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Wu A, Raack EJ, Ross CJD, Carleton BC. Implementation and Evaluation Strategies for Pharmacogenetic Testing in Hospital Settings: A Scoping Review. Ther Drug Monit 2024:00007691-990000000-00266. [PMID: 39264345 DOI: 10.1097/ftd.0000000000001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/01/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Pharmacogenetic testing in clinical settings has improved the safety and efficacy of drug treatment. There is a growing number of studies evaluating pharmacogenetic implementation and identifying barriers and facilitators. However, no review has focused on bridging the gap between identifying barriers and facilitators of testing and the clinical strategies adopted in response. This review was conducted to understand the implementation and evaluation strategies of pharmacogenetic testing programs. METHODS A PRISMA-compliant scoping review was conducted. The included studies discussed pharmacogenetic testing programs implemented in a hospital setting. Quantitative, qualitative, and mixed design methods were included. RESULTS A total of 232 of the 7043 articles that described clinical pharmacogenetic programs were included. The most common specialties that described pharmacogenetic implementation were psychiatry (26%) and oncology (16%), although many studies described institutional programs implemented across multiple specialties (19%). Different specialties reported different clinical outcomes, but all reported similar program performance indicators, such as test uptake and the number of times the test recommendations were followed. There were benefits and drawbacks to delivering test results through research personnel, pharmacists, and electronic alerts, but active engagement of physicians was necessary for the incorporation of pharmacogenetic results into clinical decision making. CONCLUSIONS Further research is required on the maintenance and sustainability of pharmacogenetic testing initiatives. These findings provide an overview of the implementation and evaluation strategies of different specialties that can be used to improve pharmacogenetic testing.
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Affiliation(s)
- Angela Wu
- Department of Experimental Medicine, University of British Columbia
- BC Children's Hospital Research Institute
| | - Edward J Raack
- BC Children's Hospital Research Institute
- Department of Medical Genetics, University of British Columbia
| | - Colin J D Ross
- BC Children's Hospital Research Institute
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia; and
| | - Bruce C Carleton
- BC Children's Hospital Research Institute
- Department of Medical Genetics, University of British Columbia
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia; and
- Therapeutic Evaluation Unit, Provincial Health Services Authority, Vancouver, British Columbia, Canada
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Subasri M, Cressman C, Arje D, Schreyer L, Cooper E, Patel K, Ungar WJ, Barwick M, Denburg A, Hayeems RZ. Translating Precision Health for Pediatrics: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:897. [PMID: 37238445 PMCID: PMC10217253 DOI: 10.3390/children10050897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023]
Abstract
Precision health aims to personalize treatment and prevention strategies based on individual genetic differences. While it has significantly improved healthcare for specific patient groups, broader translation faces challenges with evidence development, evidence appraisal, and implementation. These challenges are compounded in child health as existing methods fail to incorporate the physiology and socio-biology unique to childhood. This scoping review synthesizes the existing literature on evidence development, appraisal, prioritization, and implementation of precision child health. PubMed, Scopus, Web of Science, and Embase were searched. The included articles were related to pediatrics, precision health, and the translational pathway. Articles were excluded if they were too narrow in scope. In total, 74 articles identified challenges and solutions for putting pediatric precision health interventions into practice. The literature reinforced the unique attributes of children and their implications for study design and identified major themes for the value assessment of precision health interventions for children, including clinical benefit, cost-effectiveness, stakeholder values and preferences, and ethics and equity. Tackling these identified challenges will require developing international data networks and guidelines, re-thinking methods for value assessment, and broadening stakeholder support for the effective implementation of precision health within healthcare organizations. This research was funded by the SickKids Precision Child Health Catalyst Grant.
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Affiliation(s)
- Mathushan Subasri
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
| | - Celine Cressman
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
| | - Danielle Arje
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
- Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Leighton Schreyer
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
| | - Erin Cooper
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
| | - Komal Patel
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
| | - Wendy J. Ungar
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Avram Denburg
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Division of Haematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Robin Z. Hayeems
- Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON M5G 1X8, Canada; (M.S.); (C.C.); (D.A.); (L.S.); (E.C.); (K.P.); (W.J.U.); (M.B.); (A.D.)
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
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Gill PS, Elchynski AL, Porter-Gill PA, Goodson BG, Scott MA, Lipinski D, Seay A, Kehn C, Balmakund T, Schaefer GB. Multidisciplinary Consulting Team for Complicated Cases of Neurodevelopmental and Neurobehavioral Disorders: Assessing the Opportunities and Challenges of Integrating Pharmacogenomics into a Team Setting. J Pers Med 2022; 12:jpm12040599. [PMID: 35455715 PMCID: PMC9024886 DOI: 10.3390/jpm12040599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/16/2022] [Accepted: 04/06/2022] [Indexed: 12/15/2022] Open
Abstract
Neurodevelopmental disorders have steadily increased in incidence in the United States. Over the past decade, there have been significant changes in clinical diagnoses and treatments some of which are due to the increasing adoption of pharmacogenomics (PGx) by clinicians. In this pilot study, a multidisciplinary team at the Arkansas Children’s Hospital North West consulted on 27 patients referred for difficult-to-manage neurodevelopmental and/or neurobehavioral disorders. The 27 patients were evaluated by the team using records review, team discussion, and pharmacogenetic testing. OneOme RightMed® (Minneapolis, MN, USA) and the Arkansas Children’s Hospital comprehensive PGx test were used for drug prescribing guidance. Of the 27 patients’ predicted phenotypes, the normal metabolizer was 11 (40.8%) for CYP2C19 and 16 (59.3%) for CYP2D6. For the neurodevelopmental disorders, the most common comorbid conditions included attention-deficit hyperactivity disorder (66.7%), anxiety disorder (59.3%), and autism (40.7%). Following the team assessment and PGx testing, 66.7% of the patients had actionable medication recommendations. This included continuing current therapy, suggesting an appropriate alternative medication, starting a new therapy, or adding adjunct therapy (based on their current medication use). Moreover, 25.9% of patients phenoconverted to a CYP2D6 poor metabolizer. This retrospective chart review pilot study highlights the value of a multidisciplinary treatment approach to deliver precision healthcare by improving physician clinical decisions and potentially impacting patient outcomes. It also shows the feasibility to implement PGx testing in neurodevelopmental/neurobehavioral disorders.
