Implementation of pharmacogenomics into inpatient general medicine

Abstract

Pharmacogenomics is a crucial piece of personalized medicine. Preemptive pharmacogenomic testing is only used sparsely in the inpatient setting and there are few models to date for fostering the adoption of pharmacogenomic treatment in the inpatient setting. We created a multi-institutional project in Chicago to enable the translation of pharmacogenomics into inpatient practice. We are reporting our implementation process and barriers we encountered with solutions. This study, ‘Implementation of Point-of-Care Pharmacogenomic Decision Support Accounting for Minority Disparities’, sought to implement pharmacogenomics into inpatient practice at three sites: The University of Chicago, Northwestern Memorial Hospital, and the University of Illinois at Chicago. This study involved enrolling African American adult patients for preemptive genotyping across a panel of actionable germline variants predicting drug response or toxicity risk. We report our approach to implementation and the barriers we encountered engaging hospitalists and general medical providers in the inpatient pharmacogenomic intervention. Our strategies included: a streamlined delivery system for pharmacogenomic information, attendance at hospital medicine section meetings, use of physician and pharmacist champions, focus on hospitalists’ care and optimizing system function to fit their workflow, hand-offs, and dealing with hospitalists turnover. Our work provides insights into strategies for the initial engagement of inpatient general medicine providers that we hope will benefit other institutions seeking to implement pharmacogenomics in the inpatient setting.

Exploring NICU nurses' views of a novel genetic point‐of‐care test identifying neonates at risk of antibiotic‐induced ototoxicity: A qualitative study

“…The anxiety of incorporating a new task during a particularly demanding time was discussed at T1. This increase in workload due to the incorporation of a new POCT has been described as a barrier to implementation due to reduced staff satisfaction in several studies (Chen et al., 2023; Zydron et al., 2011). However, by T2, a structure for the test integration into the golden hour had been established.…”

“…Chen et al. (2023) also discuss the use of physician and pharmacist champions as a method to streamline the use of pharmacogenomics into inpatient general medicine. Support was provided by all staff, irrespective of hierarchy and was available from room coordinators, research team, shift float or anyone else available to assist.…”

“…This was in-keeping with Jones et al (2016) where teamwork was key in ensuring tests were carried out at an appropriate time by a suitably qualified member of staff. Chen et al (2023) also discuss the use of physician and pharmacist champions as a method to streamline the use of pharmacogenomics into inpatient general medicine. Support was provided by all staff, irrespective of hierarchy and was available from room coordinators, research team, shift float or anyone else available to assist.…”

Impact of Pharmacogenomics in Clinical Practice

“…These institutions publish genotype-based drug guidelines to help clinicians understand how available genetic test results could be used to optimize drug therapy in each patient, according to the characteristics and frequency of genetic polymorphisms in the treated population. With this information, a few hospitals have included pharmacogenomic tests in routine clinical practice to promote genetic-guided precision medicine at least in some selected patients [16,17]. However, the implementation of drug dose individualization based on pharmacogenomics remains scarce, although it has been evidenced that about 10% of children receive one drug for which a change in prescribing due to genetic variants could be recommended [18].…”

The Critical Role of Pharmacists in the Clinical Delivery of Pharmacogenetics in the U.S

“…Review PGx results for new prescriptions With respect to their roles in the clinical delivery of PGx testing, pharmacists have been involved or led the delivery of PGx testing in three major settings (Figure 1): (1) health systems or hospital-based pharmacist services [16][17][18][19][20][21][22][23]; (2) outpatient clinic-based consultation services or clinics [24][25][26][27][28][29][30]; and (3) community pharmacies [31][32][33][34][35][36][37][38][39]. Many PGx programs were initiated and reside in departments and divisions of academic medical centers where many leading pharmacist researchers are based (Figure 1).…”