Optimizing pharmacogenomics workflows: a qualitative evaluation of clinical service delivery models

Despite the promise of personalized medicine, the clinical implementation of pharmacogenomics (PGx) remains limited. Several barriers limiting implementation of PGx have been identified, some of which include provider awareness, uncertainty of clinical utility, and reimbursement issues. As clinical PGx programs have increased, different service models have been established; however, none have been formally described. We aimed to describe and compare current service models to establish a best practice workflow for future PGx programs. Qualitative interviews with 15 PGx providers across the United States were conducted and analyzed using an inductive content analysis approach. All respondents had an e-consult (provider-to-provider) model, with seven also providing a PGx specialty clinic for patients. Reported challenges include lengthy testing processes, scheduling delays, and billing uncertainty. The majority of participants described an ideal PGx workflow as a "low-touch" tiered approach where frontline pharmacists offer testing, and PGx experts are a resource for complex drug-gene interactions. This tiered approach should be explored for future PGx implementations.