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Evaluating the feasibility of performing pharmacogenetic
guided‐medication
therapy management in a retirement community: A prospective, single arm study. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Clinical implementation of drug metabolizing gene-based therapeutic interventions worldwide. Hum Genet 2021; 141:1137-1157. [PMID: 34599365 DOI: 10.1007/s00439-021-02369-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/09/2021] [Indexed: 02/05/2023]
Abstract
Over the last few years, the field of pharmacogenomics has gained considerable momentum. The advances of new genomics and bioinformatics technologies propelled pharmacogenomics towards its implementation in the clinical setting. Since 2007, and especially the last-5 years, many studies have focused on the clinical implementation of pharmacogenomics while identifying obstacles and proposed strategies and approaches for overcoming them in the real world of primary care as well as outpatients and inpatients clinics. Here, we outline the recent pharmacogenomics clinical implementation projects and provide details of the study designs, including the most predominant and innovative, as well as clinical studies worldwide that focus on outpatients and inpatient clinics, and primary care. According to these studies, pharmacogenomics holds promise for improving patients' health in terms of efficacy and toxicity, as well as in their overall quality of life, while simultaneously can contribute to the minimization of healthcare expenditure.
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Duong BQ, Arwood MJ, Hicks JK, Beitelshees AL, Franchi F, Houder JT, Limdi NA, Cook KJ, Owusu Obeng A, Petry N, Tuteja S, Elsey AR, Cavallari LH, Wiisanen K. Development of Customizable Implementation Guides to Support Clinical Adoption of Pharmacogenomics: Experiences of the Implementing GeNomics In pracTicE (IGNITE) Network. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2020; 13:217-226. [PMID: 32765043 PMCID: PMC7373415 DOI: 10.2147/pgpm.s241599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/08/2020] [Indexed: 12/13/2022]
Abstract
Introduction Clinical adoption of genomic medicine has lagged behind the pace of scientific discovery. Practice-based resources can help overcome implementation challenges. Methods In 2015, the IGNITE (Implementing GeNomics In pracTicE) Network created an online genomic medicine implementation resource toolbox that was expanded in 2017 to incorporate the ability for users to create targeted implementation guides. This expansion was led by a multidisciplinary team that developed an evidence-based, structured framework for the guides, oversaw the technical process/build, and pilot tested the first guide, CYP2C19-Clopidogrel Testing Implementation. Results Sixty-five resources were collected from 12 institutions and categorized according to a seven-step implementation framework for the pilot CYP2C19-Clopidogrel Testing Implementation Guide. Five months after its launch, 96 CYP2C19-Clopidogrel Testing Implementation Guides had been created. Eighty percent of the resources most frequently selected by users were created by IGNITE to fill an identified resource gap. Resources most often included in guides were from the test reimbursement (22%), Implementation support gathering (22%), EHR integration (17%), and genetic testing workflow steps (17%). Conclusion Lessons learned from this implementation guide development process provide insight for prioritizing development of future resources and support the value of collaborative efforts to create resources for genomic medicine implementation.
