Knowledge, attitude, and perception of Libyan pharmacists towards pharmacogenomics services: A cross sectional prospective study

Abstract

Pharmacogenomics is the study of how person's genes affect their response to drugs and could be used to personalize drug therapy and improve patient outcomes. Pharmacists are increasingly involved in the application of Pharmacogenomics services, as they are well-positioned to educate patients about their genetic risks and help them select the best medications for their individual needs. To evaluate the knowledge, attitude, and perception of Libyan pharmacists towards Pharmacogenomics services, a cross-sectional study was conducted among pharmacists in Libya using a validated, pilot-tested, and self-administered online questionnaire between August 2023 and September 2023. Descriptive statistics and multivariate logistic regression models were used to describe the results of the study. Most of the participants were female (73%), community pharmacists (56%), and from the eastern part of Libya (73.8%). The respondents have a low knowledge score in Pharmacogenomics and 75.2% of them expressed interest in attending Pharmacogenomics training in the future. Additionally, the participants showed positive attitude and perception towards Pharmacogenomics services (total mean attitude score = 2.9 out of 4 and total median perception score = 32.0 out of 35). They agreed upon barriers for the implementation the Pharmacogenomics services, such as were lack of reimbursement, knowledge, and guidelines. Overall, the survey revealed that pharmacists are interested in learning more about Pharmacogenomics and are positive about the potential benefits of this technology. Despite the low knowledge of pharmacists in Pharmacogenomics, they showed a positive attitude and perception. Therefore, there is a high need for training and improving the Pharmacy curriculum by involving more Pharmacogenomics courses to ensure the proper application of Pharmacogenomics.

Keywords

• Knowledge
• attitude
• perception
• pharmacogenomics
• pharmacists
• Libya

References

1. [1] Johnson JA. Pharmacogenetics in clinical practice: how far have we come and where are we going? Pharmacogenomics. 2013; 14(7):835-843. https://doi.org/10.2217/pgs.13.52.
2. [2] Relling MV, Evans WE. Pharmacogenomics in the clinic. Nature. 2015; 526(7573):343-350. https://doi.org/10.1038/nature15817.
3. [3] Arwood MJ, Chumnumwat S, Cavallari LH, Nutescu EA, Duarte JD. Implementing pharmacogenomics at your institution: establishment and overcoming implementation challenges. Clin Transl Sci. 2016; 9(5):233. https://doi.org/10.1111/cts.12404.
4. [4] Jiang S, Mathias PC, Hendrix N, Shirts BH, Tarczy-Hornoch P, Veenstra D, Malone D, Meline B. Implementation of pharmacogenomic clinical decision support for health systems: a cost-utility analysis. Pharmacogenomics J. 2022; 22(3):188-197. https://doi.org/10.1038/s41397-022-00275-7.
5. [5] Abubakar U, Subramaniam L, Ayinla A, Ambali MN, Mohamed Noor DA, Daud NAA, Isah HK, Al-Shami HA. Knowledge, attitude and perception of community pharmacists towards pharmacogenomics services in northern Nigeria: a cross-sectional study. J Pharm Policy Pract. 2022; 15(1):39. https://doi.org/10.1186/s40545-022-00435-x.
6. [6] Roederer MW, Van Riper M, Valgus J, Knafl G, McLeod H. Knowledge, attitudes and education of pharmacists regarding pharmacogenetic testing. Pers Med. 2012; 9(1):19-27. https://doi.org/10.2217/pme.11.87.
7. [7] Roden DM, Altman RB, Benowitz NL, Flockhart DA, Giacomini KM, Johnson JA, Krauss RM, McLeod HL, Ratain MJ, Relling MV, Ring HZ, Shuldiner AR, Weinshilboum RM, Weiss ST; Pharmacogenetics Research Network. Pharmacogenomics: challenges and opportunities. Ann Intern Med. 2006;145(10):749-57. https://doi.org/10.7326/0003-4819-145-10-200611210-00007.
8. [8] Shah S, Hanif M, Khan HU, Khan FU, Abbas G, Khurram H, Khames A, Abdelgawad MA, Said ASA, Abourehab MAS, Maheen S, Chand UR, Haris M. Knowledge, attitudes and practices of pharmacogenomics among senior pharmacy students: a cross sectional study from Punjab, Pakistan. Pharmacogenomics Pers Med. 2022:429-439. https://doi.org/10.2147/PGPM.S359920.

