Pharmacogenomically actionable medications in a safety net health care system

Carpenter, Janet S.; Rosenman, Marc B.; Knisely, Mitchell R.; Decker, Brian S.; Levy, Kenneth D.; Flockhart, David A.

doi:10.1177/2050312115624333

Cited by 21 publications

(23 citation statements)

References 20 publications

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“…Many patients would be willing to undergo testing again in the future, and many indicated that they'd prefer to undergo preemptive testing to avoid any delays in treatment. It has been estimated that the use of preemptive PGx testing could be helpful in preventing a significant number of adverse events given the multiple commonly used medications with known PGx interactions that patients will likely be prescribed [33,34].…”

Section: Discussionmentioning

confidence: 99%

Patient Experiences with Pharmacogenetic Testing in a Primary Care Setting

et al. 2016

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Aim:To investigate patient experiences with pharmacogenetic (PGx) testing. Methods: Patients were offered PGx testing through a study on pharmacist-assisted delivery of PGx testing and invited to complete pre-and post-testing surveys about their experience. Results: Of 63 patients tested, 17 completed the baseline survey (27%). Interest in testing was mostly impacted by desire to inform selection of best treatment (n = 13). Seven of 12 patients that completed the follow-up survey indicated that their provider discussed the test result with them. Five patients understood their test result very or somewhat well. All would be likely to have PGx testing again. Conclusion: Patients perceived PGx testing to be useful, though more effort may be needed to improve patient-provider communication of test results.

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Section: Discussionmentioning

confidence: 99%

Patient Experiences with Pharmacogenetic Testing in a Primary Care Setting

et al. 2016

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“…(2,4) For example, a recent retrospective analysis of EHR data in a safety-net health system found that 7,039 patients across a 73-site system initiated a prescription for at least one of 30 clinically actionable pharmacogenetic medications during the 12-month study period (the most common identified medications included tramadol, clopidogrel, and codeine). (20) As costs of panel-based genotyping become comparable to or even lower than single-gene assays because of the ability to batch samples from multiple patients to genotype together, it is logical that a preemptive model would become increasingly cost effective on a large scale, but definitive data supporting this assumption do not exist.…”

Section: Supporting Development Of Pragmatic Preemptive Pharmacogenementioning

confidence: 99%

Preemptive Panel-Based Pharmacogenetic Testing: The Time is Now

2017

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While recent discoveries have paved the way for the use of genotype-guided prescribing in some clinical environments, significant debate persists among clinicians and researchers about the optimal approach to pharmacogenetic testing in clinical practice. One crucial factor in this debate surrounds the timing and methodology of genotyping, specifically whether genotyping should be performed reactively for targeted genes when a single drug is prescribed, or preemptively using a panel-based approach prior to drug prescribing. While early clinical models that employed a preemptive approach were largely developed in academic health centers through multidisciplinary efforts, increasing examples of pharmacogenetic testing are emerging in community-based and primary care practice environments. However, educational and practice-based resources for these clinicians remain largely nonexistent. As such, there is a need for the health care system to shift its focus from debating about preemptive genotyping to developing and disseminating needed resources to equip frontline clinicians for clinical implementation of pharmacogenetics. Providing tools and guidance to support these emerging models of care will be essential to support the thoughtful, evidence-based use of pharmacogenetic information in diverse clinical practice environments. Specifically, the creation of efficient and accurate point-of-care resources, practice-based tools, and clinical models is needed, along with identification and dissemination of sustainable avenues for pharmacogenetic test reimbursement.

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“…To identify all the appellations, we combed through the list of all orderable medication names (43,300) in this EHR. In earlier preparatory work to estimate the volume of pharmacogenomics-relevant medication use, we also reviewed all dispensed medication names (417,000) [18]. In these ways we honed the normalization of the different strengths, routes, and combination forms.…”

Section: Using the Ehr To Identify Eligible Patientsmentioning

confidence: 99%