1
|
Van Heukelom J, Morgan J, Massmann A, Jacobsen K, Petry NJ, Baye JF, Frear S, Schultz A. Evolution of pharmacogenomic services and implementation of a multi-state pharmacogenomics clinic across a large rural healthcare system. Front Pharmacol 2023; 14:1274165. [PMID: 38035031 PMCID: PMC10682150 DOI: 10.3389/fphar.2023.1274165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction: Pharmacogenomics (PGx) aims to maximize drug benefits while minimizing risk of toxicity. Although PGx has proven beneficial in many settings, clinical uptake lags. Lack of clinician confidence and limited availability of PGx testing can deter patients from completing PGx testing. A few novel PGx clinic models have been described as a way to incorporate PGx testing into the standard of care. Background: A PGx clinic was implemented to fill an identified gap in provider availability, confidence, and utilization of PGx across our health system. Through a joint pharmacist and Advanced Practice Provider (APP) collaborative clinic, patients received counseling and PGx medication recommendations both before and after PGx testing. The clinic serves patients both in-person and virtually across four states in the upper Midwest. Results: The majority of patients seen in the PGx clinic during the early months were clinician referred (77%, n = 102) with the remainder being self-referred. Patients were, on average, taking two medications with Clinical Pharmacogenetics Implementation Consortium guidelines. Visits were split almost equally between in-person and virtual visits. Conclusion: Herein, we describe the successful implementation of an interdisciplinary PGx clinic to further enhance our PGx program. Throughout the implementation of the PGx clinic we have learned valuable lessons that may be of interest to other implementors. Clinicians were actively engaged in clinic referrals and early adoption of telemedicine was key to the clinic's early successes.
Collapse
Affiliation(s)
- Joel Van Heukelom
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD, United States
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermillion, SD, United States
| | - Jennifer Morgan
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD, United States
- Department of Medical Genetics, Sanford Health, Sioux Falls, SD, United States
| | - Amanda Massmann
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD, United States
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermillion, SD, United States
| | - Kristen Jacobsen
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD, United States
| | - Natasha J. Petry
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD, United States
- Department of Pharmacy Practice, North Dakota State University, Fargo, ND, United States
| | - Jordan F. Baye
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD, United States
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermillion, SD, United States
- Department of Pharmacy Practice, South Dakota State University College of Pharmacy and Allied Health Professions, Brookings, SD, United States
| | - Samantha Frear
- Translational Software, Inc., Mercer Island, WA, United States
| | - April Schultz
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD, United States
- Department of Internal Medicine, University of South Dakota School of Medicine, Vermillion, SD, United States
| |
Collapse
|
2
|
Dietz JA, Halver A, Hammer KD, Petry NJ, Westall S, Lo TS. A Narrative Review of Placebo and Nocebo Effects on Itch. J Explor Res Pharmacol 2023; 000:000-000. [DOI: 10.14218/jerp.2022.00090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
|
3
|
Massmann A, Petry NJ. Impact of transitioning to an active, noninterruptive CYP2C19/proton pump inhibitor alert on prescribing patterns. Am J Health Syst Pharm 2023:7157015. [PMID: 37155711 DOI: 10.1093/ajhp/zxad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Indexed: 05/10/2023] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE To compare rates of prescriber acceptance of interruptive and noninterruptive clinical decision support (CDS) alerts regarding potential diminished therapeutic effectiveness and safety risks associated with proton pump inhibitor (PPI) use in carriers of gene variants affecting cytochrome P450 (CYP) isozyme 2C19 metabolism. METHODS A retrospective study was conducted at a large rural health system to examine different approaches to improving CDS alert acceptance while minimizing alert fatigue. Manual reviews were conducted to identify alerts regarding CYP2C19 metabolizer status displayed at the time of PPI ordering over 30-day periods before and after the transition from interruptive to noninterruptive CDS alert functionality. A chi-square test was conducted to analyze prescriber acceptance CDS recommendations by alert modality and type of treatment modification. RESULTS Overall, interruptive alerts had an acceptance rate of 18.6% (64/344), compared to 8.4% acceptance (30/357 alerts) for noninterruptive alerts (P ≤ 0.0001). Analysis of acceptance criteria revealed the noninterruptive alert cohort had higher acceptance, as determined by documented medication dose adjustments, than the interruptive alert cohort (53.3% [16/30] and 4.7% [3/64], respectively). The difference in acceptance rates by CDS modality and treatment modification was statistically significant (P ≤ 0.00001). The predominant indication for PPI use was gastroesophageal reflux disease (GERD) in both cohorts. CONCLUSION Interruptive alerts that actively influenced workflow had higher acceptance rates than noninterruptive alerts that served an informational purpose without a direct disruption of workflow. The study results suggest the utilization of noninterruptive alerts may be a beneficial tool for prompting clinicians to alter dosing regimens rather than transition to an alternative agent.
