How to implement a pharmacogenetics service at your institution

Abstract

The vast majority of patients possess one or more pharmacogenetic variants that can influence optimal medication use. When pharmacogenetic data are used to guide drug choice and dosing, evidence points to improved disease outcomes, fewer adverse effects, and lower healthcare spending. Although its science is well established, clinical use of pharmacogenetic data to guide drug therapy is still in its infancy. Pharmacogenetics essentially involves the intersection of an individual's genetic data with their medications, which makes pharmacists uniquely qualified to provide clinical support and education in this field. In fact, most pharmacogenetics implementations, to date, have been led by pharmacists as leaders or members of a multidisciplinary team or as individual practitioners. A successful large‐scale pharmacogenetics implementation requires coordination and synergy among administrators, clinicians, informatics teams, laboratories, and patients. Because clinical implementation of pharmacogenetics is in its early stages, there is an urgent need for guidance and dissemination of shared experiences to provide a framework for clinicians. Many early adopters of pharmacogenetics have explored various strategies among diverse practice settings. This article relies on the experiences of early adopters to provide guidance for critical steps along the pathway to implementation, including strategies to engage stakeholders; evaluate pharmacogenetic evidence; coordinate laboratory testing, results interpretation and their integration into the electronic health record; identify reimbursement avenues; educate providers and patients; and maintain a successful program. Learning from early adopters' published experiences and strategies can allow clinicians leading a new pharmacogenetics implementation to avoid pitfalls and adapt and apply lessons learned by others to their own practice.

Establishing a patient‐centered, multidisciplinary pharmacogenomics clinic in an academic health system: Successes, challenges, and future direction

“…We have described our multidisciplinary pharmacogenomics clinic since its inception in 2019 and its impact on pharmacotherapy management. Previous papers [25][26][27][28][29] have described how to implement PGx testing and/or consultation services, but our paper goes one step…”

“…We have described our multidisciplinary pharmacogenomics clinic since its inception in 2019 and its impact on pharmacotherapy management. Previous papers 25–29 have described how to implement PGx testing and/or consultation services, but our paper goes one step further by quantifying specific outcomes of PGx testing in our clinic patients. We find that 75% of the patients requested PGx testing through our medical genetic clinic or through the PGS program and 25% were requesting further interpretation of PGx testing previously ordered by providers outside the program.…”

“…T A B L E 2 Clinical impact of pharmacogenetic testing. Other institutions have implemented a two-visit model [27][28][29][30] ; the first We do see a variation in the number of pharmacogenes tested per patient due to some referrals who have previously had genetic testing ordered by another provider. This lack of standardized testing causes a large variation in the consultation structure; some patients have received testing on specific genes, while others received panel testing for a certain disease state, such as attention deficit hyperactivity disorder.…”

“…Other institutions have implemented a two‐visit model 27–30 ; the first visit typically focuses on gathering a thorough patient history and general pharmacogenomics education, and patient sample collection. Once the genetic results are received, the second visit focuses on explaining the genetic tests results and implications for the patients' current or future care.…”

Pharmacogenomics in practice: a review and implementation guide

“…It should identify early adopters of change or implementation champions ( Tuteja et al, 2022 ). It may also present evidence to national officials to suggest amending regulations in favor of promoting the practice of personalized medicine, and developing reimbursement policies and educational programs ( Hartzler et al, 2013 ; Cicali et al, 2022 ).…”