Introduction patient’s journey as a platform for
The personalised medicines for the individuals started with the discovery
of the DNA double helix in the 1950s. It was then followed up by identification
of the genetic code and DNA sequencing. The very first personalised medicine
was Herceptin for the patients with excessive expression of the HER2 receptor 1
.Through the completion of the human genome project with the goal of
mapping of all the genes, which make up human being, scientists obtained useful
information about the structure, organization, and function of the human genes.
As all human beings are different from each other, healthcare professionals can
use this information as an instruction for dealing with the disease at the
individual level 2.
personalisation of medicines important?
Personalisation of medicine helps healthcare professionals to help each
patient from prevention to treatment to management. For example, it helps to
distinguish responders from non-responders and exclude the high-risk group from
both clinical trials and therapy groups. From another point of view,
personalisation of medicine not only helps to improve the patients’ outcome, by
improving their quality of life, the method of administration and the
prevention of disease, but also it can have a significant role in the
improvement of efficiencies in the healthcare system. This can be achieved by
focusing on prevention and earlier intervention, instead of treatment.
journey as a platform for personalisation of medicine:
When we are
considering a patient’s journey between community and hospital pharmacy, there
are different points where the patient and healthcare professional can engage
in personalised medicine, whether it be a primary or secondary care.
Communication among healthcare professionals is important, especially when a
patient is transferred to different care settings. From the pharmacist’s
perspective, this relates particularly in term of ensuring a patient has
understood the changes made to their medication, had opportunities to ask
questions and has otherwise received the support required to enable good and
journey is important to understand between community and hospital pharmacy as
it allows us to realise where pharmacists may face challenges, and
opportunities where personalised medicine can have a role in enhancing patient
care. Current examples of personalised medicine are limited in both the
community and hospital settings. However, with drug research developing and as
our knowledge of health conditions expands, there is more opportunity for
personalisation of medicines happen in the community pharmacy?
few examples of personalised practice in the community, there are more to the
monitoring or pre-diagnosis process. Some community pharmacies, , like day
Lewis and some boots stores, offer INR
testing thus patients do not need to visit a surgery for Warfarin dose
adjustments and monitoring frequently. Other examples of medicines personalisation
in the community pharmacy include the H. Pylori test for the stomach ulcer,
providing personal medical devices like Insulin pens, where doses can be
adjusted according to individual requirements and other enhanced services like
MUR (medical use review) and NMS (new medical services).
One of the
other areas where medicine personalisation can happen in the community pharmacy
is the improvement of unintentional non-adherence. An essential step to
overcome non-adherence is changing the treatment strategy. This strategy change
involves shifting from one size fit everyone medical regimen to personalised
medicine. It can be a guide for the development of the better therapeutic
relationship between patients and healthcare professionals. In this method, the
patient will be treated based on their specific characteristics, desires,
needs, expectations, abilities, fears, etc. In addition to this unique personal
requirements, medical history, co-morbidity, family and personal history may
also play important roles in patient’s response to the treatment.
personalised medicine can help to improve adherence in both long and
short-term. For example, in the short term personalisation of medicine,
providing written counselling in addition to the oral one can significantly
improve the adherence of the specific patient groups like dementia patients and
patients with language difficulty. Examples of long-term medical
personalisation are using alternative packaging and compliance aids (liquid
formulation like suspension instead of solid formulation like tablets for
patients with dysphagia) or using a spacer for asthmatic children, so it make
it easier for them to use the inhaler. Another example is changing and
simplifying the medicine’s dosage and dosing regimen for polypharmacy patients.
Another way to improve adherence is suggesting recording their medicine-taking
and encouraging them to monitor their conditions 3. The acronym
for patient centred adherence in the community pharmacy is SIMPLE: Select
medications respecting the patient’s preference and Simplify the regimen;
Increase knowledge; Modify negative patient’s attitudes and behaviour; Provide
person-centred pharmacotherapy and motivational interviewing; Leave paternalism
and empower patients to self-manage their medical condition; and Evaluate
adherence regularly 4 56.