Collapse
Affiliation(s)
- Amanda Massmann
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD, and Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA
| | - Natasha J Petry
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD, and Department of Pharmacy Practice, North Dakota State University, Fargo, ND, USA
| |
Collapse
|
4
|
Lee YM, Berenbrok LA, Gálvez-Peralta M, Iwuchukwu O, Kisor DF, Petry NJ, Gammal RS. Advancing Pharmacogenomics-Based Care Through Interprofessional Education. Am J Pharm Educ 2023; 87:100007. [PMID: 37288681 DOI: 10.1016/j.ajpe.2022.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 09/16/2022] [Accepted: 10/05/2022] [Indexed: 06/09/2023]
Abstract
As genomic medicine becomes increasingly complex, pharmacists need to work collaboratively with other healthcare professionals to provide genomics-based care. The core pharmacist competencies in genomics were recently updated and mapped to the entrustable professional activities (EPAs). The new competency that is mapped to the "Interprofessional Team Member" EPA domain emphasizes the role of pharmacists as the pharmacogenomics experts in an interprofessional healthcare team. Interprofessional education (IPE) activities involving student pharmacists and students from other healthcare disciplines are crucial to prepare student pharmacists for a team-based approach to patient-centered care. This commentary discusses the pharmacogenomics-focused IPE activities implemented by 3 programs, the challenges faced, and the lessons learned. It also discusses strategies to develop pharmacogenomics-focused IPE activities based on existing resources. Developing pharmacogenomics-focused IPE activities will help prepare pharmacy graduates with the knowledge, skills, and attitudes to lead collaborative, interprofessional teams in the provision of pharmacogenomics-based care, consistent with the standards described in the genomics competencies for pharmacists.
Collapse
Affiliation(s)
- Yee Ming Lee
- University of Colorado Skaggs, School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
| | | | | | - Otito Iwuchukwu
- Farleigh Dickinson University, School of Pharmacy and Health Sciences, Florham Park, NJ, USA
| | | | - Natasha J Petry
- North Dakota State University, School of Pharmacy, Fargo, ND, USA
| | - Roseann S Gammal
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| |
Collapse
|
5
|
Heukelom JV, Jacobsen K, Petry NJ, Schultz A, Baye J, Sturdevant D, Massmann A. Patient satisfaction with return of pharmacogenomic results utilizing a patient portal message. Pharmacogenomics 2023; 24:315-323. [PMID: 37125619 PMCID: PMC10318570 DOI: 10.2217/pgs-2023-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
Background: Returning pharmacogenomics (PGx) results to patients is complex and challenging. Patients prefer provider education; however, a gap in provider comfort in PGx results has been documented. Objectives: This study's purpose was to evaluate satisfaction with the return of PGx test results using a patient portal message. Methods: A survey was sent to two cohorts with PGx results, one that received a PGx result message and one that did not. Results: Following implementation of the PGx result message, there was a decrease in patients reporting negative responses surrounding satisfaction in the return of their PGx results, with 39% responding negatively pre-implementation and 21% post-implementation. Conclusion: Satisfaction with the return of results improved following the implementation of a patient portal message.