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Affiliation(s)
- Benjamin Q Duong
- Department of Precision Medicine, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Meghan J Arwood
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics & Precision Medicine, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - J Kevin Hicks
- Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, FL, USA
| | - Amber L Beitelshees
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Francesco Franchi
- Department of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - John T Houder
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics & Precision Medicine, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Nita A Limdi
- University of Alabama School at Birmingham, Birmingham, AL, USA
| | - Kelsey J Cook
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Jacksonville, FL, USA.,Department of Precision Medicine, Nemours Children's Specialty Care, Jacksonville, FL, USA
| | - Aniwaa Owusu Obeng
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Natasha Petry
- Department of Pharmacy Practice, North Dakota State University College of Health Professions, Fargo, ND, USA
| | - Sony Tuteja
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amanda R Elsey
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics & Precision Medicine, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Larisa H Cavallari
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics & Precision Medicine, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Kristin Wiisanen
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics & Precision Medicine, University of Florida College of Pharmacy, Gainesville, FL, USA
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Marcinak R, Paris M, Kinney SRM. Pharmacogenomics Education Improves Pharmacy Student Perceptions of Their Abilities and Roles in Its Use. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2018; 82:6424. [PMID: 30559496 PMCID: PMC6291667 DOI: 10.5688/ajpe6424] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/15/2017] [Indexed: 05/27/2023]
Abstract
Objective. To assess whether a required first-year course, Principles in Genetics and Pharmacogenomics, and integration into subsequent courses affected pharmacy students' perceptions of pharmacogenomics. Methods. A survey was distributed to Professional Year (PY) 1 students during the first and last weeks of the course from 2014 to 2016. A follow-up survey was distributed to PY2, PY3, and PY4 students. Results. Respondents consistently agreed that pharmacogenomics is clinically relevant. After the course, PY1 students are more comfortable in their knowledge and role in the application of pharmacogenomics. Although their comfort reverts to some degree, PY2-PY4 students believe that they should be able to apply pharmacogenomics clinically. Most PY2-PY4 students indicate that later courses review pharmacogenomics. Conclusion. A required course in genetics and pharmacogenomics can promote a perception that pharmacists should have knowledge of, and be involved in the use of genetic information clinically. Inclusion of pharmacogenomic concepts in subsequent curricular components may help in maintaining these perceptions.
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Affiliation(s)
- Rebecca Marcinak
- Western New England University, College of Pharmacy, Springfield, Massachusetts
| | - Meaghan Paris
- Western New England University, College of Pharmacy, Springfield, Massachusetts
| | - Shannon R M Kinney
- Western New England University, College of Pharmacy, Springfield, Massachusetts
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Vassy JL, Chun S, Advani S, Ludin SA, Smith JG, Alligood EC. Impact of SLCO1B1 Pharmacogenetic Testing on Patient and Healthcare Outcomes: A Systematic Review. Clin Pharmacol Ther 2018; 106:360-373. [PMID: 30137643 DOI: 10.1002/cpt.1223] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/14/2018] [Indexed: 12/22/2022]
Abstract
Demonstrated improvements in patient outcomes will facilitate the clinical implementation of pharmacogenetic testing. Using the association between solute carrier organic anion transporter family member 1B1 (SLCO1B1) and statin-associated muscle symptoms (SAMSs) as a model, we conducted a systematic review of patient outcomes after delivery of SLCO1B1 results. Using PubMed and Embase searches through December 19, 2017, we identified 37 eligible records reporting preliminary or final outcomes, including six studies delivering only SLCO1B1 results and five large healthcare system-based implementation projects of multipharmacogene panels. Two small trials have demonstrated at least short-term improvements in low-density lipoprotein cholesterol after SLCO1B1 testing among previously statin intolerant patients. Evidence from large implementation projects suggests that SLCO1B1 results may change prescribing patterns for some high-risk patients. No study has reported improvements in SAMSs or cardiovascular events or tracked the economic outcomes of SLCO1B1 testing. Ongoing studies should collect and report outcomes relevant to pharmacogenetics stakeholders.
