Congruence Rates for Pharmacogenomic Noninterruptive Alerts

Mills, Sarah Catherine; Massmann, Amanda

doi:10.2217/pgs-2023-0016

Cited by 3 publications

(2 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A few studies have been conducted on utilizing interruptive versus noninterruptive alert mechanisms with the hopes to optimize workflows and minimize excessive alerts. [34][35][36][37] Sanford Health's initiative to integrate genomic information into routine care required substantial clinician education. 14 Clinicians were surveyed in both pre and posteducation modules with secondary analysis completed to stratify PGx perceptions based on provider specialty.…”

Section: Discussionmentioning

confidence: 99%

Early evaluation of a novel alert within cardiac procedural areas to facilitate genotype‐guided antiplatelet therapy

Van Heukelom,

Weaver,

Max

et al. 2024

J Am Coll Clin Pharm

Self Cite

View full text Add to dashboard Cite

IntroductionClopidogrel remains widely utilized in patients undergoing percutaneous coronary intervention despite compelling evidence that genetic variation impacts patient response to clopidogrel. Clinical decision support (CDS) is frequently used to aid in precision medicine; however, limitations within the electronic medical record can hinder reliable CDS. Procedural areas where standard order entry is not utilized create a barrier to CDS implementation.ObjectivesWe aimed to evaluate the implementation of a novel alerting mechanism on genotype‐guided antiplatelet prescribing within the cardiac catheterization laboratory procedural setting.MethodsA retrospective cohort study was conducted to assess the rate of antiplatelet ordering in patients with one or two loss‐of‐function cytochrome P450 2C19 (CYP2C19) alleles before and after alert implementation. Pharmacogenomic congruence was measured before and after the alert via chart abstraction that included the CYP2C19 genotype and antiplatelet medications ordered within that encounter.ResultsA total of 236 patients were included in analyses, 127 encounters within the cohort before alert implementation and 136 encounters in the cohort after alert implementation. Prior to alert implementation, 40.9% (n = 127) were prescribed clopidogrel compared with 25.7% (n = 136) post implementation. After implementing a genotype‐guided alert within the cardiac catheterization laboratory procedural setting, providers were 2.22 times more likely to prescribe an alternative antiplatelet (p = 0.024). Clopidogrel‐naïve patients were 9.75 times more likely to receive a genotype‐guided antiplatelet order following alert implementation (p < 0.05).ConclusionProviders were responsive to a novel alert within the cardiac catheterization laboratory procedural setting. Genotype‐guided antiplatelet prescribing significantly increased following the alert implementation.

show abstract

Section: Discussionmentioning

confidence: 99%

Early evaluation of a novel alert within cardiac procedural areas to facilitate genotype‐guided antiplatelet therapy

Van Heukelom,

Weaver,

Max

et al. 2024

J Am Coll Clin Pharm

Self Cite

View full text Add to dashboard Cite

show abstract

“…Despite the benefits associated with CDS, there are substantial challenges to the development and acceptance/utilization of these tools [127][128][129][130][131]. Clinical decision support developers face issues such as designing a friendly user interface, extracting free text in the medical record, prioritizing clinical recommendations, maintenance, and drafting appropriate language for alerts, as well as providing additional informational sources for providers and patients.…”

Section: Pharmacist Barriersmentioning

confidence: 99%

The Critical Role of Pharmacists in the Clinical Delivery of Pharmacogenetics in the U.S

Haga

2023

Pharmacy

View full text Add to dashboard Cite

Since the rebirth of pharmacogenomics (PGx) in the 1990s and 2000s, with new discoveries of genetic variation underlying adverse drug response and new analytical technologies such as sequencing and microarrays, there has been much interest in the clinical application of PGx testing. The early involvement of pharmacists in clinical studies and the establishment of organizations to support the dissemination of information about PGx variants have naturally resulted in leaders in clinical implementation. This paper presents an overview of the evolving role of pharmacists, and discusses potential challenges and future paths, primarily focused in the U.S. Pharmacists have positioned themselves as leaders in clinical PGx testing, and will prepare the next generation to utilize PGx testing in their scope of practice.

show abstract

Impact of using dosing criteria to refine pharmacogenomic clinical decision support for tricyclic antidepressants

Massmann,

Petry,

Mills

et al. 2024

American Journal of Health-System Pharmacy

View full text Add to dashboard Cite

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To evaluate the impact of dose-specific logic for tricyclic antidepressant (TCA) pharmacogenomic (PGx) clinical decision support (CDS). We aimed to provide guidance in an area with limited supporting literature, ensure optimal dosing through CDS, and limit alert fatigue. The primary outcome was the reduction in alerts prescribers encountered, while the secondary outcome included an analysis across specialties. Methods A retrospective chart review was conducted to examine TCA PGx CDS before and after implementation of dosing criteria for alerts. Data were abstracted from the electronic medical record. A χ2 test was performed to analyze the frequency of alerts in behavioral health and other specialties. Results In the cohort lacking dose criteria, most TCA orders were for indications other than depression (76%) and guidelines would not apply to the majority of these orders. Using dosing criteria to refine CDS reduced the volume of TCA alerts by 74.8%. Alert volume decreased the most in specialties other than behavioral health due to prescriptions for indications other than anxiety or depression (P = 0.035). Conclusion Dose-centric alerts may be used as a strategy to achieve optimal dosing. Alerting clinicians when dose modifications should occur contributes to getting the right dose to the right patient. Future efforts should focus on optimal dosing of medication through CDS enhancements.

show abstract

Congruence Rates for Pharmacogenomic Noninterruptive Alerts

Cited by 3 publications

References 20 publications

Early evaluation of a novel alert within cardiac procedural areas to facilitate genotype‐guided antiplatelet therapy

Early evaluation of a novel alert within cardiac procedural areas to facilitate genotype‐guided antiplatelet therapy

The Critical Role of Pharmacists in the Clinical Delivery of Pharmacogenetics in the U.S

Impact of using dosing criteria to refine pharmacogenomic clinical decision support for tricyclic antidepressants

Contact Info

Product

Resources

About