Collapse
Affiliation(s)
- Joel Van Heukelom
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD 57105, USA
- Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA
| | | | - Natasha J Petry
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD 57105, USA
- Department of Pharmacy Practice, North Dakota State University, Fargo, ND 58102, USA
| | - April Schultz
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD 57105, USA
- Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA
| | - Jordan Baye
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD 57105, USA
- Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA
- College of Pharmacy & Allied Health Professions, South Dakota State University, Brookings, SD 57007, USA
| | | | - Amanda Massmann
- Sanford Imagenetics, Sanford Health, Sioux Falls, SD 57105, USA
- Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, USA
| |
Collapse
|
6
|
Petry NJ, Van Heukelom J, Baye JF, Massmann A. The effect of medication reconciliation on generating an accurate medication list in a pharmacogenomics practice. Ann Transl Med 2022; 10:1259. [PMID: 36618791 PMCID: PMC9816821 DOI: 10.21037/atm-2022-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022]
Abstract
Background Medication reconciliation is recognized as a critically important medication safety element and a key initiative by multiple organizations. Within our precision medicine program, accurate medication lists are essential to our ability to make specific medication recommendations based on pharmacogenetic results. Our study aimed to identify discrepancies within the patient's medication list to improve medication management via genetic factors through a pharmacy team-based approach. Methods A dedicated team of pharmacists and trained student pharmacists conducted telephone interviews to complete medication reconciliation for individuals enrolled in our precision medicine preemptive screening program. Medication list discrepancies were tracked as well as if pharmacogenetic consults were altered by findings during the telephone interviews. Results Medication reconciliation was completed on 465 participants who had recently received or were awaiting pharmacogenetic testing. We found similar results to previously described rates of medication list discrepancies with an average of 4.9 medication discrepancies per patient as well as greater than 90% of individuals having at least one medication discrepancy. Pharmacogenetic recommendations for 20 individuals (4.3%) required adjustment following medication reconciliation. Conclusions This pilot program supports the value of a dedicated team for medication reconciliation and the importance of accurate medication lists to optimize precision medicine programs.
Collapse
Affiliation(s)
- Natasha J. Petry
- Sanford Health Imagenetics, Sioux Falls, SD, USA;,Department of Pharmacy Practice, North Dakota State University, Fargo, ND, USA
| | - Joel Van Heukelom
- Sanford Health Imagenetics, Sioux Falls, SD, USA;,Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA
| | - Jordan F. Baye
- Sanford Health Imagenetics, Sioux Falls, SD, USA;,Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA;,College of Pharmacy and Allied Health Professions, South Dakota State University, Brookings, SD, USA
| | - Amanda Massmann
- Sanford Health Imagenetics, Sioux Falls, SD, USA;,Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA
| |
Collapse
|
7
|
Blout Zawatsky CL, Leonhard JR, Bell M, Moore MM, Petry NJ, Platt DM, Green RC, Hajek C, Christensen KD. Workforce Considerations When Building a Precision Medicine Program. J Pers Med 2022; 12:jpm12111929. [PMID: 36422106 PMCID: PMC9692406 DOI: 10.3390/jpm12111929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/11/2022] [Accepted: 11/12/2022] [Indexed: 11/22/2022] Open
Abstract
This paper describes one healthcare system’s approach to strategically deploying genetic specialists and pharmacists to support the implementation of a precision medicine program. In 2013, Sanford Health initiated the development of a healthcare system-wide precision medicine program. Here, we report the necessary staffing including the genetic counselors, genetic counseling assistants, pharmacists, and geneticists. We examined the administrative and electronic medical records data to summarize genetic referrals over time as well as the uptake and results of an enterprise-wide genetic screening test. Between 2013 and 2020, the number of genetic specialists employed at Sanford Health increased by 190%, from 10.1 full-time equivalents (FTEs) to 29.3 FTEs. Over the same period, referrals from multiple provider types to genetic services increased by 423%, from 1438 referrals to 7517 referrals. Between 2018 and 2020, 11,771 patients received a genetic screening, with 4% identified with potential monogenic medically actionable predisposition (MAP) findings and 95% identified with at least one informative pharmacogenetic result. Of the MAP-positive patients, 85% had completed a session with a genetics provider. A strategic workforce staffing and deployment allowed Sanford Health to manage a new genetic screening program, which prompted a large increase in genetic referrals. This approach can be used as a template for other healthcare systems interested in the development of a precision medicine program.