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Affiliation(s)
- Jason L Vassy
- Veterans Affairs (VA) VA Boston Healthcare System, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sojeong Chun
- Veterans Affairs (VA) VA Boston Healthcare System, Boston, Massachusetts, USA.,Massachusetts College of Pharmacy and Health Sciences University, Boston, Massachusetts, USA
| | - Sanjay Advani
- Veterans Affairs (VA) VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Sophie A Ludin
- Veterans Affairs (VA) VA Boston Healthcare System, Boston, Massachusetts, USA.,Cornell University, Ithaca, New York, USA
| | - Jason G Smith
- Veterans Affairs (VA) VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Elaine C Alligood
- Veterans Affairs (VA) VA Boston Healthcare System, Boston, Massachusetts, USA
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Bain KT, Schwartz EJ, Knowlton OV, Knowlton CH, Turgeon J. Implementation of a pharmacist-led pharmacogenomics service for the Program of All-Inclusive Care for the Elderly (PHARM-GENOME-PACE). J Am Pharm Assoc (2003) 2018; 58:281-289.e1. [PMID: 29602745 DOI: 10.1016/j.japh.2018.02.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/19/2018] [Accepted: 02/25/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the feasibility of implementing a pharmacist-led pharmacogenomics (PGx) service for the Program of All-Inclusive Care for the Elderly (PACE). SETTING A national centralized pharmacy providing PGx services to community-based PACE centers. PRACTICE DESCRIPTION Individuals 55 years of age and older enrolled in PACE who underwent PGx testing as part of their medical care (n = 296). PRACTICE INNOVATION Pharmacist-led PGx testing, interpreting, and consulting. EVALUATION Implementation processes and roles were ascertained by reviewing policies and procedures for the PGx service and documented observations made by pharmacists providing the service. Genetic variants and drug-gene interactions (DGIs) were determined by interpretations of PGx test results. Types of recommendations provided by pharmacists were ascertained from PGx consultations. Prescribers' acceptance of recommendations were ascertained by documented responses or drug changes made after PGx consultations. RESULTS Challenges to implementation included lack of systems interoperability, limited access to medical electronic health records, determining prescribers' responses, and knowledge and competency gaps in PGx. Pharmacist roles most essential to overcoming challenges were interpreting and applying PGx data, determining how to disseminate those data to prescribers, advocating for appropriate PGx testing, and educating about the application of test results to clinical practice. Participants frequently used drugs posing DGI risks, with the majority (73.6%) reporting more than 1 interaction. The overwhelming majority (89.0%) of pharmacists' recommendations to mitigate risks were accepted by referring prescribers. CONCLUSION Implementing a pharmacist-led PGx service for PACE is feasible. Implementation of this service highlights the leadership role of pharmacists in moving PGx from research to practice.
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Casserlie LM, Mager NAD. Pharmacists' perceptions of advancing public health priorities through medication therapy management. Pharm Pract (Granada) 2016; 14:792. [PMID: 27785167 PMCID: PMC5061523 DOI: 10.18549/pharmpract.2016.03.792] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/24/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Public health priorities can be addressed by pharmacists through channels such as medication therapy management (MTM) to optimize patient and population outcomes. However, no studies have specifically assessed pharmacists' perceptions of addressing public health priorities through MTM. OBJECTIVE The objective of this study was to assess pharmacists' opinions regarding the feasibility and appropriateness of addressing seven areas of public health priority through MTM services to impact public health in direct patient care settings. METHODS An anonymous 37-question electronic survey was conducted to evaluate Ohio pharmacists' opinions of advancing seven public health priorities identified from Healthy People 2020 (family planning, preconception care, smoking cessation, immunizations, nutrition/biometric wellness assessments, point-of-care testing, fall prevention) through MTM activities; to identify potential barriers; and to collect demographic information. The cross-sectional survey was sent to a random sample of 500 pharmacists registered with the Ohio State Board of Pharmacy. RESULTS Seventy-six pharmacists responded to the survey, resulting in a 16% response rate. On average, it took respondents 5-10 minutes to complete the survey. The majority of respondents thought that each of the seven public health priorities were "important" or "very important" to patient health; the most commonly identified areas included smoking cessation, immunizations, and fall prevention (97.5%). When asked to indicate which of the seven areas they thought they could potentially have a role to provide services through MTM, on average pharmacists picked 4 of the priority areas. Only 6.6% indicated there was no role for pharmacists to provide MTM services for any of the listed categories. Staffing, time, and reimbursement represented the most commonly perceived barriers for pharmacists in providing MTM services. Fifty-seven percent indicated an interest in learning more about MTM, with 98% of responders selecting continuing education as the preferred source. CONCLUSION The majority of pharmacists indicated they could make an impact on public health priorities through MTM services.
