Almost half of all UK adults regularly take prescription medicines and the annual NHS budget for medicines is approximately £17.4 billion per year, with over 1.1 billion items prescribed annually.
Medicines are the most common therapeutic intervention in healthcare, yet the efficacy and safety of many drugs show considerable interpersonal variation; some patients have been prescribed medication that does not work well, while others develop reactions to their medicines.
One approach to addressing adverse or ineffective medication reactions is to use knowledge of an individual’s genetic information to support medicines optimisation, better informing medicine selection and dosing, a concept known as pharmacogenetics.
Pharmacogenetics is the study of genetic causes of individual variations in drug response, whereas Pharmacogenomics (PGx) is the study of how variations in the human genome dictate a person's response to medications, and how we can leverage the knowledge of an individual’s genetic information to support medicines optimisation, better-informing medicine selection, and dosing.
The North West Genomic Medicine Service Alliance are leading on the national Pharmacogenomic and Medicines Optimisation NHS Genomic Network of Excellence across England, supporting the roll out of pharmacogenomics (PGx) and medicine optimisation across the NHS.
The Pharmacogenetics Roll Out – Gauging Response to Service [PROGRESS] programme is an NHS England (NHS E) funded transformation project led by researchers at Manchester University NHS Foundation Trust (MFT) and the NHS NW Genomic Medicine Service Alliance (NWGMSA), to investigate the feasibility of delivering pre-emptive pharmacogenetic panel testing in primary care in the NHS.
A key element of the study is the development of a digital proof of concept which translates genetic test results into prescribing advice, within a primary care setting.
Introducing ProgressRX
ProgressRX harnesses the power of pharmacogenomic data, as an ‘end-to-end diagnostic interpretation tool’ which uses existing NHS clinical data systems.
Initial trials are currently taking place within primary care, which have proven where ProgressRX has bridged the gap between the interpretation of genomic test data, and enhanced prescribing practice, without increasing cognitive burden on the prescriber.
By streamlining the integration of pharmacogenomic data into existing clinical decision support (CDS) systems, ProgressRX is a technological milestone which embodies the collective efforts of stakeholders committed to advancing genomic medicine and delivering superior patient care.
How does ProgressRX work?
- It provides real time PGx guidance, for prescribers/practitioner with clinical safety paramount.
- It maximises access and utilisation of available pharmacogenomic data, supports and harnesses existing NHS clinical decision support (CDS) systems.
- CDS systems are digital tools that can support clinicians to make equitable, evidence-based decisions. They can be used across care settings, specialties, and pathways to improve healthcare delivery and reduce errors.
- Transformation of healthcare services with CDS requires consideration of several critical success factors – encapsulated by the six Is: inclusive, intelligent, interpretable, integrated, impactful, interoperable.
- Genomic test results are interpreted and kept, to inform the prescribing process within General Practice, Primary Care Pharmacy, Mental Health Trusts, and Acute Hospital settings.
- If no PGx guidance needed, then no message is generated. There is no added cognitive burden on the prescriber/practitioner.
- The service uses the individuals’ NHS number to ensure that the correct patient is found.
- Guidance is tailored to individual patients, in line with their genomic data, for all prescribing events.
- ProgressRX has been developed in line with the national Unified Genomic Record (UGR) which is a virtual case note, and enables the collation of genomic data, to develop a single genomic profile which can be managed and updated over a lifetime, whilst ensuring compatibility and interoperability across healthcare settings.
- The digital service is hosted in the NHS cloud which seamlessly integrates with existing clinical decision support systems which currently provide pharmacogenomic guidance ‘natively.’
Through strategic partnerships and collaborative efforts, ProgressRX is poised to set a new standard for genomic medicine services, driving innovation and enhancing patient care on a regional and national scale.
Key partnerships
With trials underway at selected sites, the potential of ProgressRX to optimise medication utilisation and improve patient outcomes becomes increasingly clear. Moving forward, ProgressRX will be evaluated across existing systems to optimise and migrate existing genetic information, supplying longevity to the individuals’ genetic profile.
Collaborative working and digital innovation are at the heart of the project, in support of effective implementation of an informatic solution, a single version of the truth, which can communicate the results of pharmacogenetic testing, without adding added burden to professionals at the point of care. The project not only showcases technological innovation but also highlights the collaborative efforts of various stakeholders in advancing enhanced patient care in the North West and beyond.
Professor Bill Newman, Consultant in Genomic Medicine at MFT and Clinical Director, NHS North West Genomic Medicine Service Alliance said: “At its core, pharmacogenetics uses individual genetic information to guide medication selection and dosing. This tailored approach to medicine optimization holds immense promise for personalised patient care.
Professor Newman, who is also Rare Conditions Co-Theme Lead at the National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre (BRC), added; “For the implementation of pharmacogenetics within healthcare to be effective, an end-to-end service like ProgressRx which links testing to prescribing needs to be developed and embedded in practice”.
For more information or to read the full article, please visit https://www.nw-gmsa.nhs.uk/about-us/our-projects/spotlight