Collapse
Affiliation(s)
- Carrie L. Blout Zawatsky
- Genomes2People, Department of Medicine (Genetics), Brigham and Women’s Hospital, Boston, MA 02115, USA
- Broad Institute, Cambridge, MA 02142, USA
- Precision Population Health, Ariadne Labs, Boston, MA 02115, USA
- The MGH Institute of Health Professions, Boston, MA 02115, USA
| | - Jennifer R. Leonhard
- Department of Genetics, Sanford Health, Bemidji, MN 56601, USA
- Correspondence: ; Tel.: +1-218-333-5068
| | - Megan Bell
- Department of Genetics, Sanford Health, Sioux Falls, SD 57117, USA
- Department of Genetic Counseling, Augustana University, Sioux Falls, SD 57117, USA
| | | | - Natasha J. Petry
- Department of Sanford Imagenetics, Sanford Health, Sioux Falls, SD 57117, USA
- Department of Pharmacy Practice, North Dakota State University, Fargo, ND 58105, USA
| | - Dylan M. Platt
- Department of Genetics, Sanford Health, Sioux Falls, SD 57117, USA
- Department of Genetic Counseling, Augustana University, Sioux Falls, SD 57117, USA
| | - Robert C. Green
- Genomes2People, Department of Medicine (Genetics), Brigham and Women’s Hospital, Boston, MA 02115, USA
- Broad Institute, Cambridge, MA 02142, USA
- Precision Population Health, Ariadne Labs, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Catherine Hajek
- Department of Genetics, Sanford Health, Sioux Falls, SD 57117, USA
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57117, USA
- Helix, San Mateo, CA 94401, USA
| | - Kurt D. Christensen
- Broad Institute, Cambridge, MA 02142, USA
- Department of Population Medicine, Harvard Medical School, Boston, MA 02215, USA
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| |
Collapse
|
8
|
Sperber NR, Cragun D, Roberts MC, Bendz LM, Ince P, Gonzales S, Haga SB, Wu RR, Petry NJ, Ramsey L, Uber R. A Mixed-Methods Protocol to Identify Best Practices for Implementing Pharmacogenetic Testing in Clinical Settings. J Pers Med 2022; 12:jpm12081313. [PMID: 36013262 PMCID: PMC9410119 DOI: 10.3390/jpm12081313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Using a patient’s genetic information to inform medication prescriptions can be clinically effective; however, the practice has not been widely implemented. Health systems need guidance on how to engage with providers to improve pharmacogenetic test utilization. Approaches from the field of implementation science may shed light on the complex factors affecting pharmacogenetic test use in real-world settings and areas to target to improve utilization. This paper presents an approach to studying the application of precision medicine that utilizes mixed qualitative and quantitative methods and implementation science frameworks to understand which factors or combinations consistently account for high versus low utilization of pharmocogenetic testing. This approach involves two phases: (1) collection of qualitative and quantitative data from providers—the cases—at four clinical institutions about their experiences with, and utilization of, pharmacogenetic testing to identify salient factors; and (2) analysis using a Configurational Comparative Method (CCM), using a mathematical algorithm to identify the minimally necessary and sufficient factors that distinguish providers who have higher utilization from those with low utilization. Advantages of this approach are that it can be used for small to moderate sample sizes, and it accounts for conditions found in real-world settings by demonstrating how they coincide to affect utilization.
