PRSB launches new work on pharmacogenomics - PRSB

PRSB launches new work on pharmacogenomics

October 22, 2019

Genomics – the study of our genetic makeup – is increasingly transforming healthcare. Already genomics is helping to determine our individual risk of developing a number of diseases, detecting illness earlier, helping provide accurate diagnoses, and determining the most effective interventions to help improve our health.

Our genetic makeup also influences what medicines work best for us or should be avoided. The safe and effective prescribing of medicines tailored to an individual’s genetic makeup is known as pharmacogenomics and the NHS is keen to ensure that this information is communicated in the right way to the people that need to see it.

Research on current data shows that in a high volume (85%) of genomic records, there are findings which could be used to deliver better and safer prescribing of drugs. For example, certain information about a person’s genomic makeup could indicate which drugs might cause harm or be ineffective.

At present, the approach to drug development assumes that all patients with a particular condition respond similarly to a given drug. All patients with the same condition receive the same first line treatment even though it may be only 30 to 60% effective. Notifying prescribers of this information would mean that alternative drugs could be prescribed or an alert about the dose could be shared in order to reduce the potential harmful effects of drugs.

NHS England is currently exploring how this information can be used to improve the safety and quality of care. To inform this work PRSB has been asked to develop guidance on what information should be shared, with whom and when to support those who are prescribing medications.

The guidance will be developed with the support of experts and specialists across a broad range of services, as well as patients who are impacted. A focus group will be held in November to gain a wide range of opinions on what needs to be included in the guidance.

CHAT theory also explicitly addresses five areas which if addressed systematically will help overcome stakeholder differences in pursuit of the common goal:

1. Understanding the artefacts that characterise the group and its activity.
• The artefacts might be clinical settings or the forms and templates used to capture and share information. During the pilot we heard about hard copy Dialog response forms; locally generated templates for collating information from different systems; letters and emails to GPs; images, poems or other non-text artefacts that service users might want to include in their ‘about me’ or care plan.

2. Understanding the multi-views of the group. Such groups are always a community of multiple points of view, traditions and interests.
• Different participants in the group will have different roles and will bring to the group and their roles their own histories, language, and ‘rules’. During our Stocktake preparations and workshops we worked with psychiatrists, mental health nurses, occupational therapists, social workers, transformation leads and voluntary sector representatives, all professions and interests with their own language, approaches professional ‘rules’ but united in their interest in care plans, care planning.

3. Activity systems (like the ICSs) take shape and get transformed over periods of time. ‘Historicity’ is a term coined to express how the group’s problems and potentials can only be understood against their own history.

• ‘We’ve always done it this way’, ‘that didn’t work before’, ‘it’s always like this’, ‘it wasn’t always like this’, ‘they are changing things again’, are all typical statements that often frustrate those charged with overseeing change initiatives. Without addressing the experiences that lie behind such comments you risk repeating mistakes of the past, alienating your stakeholders or just not understanding the real starting point for your transformation project. This is particularly the case for the implementation of the PCSP standard, the success of which will be largely reliant on point-of-care practices and information protocols as well as having systems which are user friendly and appropriately configured.

4. The central role of contradictions as sources of change and development. Contradictions are not the same as problems or conflicts. Contradictions are historically accumulating structural tensions within and between activity systems. Collectively addressing contradictions in how policy, practice, culture and technology interact will empower teams to find genuinely novel solutions for apparently intractable challenges, like interoperability and shared care plan/planning.

This links to the fifth principle that:

5. the possibility of expansive transformations in activity systems. As the contradictions of an activity system are aggravated, some individual participants begin to question and deviate from its established norms. In some cases, this escalates into collaborative envisioning and a deliberate collective change effort. “An expansive transformation is accomplished when the object and motive of the activity are re-conceptualised to embrace a radically wider horizon of possibilities than in the previous mode of the activity.”