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Bosic-Reiniger J, Martin JL, Brown KE, Anderson HD, Blackburn H, Kao DP, Trinkley KE, Woodahl EL, Aquilante CL. Barriers and facilitators of the use of clinical informatics resources to facilitate pharmacogenomic implementation in resource-limited settings. JAMIA Open 2024; 7:ooae101. [PMID: 39399271 PMCID: PMC11471000 DOI: 10.1093/jamiaopen/ooae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 09/02/2024] [Accepted: 09/20/2024] [Indexed: 10/15/2024] Open
Abstract
Objective Understand perceived barriers to and facilitators of using clinical informatics applications for pharmacogenomic (PGx) implementation in resource-limited settings. Materials and Methods We conducted a qualitative research study using a semi-structured interview guide informed by the Consolidated Framework for Implementation Research (CFIR). Interview questions assessed CFIR contextual determinants related to: electronic health record (EHR) infrastructure; clinical informatics personnel and resources; EHR integration of PGx test results; PGx clinical decision support (CDS) tools; institutional resources; and partner receptivity. Transcripts were coded and analyzed to identify themes. Results We interviewed 24 clinical informaticists and executive leaders working in rural or underserved health care settings in Montana (n = 15) and Colorado (n = 9) and identified three major themes: (1) EHR infrastructure limitations, (2) insufficient supporting resources, and (3) unique contextual considerations for resource-limited settings. EHR infrastructure limitations included limited agency related to EHR build and interoperability concerns. Theme 1 highlighted challenges associated with integrating structured data into the EHR and inadequate vendor support. Theme 2 included limited familiarity with PGx across the care team, cost concerns, and allocation of non-financial resources. Theme 3 highlighted perceptions about the clinical utility of PGx within rural and underrepresented populations. Potential facilitators, such as being able to act nimbly, were found to coexist among the reported barriers. Discussion and Conclusion Our results provide insight into the clinical informatics infrastructure in resource-limited settings and identify unique considerations for clinical informatics-facilitated PGx implementation. Future efforts in these settings should consider innovative partnerships and strategies to leverage facilitators and minimize barriers associated with integrating PGx CDS applications.
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Affiliation(s)
- Jade Bosic-Reiniger
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, MT 59812, United States
- Department of Pharmacy Practice, University of Montana, Missoula, MT 59812, United States
| | - James L Martin
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO 80045, United States
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Karen E Brown
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, MT 59812, United States
- Department of Biomedical and Pharmaceutical Sciences, University of Montana Skaggs School of Pharmacy, Missoula, MT 59812, United States
| | - Heather D Anderson
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO 80045, United States
| | - Hayley Blackburn
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, MT 59812, United States
- Department of Pharmacy Practice, University of Montana, Missoula, MT 59812, United States
| | - David P Kao
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO 80045, United States
| | - Katy E Trinkley
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO 80045, United States
| | - Erica L Woodahl
- L.S. Skaggs Institute for Health Innovation, University of Montana, Missoula, MT 59812, United States
- Department of Biomedical and Pharmaceutical Sciences, University of Montana Skaggs School of Pharmacy, Missoula, MT 59812, United States
| | - Christina L Aquilante
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO 80045, United States
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
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Katapodi MC, Pedrazzani C, Barnoy S, Dagan E, Fluri M, Jones T, Kim S, Underhill-Blazey ML, Uveges MK, Dwyer AA. ACCESS: an empirically-based framework developed by the International Nursing CASCADE Consortium to address genomic disparities through the nursing workforce. Front Genet 2024; 14:1337366. [PMID: 38264211 PMCID: PMC10804848 DOI: 10.3389/fgene.2023.1337366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/14/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction: Efforts are needed across disciplines to close disparities in genomic healthcare. Nurses are the most numerous trained healthcare professionals worldwide and can play a key role in addressing disparities across the continuum of care. ACCESS is an empirically-based theoretical framework to guide clinical practice in order to ameliorate genomic disparities. Methods: The framework was developed by the International Nursing CASCADE Consortium based on evidence collected between 2005 and 2023 from individuals and families of various ethnic backgrounds, with diverse hereditary conditions, and in different healthcare systems, i.e., Israel, Korea, Switzerland, and several U.S. States. The components of the framework were validated against published scientific literature. Results: ACCESS stands for Advocating, Coping, Communication, cascadE Screening, and Surveillance. Each component is demonstrated in concrete examples of clinical practice within the scope of the nursing profession related to genomic healthcare. Key outcomes include advocacy, active coping, intrafamilial communication, cascade screening, and lifelong surveillance. Advocacy entails timely identification of at-risk individuals, facilitating referrals to specialized services, and informed decision-making for testing. Active coping enhances lifelong adaptation and management of disease risk. Effective intrafamilial communication of predisposition to hereditary disease supports cascade testing of unaffected at-risk relatives. Lifelong surveillance is essential for identifying recurrence, changes in health status, and disease trajectory for life-threatening and for life-altering conditions. Discussion: ACCESS provides a standardized, systematic, situational, and unifying guide to practice and is applicable for nursing and for other healthcare professions. When appropriately enacted it will contribute towards equitable access to genomic resources and services.
