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Design and Early Implementation Successes and Challenges of a Pharmacogenetics Consult Clinic
- Source :
- Journal of Clinical Medicine, Journal of Clinical Medicine, Vol 9, Iss 2274, p 2274 (2020), Journal of Clinical Medicine; Volume 9; Issue 7; Pages: 2274
- Publication Year :
- 2020
- Publisher :
- MDPI, 2020.
-
Abstract
- Pharmacogenetic testing (PGT) is increasingly being used as a tool to guide clinical decisions. This article describes the development of an outpatient, pharmacist-led, pharmacogenetics consult clinic within internal medicine, its workflow, and early results, along with successes and challenges. A pharmacogenetics-trained pharmacist encouraged primary care physicians (PCPs) to refer patients who were experiencing side effects/ineffectiveness from certain antidepressants, opioids, and/or proton pump inhibitors. In clinic, the pharmacist confirmed the need for and ordered CYP2C19 and/or CYP2D6 testing, provided evidence-based pharmacogenetic recommendations to PCPs, and educated PCPs and patients on the results. Operational and clinical metrics were analyzed. In two years, 91 referred patients were seen in clinic (mean age 57, 67% women, 91% European-American). Of patients who received PGT, 77% had at least one CYP2C19 and/or CYP2D6 phenotype that would make conventional prescribing unfavorable. Recommendations suggested that physicians change a medication/dose for 59% of patients; excluding two patients lost to follow-up, 87% of recommendations were accepted. Challenges included PGT reimbursement and referral maintenance. High frequency of actionable results suggests physician education on who to refer was successful and illustrates the potential to reduce trial-and-error prescribing. High recommendation acceptance rate demonstrates the pharmacist’s effectiveness in providing genotype-guided recommendations, emphasizing a successful pharmacist–physician collaboration.
- Subjects :
- precision medicine
pharmacogenetics
pharmacogenomics
implementation
primary care
internal medicine
CYP2C19
CYP2D6
medicine.medical_specialty
Referral
health care facilities, manpower, and services
education
Pharmacist
lcsh:Medicine
Primary care
030226 pharmacology & pharmacy
Article
03 medical and health sciences
0302 clinical medicine
health services administration
medicine
Reimbursement
health care economics and organizations
business.industry
lcsh:R
General Medicine
Precision medicine
Early results
030220 oncology & carcinogenesis
Pharmacogenomics
Family medicine
business
Pharmacogenetics
Subjects
Details
- Language :
- English
- ISSN :
- 20770383
- Volume :
- 9
- Issue :
- 7
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical Medicine
- Accession number :
- edsair.doi.dedup.....d47e27e2ad3184fb5a191d123671be18