Lessons Learned When Introducing Pharmacogenomic Panel Testing into Clinical Practice

Rosenman, Marc B.; Decker, Brian S.; Levy, Kenneth D.; Holmes, Ann M.; Pratt, Victoria M.; Eadon, Michael T.

doi:10.1016/j.jval.2016.08.727

Cited by 53 publications

(43 citation statements)

References 37 publications

(50 reference statements)

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“…Physicians also described test cost incurred by the patient (as many insurance companies will not cover testing) as one of the most significant barriers to PGx testing. Several other studies have highlighted cost as a barrier as well [15,35,43,44]. Following this feedback, this health system implemented cost strategies that make pricing more accessible to patients.…”

Section: Re Sending Their Cheek Cells Off That Their Dna Is Getting Smentioning

confidence: 98%

“…Guidelines have become available for a number of medications with applicable PGx testing through the Clinical Pharmacogenetics Implementation Consortium [7][8][9]. Although physicians may perceive a benefit to using PGx [3,5,[9][10][11][12], many barriers exist that have prevented implementation on a larger scale such as: physicians lacking sufficient knowledge and finding time to keep up-to-date; uncertainty surrounding clinical utility; lack of confidence or comfort in ordering PGx testing; lack of comfort interpreting results; uncertainty in how to communicate results to patients and having sufficient time to do so; difficulty in managing changes to workflow; determining how to incorporate results into the electronic medical record (EMR); and uncertainty about level of coverage by insurance and reimbursement [3,5,6,[9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Primary Care Physician Experiences with Integrated Pharmacogenomic Testing in a Community Health System

et al. 2017

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Aim: To explore primary care physicians' views of the utility and delivery of direct access to pharmacogenomics (PGx) testing in a community health system. Methods: This descriptive study assessed the perspectives of 15 healthcare providers utilizing qualitative individual interviews. Results: Three main themes emerged: perceived value and utility of PGx testing; challenges to implementation in practice; and provider as well as patient needs. Conclusion: While providers in this study viewed benefits of PGx testing as avoiding side effects, titrating doses more quickly, improving shared decision-making and providing psychological reassurance, challenges will need to be addressed such as privacy concerns, cost, insurance coverage and understanding the complexity of PGx test results.

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Section: Re Sending Their Cheek Cells Off That Their Dna Is Getting Smentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Primary Care Physician Experiences with Integrated Pharmacogenomic Testing in a Community Health System

et al. 2017

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“…Pharmacists should play a key role in patient education initiatives including in‐person, telephone, or telemedicine counseling to explain pharmacogenomic test results to patients. Additional tools to provide patient education may include web‐based educational videos, letters/pamphlets, and integrated patient portals . As testing for genetic variants that are predictive of both drug response and disease risk evolves, pharmacists should collaborate with genetic counselors to enable a broader scope of genomics education.…”

Section: Pharmacogenomics Educationmentioning

confidence: 99%

Precision pharmacotherapy: Integrating pharmacogenomics into clinical pharmacy practice

Hicks

Aquilante

Dunnenberger

et al. 2019

J Am Coll Clin Pharm

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Precision pharmacotherapy encompasses the use of therapeutic drug monitoring, evaluation of liver and renal function, genomics, and environmental and lifestyle exposures; and analysis of other unique patient or disease characteristics to guide drug selection and dosing. This paper articulates real‐world clinical applications of precision pharmacotherapy, focusing exclusively on the emerging field of clinical pharmacogenomics. Precision pharmacotherapy is evolving rapidly, and clinical pharmacists now play an invaluable role in the clinical implementation, education, and research applications of pharmacogenomics. This paper provides an overview of the evolution of pharmacogenomics in clinical pharmacy practice, together with recommendations on how the American College of Clinical Pharmacy (ACCP) can support the advancement of clinical pharmacogenomics implementation, education, and research. Commonalities among successful clinical pharmacogenomic implementation and education programs are identified, with recommendations for how ACCP can leverage and advance these common themes. Opportunities are also provided to support the research needed to move the practice and application of pharmacogenomics forward.

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“…It is important to realize that collaborative practice agreement laws between licensed physicians and pharmacists, physician assistants, and nurses are already in existence, but remains un-addressed for medical school graduates who choose only to specialize and train in clinical pharmacology. Therefore, if nothing is done, national implementation of precision medicine remains a challenge, due to not having enough trained medical doctors who focus on implementing pharmacogenomics into patient care and contribute to pharmacogenomics education ( McCauley et al , 2017 ; Rosenman et al , 2017 ).…”

Section: Introductionmentioning

confidence: 99%

An opportunity for clinical pharmacology trained physicians to improve patient drug safety: A retrospective analysis of adverse drug reactions in teenagers

Eugene

2018

F1000Res

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Background: Adverse drug reactions (ADRs) are a major cause of hospital admissions, prolonged hospital stays, morbidity, and drug-related mortality. In this study, we sought to identify the most frequently reported medications and associated side effects in adolescent-aged patients in an effort to prioritize clinical pharmacology consultation efforts for hospitals seeking to improve patient safety. Methods: Quarterly reported data were obtained from the United States Food and Drug Administration Adverse Events Reporting System (FAERS) from the third quarter of 2014 and ending in the third quarter of 2017. We then used the GeneCards database to map the pharmacogenomic biomarkers associated with the most reported FAERS drugs. Data homogenization and statistics analysis were all conducted in R for statistical programming. Results: We identified risperidone (10.64%) as the compound with the most reported ADRs from all reported cases. Males represented 90.1% of reported risperidone cases with gynecomastia being the most reported ADR. Ibuprofen OR=188 (95% CI, 105.00 – 335.00) and quetiapine fumarate OR=116 (95% CI, 48.40 – 278.00) were associated with the highest odds of completed suicide in teenagers. Ondansetron hydrochloride OR=7.12 (95% CI, 1.59 – 31.9) resulted in the highest odds of pneumothorax. Lastly, olanzapine (8.96%) represented the compound with the most reported drug-drug interactions cases, while valproic acid OR=221 (95% CI, 93.900 – 522.00) was associated with the highest odds of drug-drug interactions. Conclusion: Despite any data limitations, physicians prescribing risperidone in males should be aware of the high rates of adverse drug events and an alternative psychotropic should be considered in male patients. Further, patients with a history of pneumothorax or genetically predisposed to pneumothorax should be considered for an alternative antiemetic to ondansetron hydrochloride, due to increased odds associated with the drug and adverse event.

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Lessons Learned When Introducing Pharmacogenomic Panel Testing into Clinical Practice

Abstract: New, large-scale endeavors in health care are challenging. A description of the challenges that we encountered and the approaches that we adopted to address them may provide insights for those who implement and study innovations in other health care systems.

Cited by 53 publications

References 37 publications

Primary Care Physician Experiences with Integrated Pharmacogenomic Testing in a Community Health System

Primary Care Physician Experiences with Integrated Pharmacogenomic Testing in a Community Health System

Precision pharmacotherapy: Integrating pharmacogenomics into clinical pharmacy practice

An opportunity for clinical pharmacology trained physicians to improve patient drug safety: A retrospective analysis of adverse drug reactions in teenagers

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