Pharmacogenetics Roll Out – Gauging Response to Service (PROGRESS): Process evaluation
What were we doing?
People do not always respond to medicines in the same way. One reason is that differences in people’s genes can affect whether a medicine works well for them or causes side effects. The study of this is called pharmacogenetics.
PROGRESS was a study that introduced pharmacogenetic testing and prescribing advice in several GP practices across England. We carried out a process evaluation, to look at how this test was being delivered in real-life settings.
Why was it important?
Pharmacogenetic testing could help clinicians make more informed decisions about which medicines to prescribe. However, this type of testing is not yet routinely used in GP practices.
PROGRESS looked at how a pharmacogenetics service could be delivered in the NHS. We needed to understand what might help or hinder its use in everyday general practice, and what support would be needed if it were introduced more widely.
How did we do it?
We interviewed 30 staff working in general practices, including GPs, pharmacists, nurses, and a practice manager. These staff worked across 20 sites in England that were taking part in the PROGRESS study.
We asked them about their views on using pharmacogenetic-guided prescribing, including:
- how they thought it compared with usual care
- how it was used as part of patient care
- what made it easier or harder to include pharmacogenetic-guided prescribing in their practice.
Findings
We found that pharmacogenetic testing could be introduced in general practices in the UK, but more support would be needed before it could be used more widely.
What helped introduce the test?
- Clinicians saw value in using pharmacogenetic testing to help choose medicines that were safer, more effective, and tailored to individual patients.
- Practices developed local ways of delivering the test that fitted with how they worked.
- Local practice teams planned ahead for potential barriers and created practical tools, such as prompts, guides and training materials, to support delivery.
- Early engagement and training helped staff understand the benefits of pharmacogenetic-guided prescribing and how to use it in practice.
What made it harder to introduce the test?
- Although the test could be used for several medicines, clinicians tended to use it more for some medicines than others, depending on where they felt it would be most useful.
- Most planning focused on setting up the PROGRESS study, with less involvement from the wider practice team in planning how testing would work day to day.
- Different approaches to prescribing, recruitment and managing results across practices sometimes made testing harder to put into practice.
- Testing had to fit around the demands of a research study and clinicians' existing workloads, making it difficult to embed into routine practice.
What do the findings suggest?
- Practices should have clear ways to track who is offering the test and to give feedback to staff, so testing is used more often and more consistently.
- Greater involvement from the wider practice team, such as involving pharmacists in managing test results, could help support the introduction of testing.
- Clinicians need clear guidance on when to offer testing, when to prescribe medicines (before or after receiving test results), and how to use test results with confidence.
- For wider use, test results need to be easy to access in GP records, with enough time and resources to support this.
What are we doing with the findings?
The information is being reported back to key organisations, which allows for improvements to how pharmacogenetic guided prescribing is being introduced into, and used in, general practices.
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More information
Senior Programme Lead
Mike Spence