Pharmacogenomics‐Based Point‐of‐Care Clinical Decision Support Significantly Alters Drug Prescribing

Abstract

Changes in behavior are necessary to apply genomic discoveries to practice. We prospectively studied medication changes made by providers representing eight different medicine specialty clinics whose patients had submitted to preemptive pharmacogenomic genotyping. An institutional clinical decision support (CDS) system provided pharmacogenomic results using traffic light alerts: green/genomically favorable, yellow/genomic caution, red/high risk. The influence of pharmacogenomic alerts on prescribing behaviors was the primary endpoint. 2279 outpatient encounters were analyzed. Independent of other potential prescribing mediators, medications with high pharmacogenomic risk were changed significantly more often than prescription drugs lacking pharmacogenomic information (odds ratio [OR]=26.2 [9.0–75.3], p<0.0001). Medications with cautionary pharmacogenomic information were also changed more frequently (OR=2.4 [1.7–3.5], p<0.0001). No pharmacogenomically high-risk medications were prescribed during the entire study when physicians consulted the CDS tool. Pharmacogenomic information improved prescribing in patterns aimed at reducing patient risk, demonstrating that enhanced prescription decision-making is achievable through clinical integration of genomic medicine.

Implementation and obstacles of pharmacogenetics in clinical practice: An international survey

“…Emerging data have been supportive of the pre‐emptive PGx testing approach. By using EMRs and multi‐gene testing platforms, pre‐emptive genotyping is believed to provide an efficient mechanism to improve therapeutic decisions and outcomes based on PGx testing . More efforts are ongoing to try and determine the most suitable strategy for PGx testing and to evaluate whether the pre‐emptive approach is cost‐effective in order to get buy‐in from third‐party payers …”

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

“…Other pharmacist-assisted methods have been implemented in community pharmacies which proved feasible and took little time, but patient understanding and satisfaction were not investigated [16]. Clinical decision support methods have been employed in some primary care practices; however, physicians may not always know how to utilize and incorporate pharmacogenomics decision alerts in their medical decision-making [19]. In one study, only 30% of physicians receiving the alert were inclined to make a change in prescription based on the specific alert, and in another study physicians reported disagreement about who should be responsible for receiving results and providing patient follow-up [10,20].…”

Impact of SLCO1B1 Pharmacogenetic Testing on Patient and Healthcare Outcomes: A Systematic Review

“…In addition, five large healthcare system–based pharmacogenetics implementation projects of multigene panels, including SLCO1B1 , have reported preliminary or final results: four in the United States (1,200 Patients Project; INdiana GENomics Implementation: an Opportunity for the UnderServed (INGENIOUS); the Marshfield Clinic; and the RIGHT protocol) and one from La Paz University Hospital in Spain ( Table ). Most of these projects are using passive or active CDS in the EHR to support prescriber use of pharmacogenetic results in several different clinically actionable pharmacogenes.…”

“…Studies delivering SLCO1B1 results to providers through the EHR without provider initiation have reported providers’ EHR transactional data. For example, the 1,200 Patients Project of more than a dozen drug–gene pairs reported that 69% of 2,279 patient visits over 3 years were associated with a provider log‐in to the pharmacogenetics CDS system within 72 hours . Approximately one third of patients’ active medications had associated pharmacogenetic alerts (0.5% red, 13% yellow, and 21% green); a 10‐month analysis in the first 608 patients reported that providers clicked on 100%, 72%, and 20% of red, yellow, and green alerts, respectively .…”