Medication reconciliation to support pharmacogenomics implementation

Abstract

Petry et al.(1) reported on the first large-scale study quantifying and classifying the impact of using medication reconciliation (med rec) to support the implementation of pharmacogenomics (PGx) test results into clinical care within a health care system. Over an 8-month period, a 21-member team of pharmacists and pharmacy trainees with advanced PGx training contacted 465 patients by telephone to identify 2,311 medication discrepancies and classified them based on their implications for patient safety. PGx results were reviewed to assess for gene-drug interactions and phenoconversion due to drug-drug interactions. Subsequently, patients' primary care providers were alerted if there were opportunities to improve medication use. The authors found that 93% of patients had at least 1 medication discrepancy and that on average, each patient had at least one medication with a gene-drug interaction, but the exact proportion was not reported. Furthermore, 4.3% of patients required interventions to align their medication regimen with existing PGx guidelines (2). Finally, this study reports pharmacy staff spending an average review time of 15.8 minutes per patient, much of which was provided by pharmacy trainees (1).PGx involves testing for patient-specific genetic variation to predict drug response based on changes in pharmacokinetic or pharmacodynamic relationships between a gene and a drug. Clinicians and patients can use PGx to guide therapeutic decisions, potentially reducing the risk of adverse drug reactions and therapeutic failure. There are two general approaches by which PGx can be implemented, reactive or pre-emptive, but successful mixed models have also been reported (3). Currently, most PGx testing is still performed reactively, meaning it is ordered for select patients to guide a specific drug therapy or to explain undesirable responses to a drug after adverse events, intolerable side effects, or therapeutic failure. Increasingly, more institutions are taking a pre-emptive approach to PGx testing, so results are available at the time of prescribing (3). The pre-emptive approach offers several potential advantages, but this practice is largely confined to academic institutions and early adopters of PGx implementation, like members of the Implementing GeNomics In pracTicE (IGNITE) Network PGx Working Group (4).For new prescriptions, clinical decision support (CDS) embedded within the electronic health record (EHR) can help guide medication and dosing choices. Storing PGx results as discrete data, as Petry et al. (1) describe in their study, is also recognized as a critical component to support this CDS (3,5). Although we believe CDS to be one important aspect of implementing PGx, we also recognize that more research is needed to determine its role in improving patient outcomes (6). To address these situations, PGx test results can be analyzed by pharmacy staff or other providers with PGx expertise in conjunction with medication regimens as they are recorded in the EHR. Realistically, we know that these regime...