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Affiliation(s)
- Lucas M Casserlie
- Raabe College of Pharmacy, Ohio Northern University . Ada, OH ( United States ).
| | - Natalie A Dipietro Mager
- Associate Professor of Pharmacy Practice, Department of Pharmacy Practice, Raabe College of Pharmacy, Ohio Northern University . Ada, OH ( United States ).
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Hicks JK, Stowe D, Willner MA, Wai M, Daly T, Gordon SM, Lashner BA, Parikh S, White R, Teng K, Moss T, Erwin A, Chalmers J, Eng C, Knoer S. Implementation of Clinical Pharmacogenomics within a Large Health System: From Electronic Health Record Decision Support to Consultation Services. Pharmacotherapy 2016; 36:940-8. [DOI: 10.1002/phar.1786] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J. Kevin Hicks
- Pharmacy Department; Cleveland Clinic; Cleveland Ohio
- Genomic Medicine Institute; Cleveland Clinic; Cleveland Ohio
| | - David Stowe
- Pharmacy Department; Cleveland Clinic; Cleveland Ohio
| | | | - Maya Wai
- Pharmacy Department; Cleveland Clinic; Cleveland Ohio
| | - Thomas Daly
- Tomsich Pathology & Lab Medicine Institute; Cleveland Clinic; Cleveland Ohio
| | - Steven M. Gordon
- Medicine Institute; Infectious Disease Department; Cleveland Clinic; Cleveland Ohio
| | - Bret A. Lashner
- Digestive Disease Institute; Gastroenterology and Hepatology Department; Cleveland Clinic; Cleveland Ohio
| | - Sumit Parikh
- Neurologic Institute; Cleveland Clinic; Cleveland Ohio
| | - Robert White
- Information Technology Department; Cleveland Clinic; Cleveland Ohio
| | - Kathryn Teng
- Medicine Institute; Internal Medicine Department; Cleveland Clinic; Cleveland Ohio
| | - Timothy Moss
- Genomic Medicine Institute; Cleveland Clinic; Cleveland Ohio
| | - Angelika Erwin
- Genomic Medicine Institute; Cleveland Clinic; Cleveland Ohio
| | | | - Charis Eng
- Genomic Medicine Institute; Cleveland Clinic; Cleveland Ohio
| | - Scott Knoer
- Pharmacy Department; Cleveland Clinic; Cleveland Ohio
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Haga SB, Moaddeb J, Mills R, Patel M, Kraus W, Allen LaPointe NM. Incorporation of pharmacogenetic testing into medication therapy management. Pharmacogenomics 2015; 16:1931-41. [PMID: 26555559 DOI: 10.2217/pgs.15.124] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIM To assess feasibility and patient satisfaction with a pharmacist-delivered medication therapy management (MTM) plus pharmacogenetic (PGx) testing service. METHODS Thirty patients from a cardiology outpatient clinic were enrolled to attend two MTM sessions, undergo PGx testing and complete pre- and post-intervention surveys. Outcome measures included duration of MTM sessions, clinical application of test results, self-reported medication adherence, patient recall of results and perceived value of testing and MTM. RESULTS Overall, patients were very satisfied with the MTM plus PGx testing service. About half of participants (47%) were able to accurately recall their PGx test results. Comparable to MTM without PGx testing, the first MTM session averaged 40 min and the follow-up MTM session averaged 15 min. CONCLUSION PGx testing incorporated into a clinical MTM service offered by pharmacists may be a feasible delivery model and is satisfactory to patients.
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Affiliation(s)
- Susanne B Haga
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 201 Trent Dr, Durham, NC 27710, USA
| | - Jivan Moaddeb
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 201 Trent Dr, Durham, NC 27710, USA
| | - Rachel Mills
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 201 Trent Dr, Durham, NC 27710, USA
| | - Mahesh Patel
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 201 Trent Dr, Durham, NC 27710, USA
| | - William Kraus
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 201 Trent Dr, Durham, NC 27710, USA
| | - Nancy M Allen LaPointe
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 201 Trent Dr, Durham, NC 27710, USA
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