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Affiliation(s)
- Pritmohinder S. Gill
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA; (T.B.); (G.B.S.)
- Arkansas Children’s Research Institute, Little Rock, AR 72202, USA;
- Correspondence: ; Tel.: +1-(501)-364-1418; Fax: +1-(501)-364-3654
| | | | | | - Bradley G. Goodson
- Schmieding Developmental Center, Springdale, AR 72762, USA; (B.G.G.); (M.A.S.); (D.L.); (A.S.); (C.K.)
| | - Mary Ann Scott
- Schmieding Developmental Center, Springdale, AR 72762, USA; (B.G.G.); (M.A.S.); (D.L.); (A.S.); (C.K.)
| | - Damon Lipinski
- Schmieding Developmental Center, Springdale, AR 72762, USA; (B.G.G.); (M.A.S.); (D.L.); (A.S.); (C.K.)
| | - Amy Seay
- Schmieding Developmental Center, Springdale, AR 72762, USA; (B.G.G.); (M.A.S.); (D.L.); (A.S.); (C.K.)
- Arkansas Children’s Hospital Northwest, Springdale, AR 72762, USA
| | - Christina Kehn
- Schmieding Developmental Center, Springdale, AR 72762, USA; (B.G.G.); (M.A.S.); (D.L.); (A.S.); (C.K.)
| | - Tonya Balmakund
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA; (T.B.); (G.B.S.)
- Arkansas Children’s Hospital Northwest, Springdale, AR 72762, USA
| | - G. Bradley Schaefer
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA; (T.B.); (G.B.S.)
- Arkansas Children’s Research Institute, Little Rock, AR 72202, USA;
- Schmieding Developmental Center, Springdale, AR 72762, USA; (B.G.G.); (M.A.S.); (D.L.); (A.S.); (C.K.)
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR 72701, USA
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Berrios C, Sadaro SK, Sandritter T, Wagner JA, Soden S, Black B, Abdel-Rahman S. Parental understanding and attitudes following pharmacogenomic testing for pediatric neuropsychiatric patients. Pharmacogenomics 2022; 23:345-354. [DOI: 10.2217/pgs-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study explores parental understanding and attitudes around pharmacogenomic results in their child(ren). Patients and methods: In-depth interviews with parents whose child(ren) had received a pharmacogenomic testing panel for management of neuropsychiatric medications were completed. Interviews were analyzed for themes and accuracy of understanding of results. Results: In 18 parents interviewed, 49/63 (78%) of statements made regarding results were accurate. Differences in understanding were seen by clinic, number of medications and result type. Parents expected results to guide prescribing and perceived the greatest utility in results that could impact current care. Results predicting normal drug metabolism may create mixed feelings. Conclusion: Parents perceive utility in pharmacogenomic testing for their children. Challenges exist in understanding probabilistic and multifactorial information about pharmacogenomic results.
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Affiliation(s)
- Courtney Berrios
- Genomic Medicine Center, Children's Mercy, Kansas City, MO 64108, USA
- School of Medicine, University of Missouri Kansas City, Kansas City, MO 64108, USA
| | - Sophia K Sadaro
- Genomic Medicine Center, Children's Mercy, Kansas City, MO 64108, USA
| | - Tracy Sandritter
- Clinical Pharmacology, Toxicology, & Therapeutic Innovation, Children's Mercy, Kansas City, MO 64108, USA
- School of Pharmacy, University of Missouri Kansas City, Kansas City, MO 64108, USA
| | - Jennifer A Wagner
- School of Medicine, University of Missouri Kansas City, Kansas City, MO 64108, USA
- Clinical Pharmacology, Toxicology, & Therapeutic Innovation, Children's Mercy, Kansas City, MO 64108, USA
| | - Sarah Soden
- School of Medicine, University of Missouri Kansas City, Kansas City, MO 64108, USA
- Developmental & Behavioral Sciences, Children's Mercy, Kansas City, MO 64108, USA
| | - Benjamin Black
- The Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, Columbia, MO 65201, USA
| | - Susan Abdel-Rahman
- Clinical Pharmacology, Toxicology, & Therapeutic Innovation, Children's Mercy, Kansas City, MO 64108, USA
- School of Pharmacy, University of Missouri Kansas City, Kansas City, MO 64108, USA
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