Implementation of a multidisciplinary pharmacogenomics clinic in a community health system

Dunnenberger, Henry M.; Biszewski, Matthew; Bell, Gillian C.; Sereika, Annette; May, Holley; Johnson, Samuel G.; Hulick, Peter J.; Khandekar, Janardan D.

doi:10.2146/ajhp160072

Cited by 105 publications

(102 citation statements)

References 72 publications

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“…According to another study, physicians found utility in providing PGx testing to improve patient outcomes by individualizing treatment to guide medication decisions and to decrease time and cost for maximizing the benefits of needed medications [35]. Utilizing PGx testing in order to avoid side effects from medication and improve medication effectiveness have been proposed as benefits in other studies as well [5,17,20,[35][36][37].…”

Section: Re Sending Their Cheek Cells Off That Their Dna Is Getting Smentioning

confidence: 99%

“…Implementation of PGx has been attempted in a variety of settings and using various methods. A multidisciplinary clinic approach utilized medical geneticists, pharmacists, an advanced practice nurse and genetic counselors [17]. Although this model provides the patient a thorough evaluation of the pharmacogenetic variants they are found to carry, such effort lacks scalability to be an efficient sole implementation effort for a health system.…”

Section: Introductionmentioning

confidence: 99%

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Primary Care Physician Experiences with Integrated Pharmacogenomic Testing in a Community Health System

et al. 2017

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Aim: To explore primary care physicians' views of the utility and delivery of direct access to pharmacogenomics (PGx) testing in a community health system. Methods: This descriptive study assessed the perspectives of 15 healthcare providers utilizing qualitative individual interviews. Results: Three main themes emerged: perceived value and utility of PGx testing; challenges to implementation in practice; and provider as well as patient needs. Conclusion: While providers in this study viewed benefits of PGx testing as avoiding side effects, titrating doses more quickly, improving shared decision-making and providing psychological reassurance, challenges will need to be addressed such as privacy concerns, cost, insurance coverage and understanding the complexity of PGx test results.

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Section: Re Sending Their Cheek Cells Off That Their Dna Is Getting Smentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Primary Care Physician Experiences with Integrated Pharmacogenomic Testing in a Community Health System

et al. 2017

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“…(10–14) In many ways, these community-based care models have taken the essential elements needed for pharmacogenetic testing identified in early clinical academic models and developed pragmatic solutions individualized to their own practice environment to overcome implementation barriers. Such adaptations include outsourcing some aspects of preemptive, panel-based pharmacogenetic testing and interpretation to a commercial laboratory that provides evidence interpretation, recommendations for clinical decision making, an external platform to store test results, and capitated patient payment models to encourage test uptake (11,14); prescriber partnership with trained physician extenders (e.g., nurses, genetic counselors, pharmacists) to communicate test results to patients (12–14); exploration of patient self-pay models to overcome the immediate cost barrier of preemptive testing (10,14); increasing patient access by providing pharmacogenetic testing in nontraditional settings, such as community-based pharmacies and community hospitals (10, 12, 14); and leveraging technological advances, such as the ability to link test results to an evidence-based prescribing decision support system for clinicians. (11,14)…”

Section: The Changing Landscape Of Preemptive Panel-based Pharmacogementioning

confidence: 99%

Preemptive Panel-Based Pharmacogenetic Testing: The Time is Now

2017

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While recent discoveries have paved the way for the use of genotype-guided prescribing in some clinical environments, significant debate persists among clinicians and researchers about the optimal approach to pharmacogenetic testing in clinical practice. One crucial factor in this debate surrounds the timing and methodology of genotyping, specifically whether genotyping should be performed reactively for targeted genes when a single drug is prescribed, or preemptively using a panel-based approach prior to drug prescribing. While early clinical models that employed a preemptive approach were largely developed in academic health centers through multidisciplinary efforts, increasing examples of pharmacogenetic testing are emerging in community-based and primary care practice environments. However, educational and practice-based resources for these clinicians remain largely nonexistent. As such, there is a need for the health care system to shift its focus from debating about preemptive genotyping to developing and disseminating needed resources to equip frontline clinicians for clinical implementation of pharmacogenetics. Providing tools and guidance to support these emerging models of care will be essential to support the thoughtful, evidence-based use of pharmacogenetic information in diverse clinical practice environments. Specifically, the creation of efficient and accurate point-of-care resources, practice-based tools, and clinical models is needed, along with identification and dissemination of sustainable avenues for pharmacogenetic test reimbursement.

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“…While our study focused on the specific application of CYP2C19 genotype-guided therapy for clopidogrel therapy, efforts to incorporate genetics into medication prescribing and management are becoming more common 32. The uptake in pharmacogenetics in clinical settings is being driven by the availability of evidence-based guidelines for valid and clinically actionable drug-gene pairs, as well as the incorporation of genetic information in EHR and development of associated clinical decision support tools 33.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of clinical pharmacist-led CYP2C19 genotyping for patients receiving non-emergent cardiac catheterization in an integrated health system

Johnson¹,

Shaw²,

Delate³

et al. 2017

Pharm Pract (Granada)

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Objective:To assess the feasibility of clinical pharmacist-led CYP2C19 genotype-guided P2Y12 inhibitor antiplatelet drug therapy recommendations to cardiologists in an outpatient cardiology practice.Methods:This was a prospective, open-labeled, single-arm study conducted in an integrated healthcare delivery system between March 1, 2013 and January 23, 2014. Patients requiring non-emergent cardiac catheterization were included. A clinical pharmacist provided interpretation and recommendations from genotyping results. The feasibility of implementing CYP2C19 genotype-guided antiplatelet therapy was assessed by the: 1) percentage of patients approached who consented to CYP2C19 genotyping, 2) percentage of patients with CYP2C19 genotyping results available prior to cardiac catheterization, and 3) percentage of clinical pharmacist CYP2C19 genotype-based antiplatelet recommendations accepted by cardiologists.Results:Of the 43 patients identified for potential recruitment, 22 of these were eligible for study enrollment and 6 (27%) patients consented and received CYP2C19 genotyping. All patients had genotyping results available prior to catheterization and all clinical pharmacists’ antiplatelet therapy recommendations were accepted by the patients’ cardiologists. Three patients had the CYP2C19 wild-type (*1/*1) genotype and the clinical pharmacist recommended clopidogrel therapy. CYP2C19 variant genotypes (i.e., *1/*2, *1/*17, and *2/*17) were found in the other three patients; alternative antiplatelet therapy was recommended for the patient with the *1/*2 genotype, while clopidogrel was recommended for those with *1/*17 and *2/*17 genotypes.Conclusion:A relatively small proportion of patients undergoing non-emergent cardiac catheterization consented to pharmacogenetic testing; however, their cardiologists were receptive to clinical pharmacists conducting such testing and providing corresponding pharmacotherapy recommendations. Future studies should identify patient barriers to pharmacogenetic testing.

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Implementation of a multidisciplinary pharmacogenomics clinic in a community health system

Abstract: A multidisciplinary clinic providing genotyping and related services can facilitate the integration of pharmacogenomics into clinical care and meet the needs of early adopters of precision medicine.

Cited by 105 publications

References 72 publications

Primary Care Physician Experiences with Integrated Pharmacogenomic Testing in a Community Health System

Primary Care Physician Experiences with Integrated Pharmacogenomic Testing in a Community Health System

Preemptive Panel-Based Pharmacogenetic Testing: The Time is Now

Feasibility of clinical pharmacist-led CYP2C19 genotyping for patients receiving non-emergent cardiac catheterization in an integrated health system

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