Collapse
Affiliation(s)
- Nina R. Sperber
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC 27701, USA
- Durham VA Health Care System, Durham, NC 27705, USA
- Correspondence:
| | - Deborah Cragun
- College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Megan C. Roberts
- UNC Eshelman School of Pharmacy, University of North Carolina–Chapel Hill, Chapel Hill, NC 27599, USA
| | - Lisa M. Bendz
- Center for Medication Policy and Drug Information, Department of Pharmacy, Duke University Hospital, Durham, NC 27710, USA
| | - Parker Ince
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC 27701, USA
| | - Sarah Gonzales
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC 27701, USA
| | - Susanne B. Haga
- Department of Medicine, Duke University, Durham, NC 27701, USA
| | - R. Ryanne Wu
- Durham VA Health Care System, Durham, NC 27705, USA
- Department of Medicine, Duke University, Durham, NC 27701, USA
| | - Natasha J. Petry
- School of Pharmacy, North Dakota State University/Sanford Health Imagenetics, Fargo, ND 58108, USA
| | - Laura Ramsey
- Department of Pediatrics, Divisions of Clinical Pharmacology and Research in Patient Services, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Ryley Uber
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, CA 17822, USA
| |
Collapse
|
9
|
Petry NJ, Baye JF, Frear S, Jacobsen K, Massmann A, Schultz A, Heukelom JV, Christensen K. Progression of precision statin prescribing for reduction of statin-associated muscle symptoms. Pharmacogenomics 2022; 23:585-596. [PMID: 35775396 DOI: 10.2217/pgs-2022-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Statins are among the most commonly prescribed medications, and improve patient outcomes by lowering cholesterol levels, but also have side effects. Variations in statin response can be attributed to a handful of factors that include pharmacogenetics. Methods: While not a true review article, this work was written using various search engines and terms and previous and newly published Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for statins to provide a historical perspective in addition to the current status of statin-related pharmacogenetics and future perspectives. Results: This article provides historical background on statins and associated adverse effects, reviews pharmacogenetic implications, applies clinical-decision support, incorporates the latest CPIC guidelines and addresses future implications. Conclusion: Statins are a beneficial medication, but not without risk. Pharmacogenomics can help mitigate some risk factors. Clinical-decision support, implementation, research and guidelines will continue to influence statin prescribing.
Collapse
Affiliation(s)
- Natasha J Petry
- Sanford Health Imagenetics, 1321 W 22nd St, Sioux Falls, SD 57105, USA.,Department of Pharmacy Practice, North Dakota State University, Fargo, ND 58108, USA
| | - Jordan F Baye
- Sanford Health Imagenetics, 1321 W 22nd St, Sioux Falls, SD 57105, USA.,South Dakota State University, College of Pharmacy & Allied Health Professions, SD 57007, USA.,University of South Dakota, Department of Internal Medicine, SD 57105, USA
| | - Samantha Frear
- Sanford Health Imagenetics, 1321 W 22nd St, Sioux Falls, SD 57105, USA
| | - Kristen Jacobsen
- Sanford Health Imagenetics, 1321 W 22nd St, Sioux Falls, SD 57105, USA
| | - Amanda Massmann
- Sanford Health Imagenetics, 1321 W 22nd St, Sioux Falls, SD 57105, USA.,University of South Dakota, Department of Internal Medicine, SD 57105, USA
| | - April Schultz
- Sanford Health Imagenetics, 1321 W 22nd St, Sioux Falls, SD 57105, USA.,University of South Dakota, Department of Internal Medicine, SD 57105, USA
| | - Joel Van Heukelom
- Sanford Health Imagenetics, 1321 W 22nd St, Sioux Falls, SD 57105, USA.,University of South Dakota, Department of Internal Medicine, SD 57105, USA
| | - Kurt Christensen
- Department of Population Medicine, PRecisiOn Medicine Translational Research (PROMoTeR) Center, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA.,Department of Population Medicine, Harvard Medical School, Boston, MA 02215, USA.,Broad Institute of MIT & Harvard, Cambridge, MA 02142, USA
| |
Collapse
|
10
|
Gammal RS, Lee YM, Petry NJ, Iwuchukwu O, Hoffman JM, Kisor DF, Empey PE. Pharmacists Leading the Way to Precision Medicine: Updates to the Core Pharmacist Competencies in Genomics. Am J Pharm Educ 2022; 86:8634. [PMID: 34301570 PMCID: PMC10159420 DOI: 10.5688/ajpe8634] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/23/2021] [Indexed: 05/06/2023]
Abstract
Genomics is becoming an increasingly important part of health care, and pharmacists are well-positioned to be practice-based leaders in pharmacogenomics and precision medicine. Competencies available through the Genetics/Genomics Competency Center provide a framework for pharmacogenomics instruction in both pharmacy school curricula and continuing education programs. Given the significant advancements in pharmacogenomics over the past decade, the 2019-2020 American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group updated the pharmacist competencies. The process used a systematic approach which included mapping pharmacogenomics-specific competencies to the entrustable professional activities for pharmacists and seeking consensus from key stakeholders. The result is an expansion to 30 competencies that reflect the contemporary roles pharmacists play in the application of pharmacogenomics in clinical practice. When implemented into curricula, these competencies will ensure that learners are "practice ready" to integrate pharmacogenomics into patient care. Additional postgraduate training is needed for advanced roles in pharmacogenomics implementation, education, and research.
