Integrating Pharmacogenetic Testing Via Medication Therapy Management in an Outpatient Family Medicine Clinic

Brown, Jacob T.; MacDonald, Danielle A.; Yapel, Ann; Luczak, Tiana; Hanson, A; Stenehjem, David D.

doi:10.2217/pgs-2020-0178

Cited by 7 publications

(5 citation statements)

References 18 publications

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“…PGx testing offered in combination with medication therapy management (MTM) allows careful consideration of the patient's medication history, adverse experiences, and both drug-drug and drug-gene interactions. 21,22 Additionally, the incorporation of PGx allows for the identification of clinically important drugdrug interactions through recognition of phenoconversion. 23 Pharmacist-delivered PGx testing with MTM has been reported to reduce costs for elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Independent Community Pharmacists’ Experience in Offering Pharmacogenetic Testing

Haga¹,

Mills²,

Moaddeb³

et al. 2021

PGPM

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This study assessed pharmacist experiences with delivering pharmacogenetic (PGx) testing in independent community pharmacies. Methods: We conducted a cluster randomized trial of independent community pharmacies in North Carolina randomized to provide either PGx testing as a standalone service or integrated into medication therapy management (MTM) services. Surveys and pharmacist data about the delivery of PGx testing were collected. Semi-structured interviews were also conducted. Results: A total of 36 pharmacists participated in the study from 22 pharmacies. Sixteen pharmacists completed the pre-study and post-study surveys, and four pharmacists completed the semi-structured interviews. Thirty-one percent (11/36) of pharmacists had had some education in personalized medicine or PGx prior to the study. The only outcome that differed by study arm was the use of educational resources, with significantly higher utilization in the PGx testing only arm (p=0.007). Overall, compared to the pre-study assessment, pharmacists' knowledge about PGx significantly improved post-study (p=0.018). In the post-study survey, almost all pharmacists indicated that they felt qualified/able to provide PGx testing at their pharmacy. While 75% of pharmacists indicated that they may continue to provide PGx testing at their pharmacy after the study, the major concerns were lack of reimbursement for PGx counseling and consultation given the necessary time required. Conclusion:Our findings demonstrated a positive experience with delivering PGx testing in the community pharmacy setting with little difference in pharmacists' experiences in providing PGx testing with or without MTM. Pharmacists were confident in their ability to provide PGx testing and were interested in continuing to offer testing, though sustained delivery may be challenged by lack of prescribing provider engagement and reimbursement.

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Section: Introductionmentioning

confidence: 99%

Independent Community Pharmacists’ Experience in Offering Pharmacogenetic Testing

Haga¹,

Mills²,

Moaddeb³

et al. 2021

PGPM

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“…Several programs were able to integrate pharmacogenetic data directly into their local EHRs, thus facilitating implementation. Centers which were unable to integrate results into their local EHRs via clinical decision support tools were more likely to discuss adaptability as a challenge or barrier to integration ( 63 ). One study which did not have BPA functionality noted that “developing CDS tools is critical for the clinical utility to parallel the longevity of PGx results,” whilst another concluded that “current electronic and paper laboratory test information stores relegate historical test findings to an ‘out of mind’ position for most clinicians” ( 47 ).…”

Section: Resultsmentioning

confidence: 99%

Characterizing pharmacogenetic programs using the consolidated framework for implementation research: A structured scoping review

et al. 2022

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Several healthcare organizations have developed pre-emptive pharmacogenetic testing programs, where testing is undertaken prior to the prescription of a medicine. This review characterizes the barriers and facilitators which influenced the development of these programs. A bidirectional citation searching strategy identified relevant publications before a standardized data extraction approach was applied. Publications were grouped by program and data synthesis was undertaken using the Consolidated Framework for Implementation Research (CFIR). 104 publications were identified from 40 programs and 4 multi-center initiatives. 26 (66%) of the programs were based in the United States and 95% in high-income countries. The programs were heterogeneous in their design and scale. The Characteristics of the Intervention, Inner Setting, and Process domains were referenced by 92.5, 80, and 77.5% of programs, respectively. A positive institutional culture, leadership engagement, engaging stakeholders, and the use of clinical champions were frequently described as facilitators to implementation. Clinician self-efficacy, lack of stakeholder knowledge, and the cost of the intervention were commonly cited barriers. Despite variation between the programs, there were several similarities in approach which could be categorized via the CFIR. These form a resource for organizations planning the development of pharmacogenetic programs, highlighting key facilitators which can be leveraged to promote successful implementation.

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“…Pharmacists are crucial in the PGx service for evaluating appropriate patient eligibility, providing informative post-test counselling, or leading a PGx consult service (Crews et al, 2011 ; Brown et al, 2021 ; Bagautdinova et al, 2022 ; Krause and Dowd, 2022 ).…”

Section: Pgx Implementationmentioning

confidence: 99%

Cardiovascular precision medicine – A pharmacogenomic perspective

Padmanabhan¹,

Toit²,

Dominiczak³

2023

Camb. prisms Precis. med.

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Precision medicine envisages the integration of an individual’s clinical and biological features obtained from laboratory tests, imaging, high-throughput omics and health records, to drive a personalised approach to diagnosis and treatment with a higher chance of success. As only up to half of patients respond to medication prescribed following the current one-size-fits-all treatment strategy, the need for a more personalised approach is evident. One of the routes to transforming healthcare through precision medicine is pharmacogenomics (PGx). Around 95% of the population is estimated to carry one or more actionable pharmacogenetic variants and over 75% of adults over 50 years old are on a prescription with a known PGx association. Whilst there are compelling examples of pharmacogenomic implementation in clinical practice, the case for cardiovascular PGx is still evolving. In this review, we shall summarise the current status of PGx in cardiovascular diseases and look at the key enablers and barriers to PGx implementation in clinical practice.

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Integrating Pharmacogenetic Testing Via Medication Therapy Management in an Outpatient Family Medicine Clinic

Cited by 7 publications

References 18 publications

Independent Community Pharmacists’ Experience in Offering Pharmacogenetic Testing

Independent Community Pharmacists’ Experience in Offering Pharmacogenetic Testing

Characterizing pharmacogenetic programs using the consolidated framework for implementation research: A structured scoping review

Cardiovascular precision medicine – A pharmacogenomic perspective

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