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Affiliation(s)
- Maria C. Katapodi
- International Nursing CASCADE Consortium, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Carla Pedrazzani
- International Nursing CASCADE Consortium, Basel, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Sivia Barnoy
- International Nursing CASCADE Consortium, Basel, Switzerland
- Nursing Department, Tel-Aviv University, Tel Aviv, Israel
| | - Efrat Dagan
- International Nursing CASCADE Consortium, Basel, Switzerland
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | - Muriel Fluri
- International Nursing CASCADE Consortium, Basel, Switzerland
- Inselspital, Bern University Hospital, Bern, Switzerland
| | - Tarsha Jones
- International Nursing CASCADE Consortium, Basel, Switzerland
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, United States
| | - Sue Kim
- International Nursing CASCADE Consortium, Basel, Switzerland
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Meghan L. Underhill-Blazey
- International Nursing CASCADE Consortium, Basel, Switzerland
- School of Nursing, University of Rochester, Rochester, NY, United States
| | - Melissa K. Uveges
- International Nursing CASCADE Consortium, Basel, Switzerland
- William F. Connell School of Nursing, Boston College, Boston, MA, United States
| | - Andrew A. Dwyer
- International Nursing CASCADE Consortium, Basel, Switzerland
- William F. Connell School of Nursing, Boston College, Boston, MA, United States
- Massachusetts General Hospital, Harvard Center for Reproductive Medicine, Boston, MA, United States
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Lim CX, Bozkurt A, Chen ZY, Hird A, Wickens J, Lazarakis S, Hussainy SY, Alexander M. Healthcare professionals' and consumers' knowledge, attitudes, perspectives, and education needs in oncology pharmacogenomics: A systematic review. Clin Transl Sci 2023; 16:2467-2482. [PMID: 37991131 PMCID: PMC10719462 DOI: 10.1111/cts.13672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/19/2023] [Accepted: 10/04/2023] [Indexed: 11/23/2023] Open
Abstract
Clinical implementation of pharmacogenomic (PGx)-guided prescribing in oncology lags behind research evidence generation. We aimed to identify healthcare professionals' (HCPs) and consumers' knowledge, attitudes, perspectives, and education needs to inform strategies for implementation of scalable and sustainable oncology PGx programs. Systematic review of original articles indexed in EMBASE, EMCARE, MEDLINE, and PsycInfo from January 2012 until June 2022, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and using the Mixed Methods Appraisal Tool. PROSPERO registration number CRD42022352348. Of 1442 identified studies; 23 met inclusion criteria with 87% assessed high quality. Of these, 52% reported on HCPs, 35% on consumers, and 13% on both HCPs and consumers. Most were conducted in the United States (70%) and included multiple cancer types (74%). Across studies, HCPs and consumers mostly perceived value in PGx, however, both groups reported barriers to utilization, including cost, lack of consistent recommendations across guidelines, and limited knowledge among HCPs; test accuracy, clear testing benefits, and genomic information confidentiality among consumers. HCPs and consumers value and want to engage in PGx strategies in oncology care, however, are inhibited by unmet needs and practice and knowledge gaps. Implementation strategies aimed at addressing these issues may best support increased PGx uptake in oncology practice.
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Affiliation(s)
- Chiao Xin Lim
- Pharmacy, School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Alistair Bozkurt
- Pharmacy, School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Zi Yue Chen
- Pharmacy, School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Abbey Hird
- Pharmacy, School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Joanne Wickens
- Pharmacy, School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Smaro Lazarakis
- Health Sciences Library, Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Safeera Y. Hussainy
- Pharmacy Department, Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
- Department of General Practice, School of Public Health and Preventive MedicineMonash UniversityClaytonVictoriaAustralia
| | - Marliese Alexander
- Pharmacy Department, Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
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Haga SB. The Critical Role of Pharmacists in the Clinical Delivery of Pharmacogenetics in the U.S. PHARMACY 2023; 11:144. [PMID: 37736916 PMCID: PMC10514841 DOI: 10.3390/pharmacy11050144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023] Open
Abstract
Since the rebirth of pharmacogenomics (PGx) in the 1990s and 2000s, with new discoveries of genetic variation underlying adverse drug response and new analytical technologies such as sequencing and microarrays, there has been much interest in the clinical application of PGx testing. The early involvement of pharmacists in clinical studies and the establishment of organizations to support the dissemination of information about PGx variants have naturally resulted in leaders in clinical implementation. This paper presents an overview of the evolving role of pharmacists, and discusses potential challenges and future paths, primarily focused in the U.S. Pharmacists have positioned themselves as leaders in clinical PGx testing, and will prepare the next generation to utilize PGx testing in their scope of practice.
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Affiliation(s)
- Susanne B Haga
- Division of General Internal Medicine, Department of Medicine, School of Medicine, Duke University, 101 Science Drive, Durham, NC 27708, USA
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