Clinician Response to Pharmacogenetic Clinical Decision Support Alerts

Abstract

The objective of this study was to characterize clinician response following standardization of pharmacogenetic (PGx) clinical decision support alerts at University of Florida (UF) Health. A retrospective analysis of all PGx alerts that fired at a tertiary academic medical center from August 2020 through May 2022 was performed. Alert acceptance rate was calculated and compared across six gene‐drug pairs, patient care setting, and clinician specialty. The disposition of the triggering medication was compared to the alert response and evaluated for congruence. There were a total of 818 alerts included for analysis of alert response, 557 alerts included in acceptance rate calculations, and 392 alerts with sufficient information to assess clinical response. The overall acceptance rate was 63%. The alert response and clinical response were congruent for 47% of alerts. Alert response was influenced by the triggering gene‐drug pair, clinician specialty, patient care setting, and specialty of the provider who initially ordered the PGx test. Clinical response was mostly incongruent with alert response. Alert acceptance is influenced by the triggering gene‐drug pair, clinician specialty, and care setting. Alert response is not a reliable surrogate marker for clinical action. Any future research into the impact of CDS alerts should focus on clinical response rather than alert response. Given the reliance on CDS alerts to enhance uptake of PGx, it is worthwhile to further investigate their impact on prescribing and patient outcomes.

Early evaluation of a novel alert within cardiac procedural areas to facilitate genotype‐guided antiplatelet therapy

“…Multiple health care systems have implemented an alerting system within native EMR functionality in the form of Best Practice Advisories (BPA). 10,13,[26][27][28] Unfortunately, the BPA methodology does not function within the cath lab module at our institution. To the best of our knowledge, we provide the first implementation and analysis of a PGx alert within a cath lab where standard medications order modalities are not utilized.…”

“…29 Whereas we believe the clinical impact of alerting clinicians while patients are undergoing procedures 70%, although studies differed in both their alert implementation and data analysis. 13,26,27,30,31 Rates as low as 15% were noted when investigating clinician behaviors while interacting with the alert and as high as 70% when CDS was utilized in conjunction with automated messages to the clinic pharmacist working with the cardiology team. 26,30 In addition, CDS acceptance rates have been shown to vary by clinician specialty, as cardiologists had a higher acceptance rate compared with noncardiology providers.…”

“…26,30 In addition, CDS acceptance rates have been shown to vary by clinician specialty, as cardiologists had a higher acceptance rate compared with noncardiology providers. 27 Despite the valuable impact of implementing an alerting mechanism within the cath lab for clopidogrel, there are some reservations about more widescale utilization due to the potential of alert fatigue.…”