9. [9] Anderson C, Bates I, Beck D, Brock TP, Futter B, Mercer H, et al. The WHO UNESCO FIP pharmacy education taskforce. Human Resources for Health. 2009; 7:1-8. https://doi.org/10.1186/1478-4491-7-45.
10. [10] Algahtani M. Knowledge, perception, and application of pharmacogenomics among hospital pharmacists in Saudi Arabia. Risk Manag Healthc Policy. 2020:1279-1291. https://doi.org/10.2147/RMHP.S267492. [11] Bagher AM, Neamatallah T, Balto G, Almikhy L, Almutairi SS, Abushal MO, Baghlaf K, Bagher SM. Knowledge, perception, and confidence of hospital pharmacists toward pharmacogenetics in Jeddah, Kingdom of Saudi Arabia. Saudi Pharm J. 2021; 29(1):53-58. https://doi.org/10.1016/j.jsps.2020.12.006.
11. [12] Stäuble CK, Jeiziner C, Bollinger A, Wiss FM, Hatzinger M, Hersberger KE, Ihde T, Lampert ML, Mikoteit T, Meyer Zu Schwabedissen HE, Allemann SS. A Guide to a Pharmacist-Led Pharmacogenetic Testing and Counselling Service in an Interprofessional Healthcare Setting. Pharmacy (Basel). 2022 ;10(4):86. https://doi.org/10.3390/pharmacy10040086.
12. [13] Haidar C-E, Petry N, Oxencis C, Douglas JS, Hoffman JM. ASHP statement on the pharmacist’s role in clinical pharmacogenomics. Am Journal of Health-Syst Pharm. 2022; 79(8):704-707. https://doi.org/10.1093/ajhp/zxab339.
13. [14] Rahma AT, Elbarazi I, Ali BR, Patrinos GP, Ahmed LA, Al Maskari F. Genomics and pharmacogenomics knowledge, attitude and practice of pharmacists working in United Arab Emirates: Findings from focus group discussions—a qualitative study. J Pers Med. 2020; 10(3):134. https://doi.org/10.3390/jpm10030134.
14. [15] Arafah A, Rehman MU, Syed W, Babelghaith SD, Alwhaibi A, Al Arifi MN. Knowledge, attitude and perception of pharmacy students towards pharmacogenomics and genetics: An observational study from King Saud University. Genes. 2022; 13(2):269. https://doi.org/10.3390/genes13020269.
15. [16] Albitar L, Alchamat GA. Pharmacogenetics: Knowledge assessment amongst Syrian pharmacists and physicians. BMC Health Serv Res. 2021; 21:1-8. https://doi.org/10.1186/s12913-021-07040-9.
16. [17] Edris A, Vanoverschelde A, Bushaj P, Van Nieuwerburgh F, Lahousse L. Pharmacogenetics in clinical practice: current level of knowledge among Flemish physicians and pharmacists. Pharmacogenomics J. 2021; 21(1):78-84. https://doi.org/10.1038/s41397-02000180-x.
17. [18] Nagy M, Lynch M, Kamal S, Mohamed S, Hadad A, Abouelnaga S, Aquilante CL. Assessment of healthcare professionals' knowledge, attitudes, and perceived challenges of clinical pharmacogenetic testing in Egypt. Per Med. 2020 ;17(4):251-260. https://doi.org/10.2217/pme-2019-0163.
18. [19] Tsuji D, Saito Y, Mushiroda T, Miura M, Hira D, Terada T. Results of a nationwide survey of Japanese pharmacists regarding the application of pharmacogenomic testing in precision medicine. J Clin Pharm Ther. 2021; 46(3):649 657. https://doi.org/10.1111/jcpt.13367.
