Implementing comprehensive pharmacogenomics in a community hospital-associated primary care setting

Area of Science:

• Clinical Pharmacology
• Genetics
• Translational Medicine

Background:

• Pharmacogenomics (PGx) is an emerging field with known drug-gene interactions not yet standard in clinical practice, creating a care gap.
• Implementation strategies are needed to integrate PGx into routine healthcare.
• A significant gap exists in translating pharmacogenomic knowledge into clinical practice.

Approach:

• A PGx practice model was implemented across 30 primary care clinics, involving 7 PGx-certified pharmacists.
• Patients were identified for PGx testing via a clinical decision support tool (CDST) integrated into the electronic medical record (EMR) or by provider referral.
• Testing used buccal swabs, with results directly entered into the EMR/CDST for pharmacist review and collaborative medication optimization.

Key Points:

• An interim analysis assessed 422 interactions, with 213 being pharmacogenomic and 124 actionable.
• Medication changes were recommended in 82% of actionable cases, primarily to address ineffective therapy (43%) or prevent/manage adverse drug reactions (34%/13%).

Conclusions:

• Pharmacogenomic testing, integrated with clinical decision support, facilitates comprehensive medication review and optimization within team-based care.
• Comprehensive PGx testing should be considered to improve medication safety and efficacy in at-risk patient populations.
• Addressing genetic variations in drug metabolism and response is crucial for improving patient outcomes.