There are few subjects that have received as much coverage in the genetics space in recent months as precision medicine. The conversation about precision medicine began many years ago but the recent launch of the Precision Medicine Initiative in the United States and similar projects in many other countries around the world has brought this topic to the main stream. There remain many questions about the implementation of precision medicine with people looking to doctors and clinicians as the first and most obvious choice as the point of contact for patients. However, one group in British Columbia, Canada is looking to local community pharmacists to bring precision medicine closer to those who can benefit most. 

Why are pharmacists a natural choice? According to Mark Kunzli, Project Manager and Associate Director of the University of British Columbia’s Sequencing Centre and a Pharmacist himself:

“Within the healthcare team, pharmacists are the medication experts. When it comes to the implementation of precision medicine, and considering how genetics can impact medication response, it’s an extension of what pharmacists already do.”

Mark Kunzli is a registered pharmacist with an MBA based in Vancouver, BC, Canada. He was exposed to pharmacogenomics as part of his pharmacy degree and when he began work as a pharmacist, soon realized that integrating genetics was a natural progression for his profession. When he decided to pursue his Healthcare MBA, it was a logical next step for him to focus his studies on how to get pharmacists involved in implementing pharmacogenomics. This led to working at the University of British Columbia (UBC) Faculty of Pharmaceutical Sciences with the BC Pharmacy Association on a recently completed research study, in which pharmacists collected patient saliva samples in the community pharmacy to look for genetic variations that affect how individuals respond to medications.

Recently featured in the Globe and Mail:

“The study is the largest in North America to look at whether community pharmacists can gain the skills required to collect DNA samples from patients, walk them through the consent process and explain how specific drugs may interact with the patient’s genetic makeup.”

In this project, the pharmacists were key members of the research team. Each pharmacist involved in the study was responsible for educating participants about the research project. The participant sat down with his/her pharmacists to learn about genomics and what the study involved, then went home with information to review and return at a later date to complete the consent process. Once the consent process was complete, each participant provided a saliva sample while in the pharmacy (using Oragene) and returned it to the pharmacist. The saliva sample was then de-identified so no personal information was associated with it and sent to UBC for whole exome sequencing. Because this was a research study, no results were returned to the participants. The study’s goal was to prove that community pharmacists are ideal healthcare professionals to bring precision medicine to patients. And with 33 community pharmacies having participated in the study and samples collected from over 200 participants, the project is being considered an overwhelming success.

Mark, who co-ordinated pharmacist participation as the project manager and a Co-Investigator for the project, added that there were a number of positive outcomes due to the choice of saliva for the method of DNA collection.

“Having a non-invasive collection device that we could use in a community pharmacy was crucial to the study, and the fact that saliva samples can be shipped via regular courier was another key aspect. If we didn’t use saliva, we would have had to arrange blood collection, which would have increased the complexity and cost of the sample collection process, and most importantly decreased the comfort of our patient participants. As one of our primary goals was to show that pharmacists are ideally equipped and positioned to use pharmacogenomics to improve patient health and wellness, saliva sampling allowed us to show that this is possible within the community pharmacy, and without the cost, logistical and biohazard issues related to blood sampling.”

The study is now complete and the team is currently writing a paper for publication based on their experiences and working with the BC Pharmacy Association to prepare for Phase 2 of the project (Learn more at http://www.bcpharmacy.ca/genome). However, it’s already clear the study has proved that researchers and community pharmacists can be healthcare innovators and spark positive change and collaboration. Do you think community pharmacists have a role to play in precision medicine? Leave a comment and let us know.