Collapse
Affiliation(s)
- Roseann S Gammal
- American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group, Arlington, Virginia
- Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts
| | - Yee Ming Lee
- American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group, Arlington, Virginia
- University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado
| | - Natasha J Petry
- American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group, Arlington, Virginia
- North Dakota State University, School of Pharmacy, Fargo, North Dakota
| | - Otito Iwuchukwu
- American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group, Arlington, Virginia
- Farleigh Dickinson University, School of Pharmacy, Florham Park, New Jersey
| | - James M Hoffman
- American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group, Arlington, Virginia
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - David F Kisor
- American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group, Arlington, Virginia
- Manchester University, Fort Wayne, Indiana
| | - Philip E Empey
- American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group, Arlington, Virginia
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| |
Collapse
|
11
|
Petry NJ, Curtis B, Feldhege E, Khan S, Leedahl DD, Breidenbach JL, Hines L. Impact of Automated Best Practice Advisories on Provider Response to CYP2C19 Genotyping Results for Patients on Clopidogrel. J Pharm Pract 2021; 36:487-493. [PMID: 34622701 DOI: 10.1177/08971900211049589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
ObjectiveThe study objective was to examine provider acceptance and genotyping responses to a best practice advisory (BPA) concerning clopidogrel and CYP2C19 intermediate and poor metabolizers within the context of a new pharmacogenomics program at a Midwestern health system. Other secondary objectives analyzed included appropriate BPA firing, the distribution of alleles in study population, indications for clopidogrel use, and impact of indication on therapy change. Methods: In this study, the progress of this program was assessed by quantifying how providers respond to BPAs generated in the electronic medical record (EMR), in the context of a single representative gene-drug-outcome relationship. Patient data was pulled via reports yielding patients with genotyped information in the EMR and cross-referenced with a report evaluating BPA firing occurrences. Results: By capturing antiplatelet therapy changes in response to CYP2C19 genotyping results, 37 patients were found that had 73 BPAs fire. Nine of those patients had alternative antiplatelet therapy ordered. Of these, 6 alternative antiplatelet therapies were ordered from the BPA. Conclusion: Providers utilized BPAs, but responded differently based on individual knowledge of genotypes and indications. Information obtained from this study can be used for provider education and as reference for future design and wording of BPAs.
