Precision Medicine – Pharmacy needs to get a move on

Primary health care teams in the US are currently being considered for the promotion of personalised medicine based on gene analysis.
This has to be pharmacist territory, but given the time lag of pharmacist leadership organisations, Australian pharmacists may again miss the boat by not having decentralised training systems to be able to deliver suitable training and education.
Personalised medicine has now been renamed as “
Precision Medicine” 
and in the US is being backed by an Obama administration that wants to increase funding for this technology.

Given this type of impetus there will be an acceleration of information and activity.
i2P first touched on this technology in a series of articles approximately five years ago, advising clinical pharmacists to become accredited in genetic counselling.
Precision Medicine will be up and running in Australia before you know it, so encourage pharmacy leadership bodies to get involved in this activity – it will be a game-changer.

Precision Medicine, with its focus on an individual patient’s genome will sit well in a patient-centred home that has an outreach to care access, safe transitional care and community health care with all these systems converging on the patient, particularly patients that are at the highest risk for specific diseases

The promise of Precision Medicine is to be able to tell primary health care providers which patients need screening or diagnostic testing that can forecast the potential for serious illness.
Part of diagnosis therefore is transformed into genetic forecasting.

This will be a new paradigm in the way we think about disease and patient risk.
Pharmaceutically, medicines will be able to be better targeted or assessed to be necessary at all.
The shotgun approach to prescribing, particularly in areas like hypertension, will be able to be eliminated.

Precision Medicine can potentially show:
which patient will develop high blood pressure? Which patients are salt responsive? Which patient will respond to which medicine? Which patients’ blood pressure, left uncontrolled, will lead to end-organ damage down the road?

Just as the Internet exploded the amount of information (some good, some not so good) available to patients about their health, Precision Medicine may open up a Pandora’s box, with both positive and negative implications.

No one is going to be better positioned to help administer this, to help foster this, to move it along to its best implementation than the primary care providers, particularly the clinical pharmacists who already have the proven skills of patient education and compliance (better than nurses and doctors).
Pharmacists, as part of the primary health care team are going to be able to help patients put this information in the context of their overall health goals.

Australian pharmacies with their unique geographic spread, that are properly fitted out, and have partnerships with clinical pharmacists, will win the patients.
Primary care providers in the form of clinical service pharmacists are the ones who have that relationship with the patient, who can most successfully combine their hopes, dreams, fears, and anxieties, with the genomic answer that comes out of the other end of Precision Medicine.

Pharmacists will be the ones who help patients to understand that Precision Medicine has told us that their blood pressure is going to make them one of those people that hypertension hurts, and which medicine will be the one that they are going to respond to.

Pharmacists will be able to overlay this new type of knowledge on top of patient feelings about their health, their cultural background, their likes and dislikes, and pharmacists will be the ones hearing about it when it gives them side effects.
That is, provided our leadership organisations get moving now!

I am not saying that pharmacists should become geneticists, but instead, interpreters for a patient genome specific for preparing a health map and strategy for that patient.
For that reason, this activity definitely forms part of patient-centred care.

Let us not overlook this opportunity lest competing health practitioners are quicker on their feet – and that is the current reality.
This type of innovation must outreach by an education system that is decentralised and can be taught to busy working practitioners on the job.
For this we look to our various pharmacy schools.
And we look to our leadership organisations to foster appropriate communications with pharmacy schools to support the concept.

Existing genetic counselling is found mostly in hospital settings.
For this reason, nurses will have a natural advantage as genetics counselling is already housed in their natural environment.
We do not want to have to compete against them inside community pharmacies!

As I was writing this article a media release from the NSW branch of the PSA arrived in my email inbox, so it becomes a fitting item to sign off with for this article.
It follows in coloured text:

Branch calls for medicinal cannabis program, community liaison pharmacists. 

The Pharmaceutical Society of Australia (PSA) NSW branch has released its 2015 election manifesto, which it says would make up to $12m available to reinvest elsewhere in the health system.

The proposals call for the introduction of Community Liaison Pharmacists attached to public hospitals with an emergency department, to reduce medication misadventure and readmissions by improving discharge processes and post-discharge patient management.

The manifesto also calls for investment in a medicinal cannabis program, with set up costs of $250,000 to provide for compliance with storage and setup requirements, consultation facilities, and credential training.

Other proposals include $9m investment over five years to embed pharmacists in community mental health teams in each Local Health District in the state, as well as the implementation of a state-wide electronic recording and reporting of controlled drugs system, and a training and familiarisation program for pharmacists.

The manifesto was been sent out to politicians yesterday, the PSA said.

The interesting component of this media release concerns the Community Liaison Pharmacists to be attached to public hospitals.

In this same i2P edition, but written 48 hours earlier, is a feature article called “Downstream from hospital re-admissions”.
I am thankful that PSA (NSW Branch) seems to be moving, and in the right direction.
But it still needs to pick up speed to preserve pharmacy’s future.

Interestingly, articles relating to medical cannabis are scheduled for the i2P edition after this one.

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