Integrating Pharmacogenomics into Clinical Practice: Promise vs Reality

Abstract

BACKGROUND Limited information is available regarding primary care clinicians’ response to pharmacogenomic Clinical Decision Support (PGx-CDS) alerts integrated in the electronic health record. METHODS In February 2015, 159 clinicians in the Mayo Clinic primary care practice were sent e-mail surveys to understand their perspectives on the implementation and use of pharmacogenomic testing in their clinical practice. Surveys assessed how the clinicians felt about pharmacogenomics and whether they thought electronic PGx-CDS alerts were useful. Information was abstracted on the number of CDS alerts the clinicians received between October, 2013 and the date their survey was returned. CDS alerts were grouped into two categories: alert recommended caution using the prescription or the alert recommended an alternate prescription. Finally, data were abstracted regarding whether the clinician changed their prescription in response to the alert recommendation. RESULTS The survey response rate was 57% (n=90). Overall, 52% of the clinicians did not expect to use or did not know whether they would use pharmacogenomic information in their future prescribing practices. Additionally, 53% of the clinicians felt that the alerts were confusing, irritating, frustrating, or that it was difficult to find additional information. Finally, only 30% of the clinicians that received a CDS alert changed their prescription to an alternative medication. CONCLUSIONS Our results suggest a lack of clinician comfort with integration of pharmacogenomic data into primary care. Further efforts to refine PGx-CDS alerts to make them as useful and user-friendly as possible are needed to improve clinician satisfaction with these new tools.

Pharmacogenomic findings from clinical whole exome sequencing of diagnostic odyssey patients

“…; St Sauver et al. ). Even with these systems, however, barriers to successful and efficient integration of PGx results exist.…”

“…There are both technical and clinical barriers to the appropriate access and use of PGx results. Considerable effort has been made to implement clinical decision support (CDS) systems with automatic alerts to notify a prescribing physician when a relevant gene-drug interaction is present for a patient and educational components to assist the clinician with understanding the alerts (Arwood et al 2016;Caraballo et al 2016;Hicks et al 2016;Hoffman et al 2016;Manzi et al 2016;St Sauver et al 2016). Even with these systems, however, barriers to successful and efficient integration of PGx results exist.…”

Clinical Implementation of Pharmacogenetic Testing in a Hospital of the Spanish National Health System: Strategy and Experience Over 3 Years

“…In addition, one of the challenges reported for the delivery of pharmacogenetics results is the identification of the right person to receive a recommendation as well as the various uses of information that might be made by each healthcare discipline. 14,15 Moreover, we found that the elaboration of an accurate clinical recommendation (with a clinical report and a posttest consultation when necessary), in addition to the molecular report, made the comprehension and application of the pharmacogenetics results easier for the specialists of the petitionary clinical departments, overcoming the already mentioned barriers to interpretation and application of the use of pharmacogenetics.…”

A practical first step using needs assessment and a survey approach to implementing a clinical pharmacogenomics consult service

“…Scientific, financial, regulatory, ethical, and process challenges to clinical implementation of PG exist, with limited or lack of payer reimbursement prominent among them. Other specific challenges include limited education of clinicians, slow turnaround time of PG testing, inadequate electronic clinical decision support tools, ineffective integration of PG into the electronic health record (EHR), and limited or lack of cost‐effectiveness and clinical utility data in support of PG . While these barriers are a general representation of the field of clinical PG, they may not equally contribute to lack or limited practice of PG at specific institutions across the US.…”

“…Other specific challenges include limited education of clinicians, slow turnaround time of PG testing, inadequate electronic clinical decision support tools, ineffective integration of PG into the electronic health record (EHR), and limited or lack of cost-effectiveness and clinical utility data in support of PG. 2,[12][13][14][15][16][17][18] While these barriers are a general representation of the field of clinical PG, they may not equally contribute to lack or limited practice of PG at specific institutions across the US. For example, for clinicians at Vanderbilt University, electronic decision support may not be a barrier, given that they have an extensive system in place.…”