Collapse
Affiliation(s)
- Natasha J Petry
- Department of Pharmacy Practice, School of Pharmacy, College of Health Professions, 3323North Dakota State University, Fargo, ND, USA.,Imagenetics, 24195Sanford Health, Sioux Falls, SD, USA
| | - Breanna Curtis
- Department of Pharmacy, 24195Sanford Health, Fargo, ND, USA
| | - Erica Feldhege
- Department of Pharmacy Practice, School of Pharmacy, College of Health Professions, 3323North Dakota State University, Fargo, ND, USA
| | - Shahjahan Khan
- Department of Internal Medicine, Sanford School of Medicine, 8191University of South Dakota, Sioux Falls, SD, USA
| | | | | | - Lindsay Hines
- Department of Neuropsychology, 24195Sanford Health, Fargo, ND, USA
| |
Collapse
|
12
|
Kisor DF, Petry NJ, Bright DR. Pharmacogenomics in the United States Community Pharmacy Setting: The Clopidogrel- CYP2C19 Example. Pharmgenomics Pers Med 2021; 14:569-577. [PMID: 34040417 PMCID: PMC8140945 DOI: 10.2147/pgpm.s224894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022] Open
Abstract
Pharmacogenomics (PGx) is expanding across health-care practice settings, including the community pharmacy. In the United States, models of implementation of PGx in the community pharmacy have described independent services and those layered on to medication therapy management. The drug-gene pair of clopidogrel-CYP2C19 has been a focus of implementation of PGx in community pharmacy and serves as an example of the evolution of the application of drug-gene interaction information to help optimize drug therapy. Expanded information related to this drug-gene pair has been provided by the US Food and Drug Administration and clinical PGx guidelines have and continue to be updated to support clinical decision-making. Most recently direct-to-consumer (DTC) PGx has resulted in patient generated sample collection and submission to a genetic testing-related company for analysis, with reporting of genotype and related phenotype information directly to the patient without a health-care professional guiding or even being involved in the process. The DTC testing approach needs to be considered in the development or modification of PGx service models in the community pharmacy setting. The example of clopidogrel-CYP2C19 is discussed and current models of PGx implementation in the community pharmacy in the United States are presented. New approaches to PGx services are offered as implementation continues to evolve and may now include DTC information.
Collapse
Affiliation(s)
- David F Kisor
- Manchester University, Department of Pharmaceutical Sciences and Pharmacogenomics, Fort Wayne, IN, USA
| | - Natasha J Petry
- North Dakota State University, College of Health Professions, Department of Pharmacy Practice, Fargo, ND, USA
- Sanford Imagenetics, Sioux Falls, ND, USA
| | - David R Bright
- Ferris State University, Department of Pharmaceutical Sciences, Big Rapids, MI, USA
| |
Collapse
|
13
|
Baye JF, Petry NJ, Jacobson SL, Moore MM, Tucker B, Shaaban S, Massmann AK, Clark NM, Schultz AJ. Malignant hyperthermia susceptibility: utilization of genetic results in an electronic medical record to increase safety. Pharmacogenomics 2020; 21:1207-1215. [PMID: 33118445 DOI: 10.2217/pgs-2020-0088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Aim: This manuscript describes implementation of clinical decision support for providers concerned with perioperative complications of malignant hyperthermia susceptibility. Materials & methods: Clinical decision support for malignant hyperthermia susceptibility was implemented in 2018 based around our pre-emptive genotyping platform. We completed a brief descriptive review of patients who underwent pre-emptive testing, focused particularly on RYR1 and CACNA1S genes. Results: To date, we have completed pre-emptive genetic testing on more than 10,000 patients; 13 patients having been identified as a carrier of a pathogenic or likely pathogenic variant of RYR1 or CACNA1S. Conclusion: An alert system for malignant hyperthermia susceptibility - as an extension of our pre-emptive genomics platform - was implemented successfully. Implementation strategies and lessons learned are discussed herein.
Collapse
Affiliation(s)
- Jordan F Baye
- Sanford Health, Imagenetics, Sioux Falls, SD 57105, USA.,Department of Pharmacy Practice, South Dakota State University College of Pharmacy & Allied Health Professions, Brookings, SD 57006, USA.,Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Vermillion, SD, 57069, USA
| | - Natasha J Petry
- Sanford Health, Imagenetics, Sioux Falls, SD 57105, USA.,Department of Pharmacy Practice, North Dakota State University College of Health Professions, Fargo, ND 58108, USA
| | - Shauna L Jacobson
- Department of Anesthesiology, Sanford Health, Sioux Falls, SD 57117, USA
| | | | | | - Sherin Shaaban
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT 84108, USA
| | - Amanda K Massmann
- Sanford Health, Imagenetics, Sioux Falls, SD 57105, USA.,Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Vermillion, SD, 57069, USA
| | | | - April J Schultz
- Sanford Health, Imagenetics, Sioux Falls, SD 57105, USA.,Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Vermillion, SD, 57069, USA
| |
Collapse
|