Implementing Pharmacogenomics Testing: Single Center Experience at Arkansas Children’s Hospital

Gill, Pritmohinder; Yu, Feliciano; Porter-Gill, Patricia; Boyanton, Bobby L.; Allen, Judy C; Veerapandiyan, Aravindhan; Prodhan, Parthak; Bielamowicz, Kevin; Sellars, Elizabeth A.; Burrow, A. L.; Kennedy, Joshua L.; Clothier, Jeffery L; Becton, David L.; Rule, Don; Schaefer, Gerald

doi:10.3390/jpm11050394

Cited by 17 publications

(12 citation statements)

References 40 publications

(48 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This Genomic Module is relatively new, but several institutions have already implemented it with pharmacogenetic data. 42,45,46 Due to the historical lack of a standard repository for pharmacogenetic data, many implementation sites have used workaround solutions to display test results, such as the problem list field as with Boston Children's Hospital or the allergy list field. 47 However, this is not an ideal solution since laboratory results are not easily found and have sometimes been misplaced in random locations.…”

Section: Pharmacogenetic Test Results Interpretationmentioning

confidence: 99%

“…Within Epic's Genomic Module, a genomics profile can be created to store and display all genomic information for the provider and/or the patient (Figure 2). This Genomic Module is relatively new, but several institutions have already implemented it with pharmacogenetic data 42,45,46 . Due to the historical lack of a standard repository for pharmacogenetic data, many implementation sites have used workaround solutions to display test results, such as the problem list field as with Boston Children's Hospital or the allergy list field 47 .…”

Section: Ehr Integrationmentioning

confidence: 99%

See 1 more Smart Citation

How to implement a pharmacogenetics service at your institution

Cicali

Lemke

Alshaykh

et al. 2022

J Am Coll Clin Pharm

View full text Add to dashboard Cite

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.

show abstract

Section: Pharmacogenetic Test Results Interpretationmentioning

confidence: 99%

Section: Ehr Integrationmentioning

confidence: 99%

How to implement a pharmacogenetics service at your institution

Cicali

Lemke

Alshaykh

et al. 2022

J Am Coll Clin Pharm

View full text Add to dashboard Cite

show abstract

“…This would then require the prescriber to search for the stored results if they wished to make use of them. Where organizations were able to store pharmacogenetic results as a discrete variable within their EHR, they were able to make use of active BPAs (Level 1) ( 36 , 40 , 42 , 56 – 61 ). These would trigger when a drug was prescribed where there was a clinically actionable pharmacogenetic prescribing recommendation available.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

“…2020 for both adult and pediatric patients. [3][4][5][6][7][8][9] Given that clinical use of genotype-guided CDS for SSRIs in pediatrics is not routine at this time, in this article we will share considerations for pediatric implementation based on our experience at a tertiary medical center including a children's hospital and pediatric behavioral clinics, with the goal of increasing familiarity among pediatric clinicians and healthcare sites. [10][11][12] General PGx considerations that also apply to the adult population should also be reviewed, including availability and form of PGx results, institutional resources supporting implementation, and readiness of providers and patients.…”

mentioning

confidence: 99%

Pediatric considerations for pharmacogenetic selective serotonin reuptake inhibitors clinical decision support

Liu

Rossow²,

Maxwell-Horn

et al. 2022

Pharmacotherapy

View full text Add to dashboard Cite

Pharmacogenetic testing for psychiatry is growing at a rapid pace, with multiple sites utilizing results to help clinical decision‐making. Genotype‐guided dosing and drug selection have been implemented at several sites, including Vanderbilt University Medical Center, where clinical decision support (CDS) based on pharmacogenetic results went live for selective serotonin reuptake inhibitors in 2020 for both adult and pediatric patients. Effective and appropriate implementation of CYP2D6‐ and CYP2C19‐guided CDS for the pediatric population requires consideration of the evidence for the pharmacogenetic associations, medication indications, and appropriate alternative therapies to be used when a pharmacogenetic contraindication is identified. In this article, we review these pediatric pharmacogenetic considerations for selective serotonin reuptake inhibitor CDS. We include a case study, the current literature supporting clinical recommendations, considerations when designing pediatric CDS, future implications, and examples of sertraline, (es)citalopram, paroxetine, and fluvoxamine alerts.

show abstract

Implementing Pharmacogenomics Testing: Single Center Experience at Arkansas Children’s Hospital

Cited by 17 publications

References 40 publications

How to implement a pharmacogenetics service at your institution

How to implement a pharmacogenetics service at your institution

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

Pediatric considerations for pharmacogenetic selective serotonin reuptake inhibitors clinical decision support

Contact Info

Product

Resources

About