Table 3.
Top 3 challenges [n (%)] for bringing pharmacogenetics into clinical practice
| Very high HDI—North America | Very high HDI—Europe | Very high HDI—other | High HDI | Medium HDI | Low HDI | No country information | |
|---|---|---|---|---|---|---|---|
| Number of respondents | 62 | 32 | 12 | 19 | 16 | 2 | 27 |
| Challenges | 176 | 81 | 32 | 51 | 44 | 6 | 78 |
| Test cost and reimbursement | 39 (22.2) | 10 (12.3) | 6 (18.8) | 9 (17.6) | 13 (29.5) | 1 (16.7) | 13 (16.7) |
| Insufficient physician knowledge or awareness | 25 (14.2) | 13 (16.0) | 1 (3.1) | 3 (5.9) | 6 (13.6) | 1 (16.7) | 6 (7.7) |
| Physician scepticism or lack of interest | 15 (8.5) | 8 (9.9) | 6 (18.8) | 7 (13.7) | 1 (2.3) | 0 (0) | 9 (11.5) |
| Unclear test interpretation | 15 (8.5) | 6 (7.4) | 2 (6.3) | 2 (3.9) | 2 (4.5) | 0 (0) | 7 (9) |
| Limited evidence for clinical utility: clinical benefit and cost‐effectiveness | 14 (8) | 11 (13.6) | 1 (3.1) | 1 (2) | 1 (2.3) | 0 (0) | 4 (5.1) |
| Unclear or lack of guidelines | 9 (5.1) | 4 (4.9) | 1 (3.1) | 4 (7.8) | 1 (2.3) | 0 (0) | 12 (15.4) |
| Unavailability of test, technology, infrastructure, manpower or experts | 5 (2.8) | 2 (2.5) | 2 (6.3) | 4 (7.8) | 7 (15.9) | 1 (16.7) | 4 (5.1) |
| Lack of adequate counsellors or adequate communication of results | 3 (1.7) | 8 (9.9) | 1 (3.1) | 4 (7.8) | 0 (0) | 1 (16.7) | 6 (7.7) |
| Electronic medical records integration and clinical decision support | 17 (9.7) | 2 (2.5) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 3 (3.8) |
| Data from different populations or ethnicities | 4 (2.3) | 0 (0) | 5 (15.6) | 6 (11.8) | 3 (6.8) | 0 (0) | 3 (3.8) |
| Insufficient public understanding or awareness | 3 (1.7) | 2 (2.5) | 2 (6.3) | 2 (3.9) | 1 (2.3) | 0 (0) | 2 (2.6) |
| Lack of funding, investment or support | 0 (0) | 2 (2.5) | 3 (9.4) | 3 (5.9) | 3 (6.8) | 0 (0) | 0 (0) |
| Lack of legislative mandate or endorsement | 2 (1.1) | 4 (4.9) | 0 (0) | 2 (3.9) | 2 (4.5) | 0 (0) | 0 (0) |
| Integration into clinical workflow | 7 (4) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (1.3) |
| Turn‐around time and efficiency | 3 (1.7) | 3 (3.7) | 0 (0) | 1 (2) | 0 (0) | 0 (0) | 1 (1.3) |
| Suboptimal ethical regulations for information protection | 0 (0) | 4 (4.9) | 0 (0) | 1 (2) | 1 (2.3) | 1 (16.7) | 1 (1.3) |
| Data management and bioinformatics | 3 (1.7) | 1 (1.2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 2 (2.6) |
| Inefficient administrative and regulative bodies | 0 (0) | 0 (0) | 0 (0) | 2 (3.9) | 1 (2.3) | 1 (16.7) | 2 (2.6) |
| Lack of standardization of genotyping tests and results across laboratories | 5 (2.8) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
| Disconnect between clinical practitioners and researchers | 1 (0.6) | 0 (0) | 1 (3.1) | 0 (0) | 2 (4.5) | 0 (0) | 1 (1.3) |
| Patient expectations or concerns | 3 (1.7) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
| Need for large‐scale genetic screening | 2 (1.1) | 0 (0) | 1 (3.1) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
| Unrealistic ideas to apply large‐scale genetic testing | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (1.3) |
| Lack of alternative treatments | 1 (0.6) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
| Lack of parallel testing of drug levels | 0 (0) | 1 (1.2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
| Patient expectations or concerns | 3 (1.7) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
HDI: Human Development Index (2018).
Number of respondents does not total 204 due to missing answers.
Number of challenges are less than the triple of the number of respondents due to unclassifiable answers such as knowledge, priority etc.