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

Abstract

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.

An Integrated Multidisciplinary Circuit Led by Hospital and Community Pharmacists to Implement Clopidogrel Pharmacogenetics in Clinical Practice

“…Notably, 50% of the participants had received clopidogrel for a year or less, 36% for between 1 and 8 years, and 14% for longer than 8 years (maximum of 17 years per participant). All patients were polymedicated, with an average of 9.3 ± 3.1 prescribed medicines per patient (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Figure 2 shows information regarding the proportion of patients taking drugs from each ATC level, along with the quantity per patient.…”

“…Genetic factors are determinant in drug response and explain much of the interindividual variability [4]. Consequently, there is currently great interest in conducting pharmacogenetic studies that contribute to the implementation of personalized medicine [5][6][7].…”

Clinical Pharmacogenomic MT‐RNR1 Screening for Aminoglycoside‐Induced Ototoxicity and the Post‐Test Counseling Conundrum

“…Clinical decision support alerts, messages within the EHR that alert clinicians if a contraindicated medication is being prescribed, provide an extra layer of support against inappropriate aminoglycoside prescribing for MT‐RNR1 variant carriers. However, EHR integration at most healthcare centers is heterogeneous and evolving, which has been cited as a barrier to implementing pharmacogenomics broadly 11 …”

“…However, EHR integration at most healthcare centers is heterogeneous and evolving, which has been cited as a barrier to implementing pharmacogenomics broadly. 11…”

Pharmacogenetics Clinical Decision Support Systems for Primary Care in England: Co-Design Study

“…Although there is notable heterogeneity in the design and implementation of these programmes, most make use of pharmacogenetic gene panels as their modality for testing. [4] These panels can survey a range of genes simultaneously, meaning the data produced has utility beyond a single prescription at a single time point.…”