen individuals who are starting a new antidepressant or antipsychotic medication or who are already taking one of these medications and not responding to the medication or experiencing significant side effects. Genetic testing will be conducted as part of CAMH’s IMPACT (Individualized Medicine: Pharmacogenetic Assessment & Clinical Treatment) study, led by Dr. Jim Kennedy.
As well as investigating health outcomes, the researchers will assess this new model of personalized medicine, including response and acceptance rates by individuals and their doctors, and evaluate the new personalized medicine training program for pharmacists.
Pharmacy’s evolving clinical role
The new study reflects a “sea change in the role of pharmacists, moving away from working with and dispensing drugs and focusing more on the clinical aspects – assessing a patient, identifying problems, developing a care plan related to their drug therapy and following up with the patient,” says Beth.
While her profession has been increasingly focusing on clinical care during her 30 years as a pharmacist, new developments over the last five to 10 years are having a significant impact. For example, in 2010, the Ontario College of Pharmacists (OCP) began registering pharmacy technicians, a new class of professional qualified to complete the technical aspects of dispensing medications, an area previously designated to pharmacists. As of the start of 2016, all pharmacy technicians in CAMH’s pharmacy team have completed the registration requirements and are registered with the OCP.
As well, in education, the first class of students graduated in 2015 from U of T’s new 4-year Doctor of Pharmacy (PharmD) entry-to-practice degree program. The program focuses heavily on clinical care, with the final year dedicated to hands-on experience in pharmacy practice settings.
With strong clinical training for pharmacists and the enhanced role of pharmacy technicians, the hope is that new pharmacists will find that the conditions are right to carry on their clinical focus as they enter practice.
“I expect our profession will keep moving in this direction,” says Beth.
As well, “lots of work is being done to enhance mental health education for students,” says Beth. CAMH’s pharmacy team welcomes 30 to 40 pharmacy students each year.
This research is funded by the Canadian Foundation for Pharmacy. The study team also includes Dr. Jim Kennedy at CAMH, Dr. Natalie Crown at WCH and LDFP and Dr. Micheline Piquette-Miller at LDFP.