Pharmacogenomic Clinical Decision Support: A Scoping Review

Area of Science:

• Pharmacogenomics
• Clinical Informatics
• Health Services Research

Background:

• Clinical decision support (CDS) is recognized as vital for pharmacogenomics (PGx) integration into clinical practice.
• However, the effectiveness of various PGx CDS strategies and the metrics used to assess clinical utility are not well-defined.
• This knowledge gap hinders the optimization and widespread adoption of PGx services.

Purpose of the Study:

• To conduct a scoping review of existing literature on pharmacogenomics clinical decision support (PGx CDS) implementations.
• To synthesize the current landscape of PGx CDS tools and the metrics employed to evaluate their impact.
• To identify research gaps concerning the optimization and effectiveness of PGx CDS.

Main Methods:

• A systematic search was performed for articles describing electronic CDS tools for PGx that reported relevant metrics.
• Included studies were those detailing PGx CDS tools and their associated performance or outcome measures.
• Data from 20 selected articles, representing 15 institutions, were aggregated and analyzed.

Main Results:

• The review identified interruptive post-test alerts as the most common PGx CDS tool, primarily implemented in academic medical centers (93%).
• Reported metrics showed significant variability, with clinical response rates ranging from 12-73% and alert response rates from 21-98%.
• Limited data were available on metric changes over time, factors influencing CDS evolution, or optimal PGx CDS approaches.

Conclusions:

• Post-test alerts are the most studied PGx CDS strategy, but their effectiveness is highly variable.
• There is a substantial need for further research into the usability, effectiveness, and optimization of various PGx CDS tools.
• Future studies should focus on developing and validating metrics to better quantify the clinical utility and guide the evolution of PGx CDS systems.