19. [20] Beshna EA, Alahrish RA. Pharmacists' knowledge and attitudes toward Pharmacogenomics in Zawia, Libya. Med Pharm J. 2023;2(3):158-166. https://doi.org/10.55940/medphar202355.
20. [21] Tuteja S, Haynes K, Zayac C, Sprague JE, Bernhardt B, Pyeritz R. Community pharmacists ‘attitudes towards clinical utility and ethical implications of pharmacogenetic testing. Pers Med. 2013;10(8):793-800. https://doi.org/10.2217/pme.13.85.
21. [22] Thornley T, Esquivel B, Wright DJ, Dop HV, Kirkdale CL, Youssef E. Implementation of a pharmacogenomic testing service through community pharmacy in the Netherlands: results from an early service evaluation. Pharmacy. 2021;9(1):38. https://doi.org/10.3390/pharmacy9010038.
22. [23] Adesta F, Mahendra C, Junusmin KI, Rajah AM, Goh S, Sani L, Chan A, Irwanto A. Pharmacogenomics implementation training improves self-efficacy and competency to drive adoption in clinical practice. Front Pharmacol. 2021;12:684907. https://doi.org/10.3389/fphar.2021.684907.
23. [24] Bright D, Worley M, Porter BL. Patient perceptions of pharmacogenomic testing in the community pharmacy setting. Res Soc Adm Pharm. 2021;17(4):744-749. https://doi.org/10.1016/j.sapharm.2020.06.022.
24. [25] Albassam A, Alshammari S, Ouda G, Koshy S, Awad A. Knowledge, perceptions and confidence of physicians and pharmacists towards pharmacogenetics practice in Kuwait. PLoS One. 2018; 13(9):e0203033. https://doi.org/10.1371/journal.pone.0203033.
25. [26] Hundertmark ME, Waring SC, Stenehjem DD, Macdonald DA, Sperl DJ, Yapel A, Brown JT. Pharmacist's attitudes and knowledge of pharmacogenomics and the factors that may predict future engagement. Pharm Pract (Granada). 2020;18(3):2008. https://doi.org/10.18549/pharmpract.2020.3.2008.
26. [27] Luzum JA, Luzum MJ. Physicians’ attitudes toward pharmacogenetic testing before and after pharmacogenetic education. Pers Med. 2016; 13(2):119-127. https://doi.org/10.2217/pme.15.57.
27. [28] Ho TT, Gift M, Alexander E. Prioritizing pharmacogenomics implementation initiatives: a survey of healthcare professionals. Pers Med. 2022; 19(1):15-23. https://doi.org/10.2217/pme-2021-0061.
28. [29] AlEjielat R, Ejielat Z, Andrawes S, Mhaidat NM. An evaluation of the knowledge, opinions, expectations and concerns toward pharmacogenomics among Jordanian pharmacists. Pers Med. 2016; 13(2):143-54. https://doi.org/10.2217/pme.15.50.
29. [30] Abu-Elmagd M, Assidi M, Schulten HJ, Dallol A, Pushparaj P, Ahmed F, Scherer SW, Al-Qahtani M. Individualized medicine enabled by genomics in Saudi Arabia. BMC Med Genomics. 2015;8 Suppl 1(Suppl 1):S3. https://doi.org/10.1186/1755-8794-8-S1-S3.
30. [31] Al-Mahayri ZN, Khasawneh LQ, Alqasrawi MN, Altoum SM, Jamil G, Badawi S, Hamza D, George L, AlZaabi A, Ouda H, Al-Maskari F, AlKaabi J, Patrinos GP, Ali BR. Pharmacogenomics implementation in cardiovascular disease in a highly diverse population: initial findings and lessons learned from a pilot study in United Arab Emirates. Hum Genomics. 2022;16(1):42. https://doi.org/10.1186/s40246-022-00417-9.