Design and Early Implementation Successes and Challenges of a Pharmacogenetics Consult Clinic.

Autor: Arwood MJ; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA.; Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA., Dietrich EA; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA., Duong BQ; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA.; Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA., Smith DM; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA.; Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA., Cook K; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA.; Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA., Elchynski A; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA.; Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA., Rosenberg EI; Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA., Huber KN; Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA., Nagoshi YL; Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA., Wright A; Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA., Budd JT; Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA., Holland NP; Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA., Maska E; Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA., Panna D; Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA., Elsey AR; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA.; Clinical and Translational Science Institute, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, USA., Cavallari LH; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA.; Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA., Wiisanen K; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA.; Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA., Johnson JA; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA.; Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA., Gums JG; Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2020 Jul 17; Vol. 9 (7). Date of Electronic Publication: 2020 Jul 17.
DOI: 10.3390/jcm9072274
Abstrakt: 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.
Databáze: MEDLINE
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