Hicks J Kevin, Stowe David, Willner Marc A, Wai Maya, Daly Thomas, Gordon Steven M, Lashner Bret A, Parikh Sumit, White Robert, Teng Kathryn, Moss Timothy, Erwin Angelika, Chalmers Jeffrey, Eng Charis, Knoer Scott
Pharmacy Department, Cleveland Clinic, Cleveland, Ohio.
Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
Pharmacotherapy. 2016 Aug;36(8):940-8. doi: 10.1002/phar.1786. Epub 2016 Jul 20.
The number of clinically relevant gene-based guidelines and recommendations pertaining to drug prescribing continues to grow. Incorporating gene-drug interaction information into the drug-prescribing process can help optimize pharmacotherapy outcomes and improve patient safety. However, pharmacogenomic implementation barriers exist such as integration of pharmacogenomic results into electronic health records (EHRs), development and deployment of pharmacogenomic decision support tools to EHRs, and feasible models for establishing ambulatory pharmacogenomic clinics. We describe the development of pharmacist-managed pharmacogenomic services within a large health system. The Clinical Pharmacogenetics Implementation Consortium guidelines for HLA-B57:01-abacavir, HLA-B15:02-carbamazepine, and TPMT-thiopurines (i.e., azathioprine, mercaptopurine, and thioguanine) were systematically integrated into patient care. Sixty-three custom rules and alerts (20 for TPMT-thiopurines, 8 for HLA-B57:01-abacavir, and 35 for HLA-B15:02-anticonvulsants) were developed and deployed to the EHR for the purpose of providing point-of-care pharmacogenomic decision support. In addition, a pharmacist and physician-geneticist collaboration established a pharmacogenomics ambulatory clinic. This clinic provides genetic testing when warranted, result interpretation along with pharmacotherapy recommendations, and patient education. Our processes for developing these pharmacogenomic services and solutions for addressing implementation barriers are presented.
与药物处方相关的基于基因的临床相关指南和建议的数量持续增加。将基因-药物相互作用信息纳入药物处方过程有助于优化药物治疗效果并提高患者安全性。然而，药物基因组学的实施存在障碍，例如将药物基因组学结果整合到电子健康记录（EHR）中、开发药物基因组学决策支持工具并将其部署到EHR中，以及建立门诊药物基因组学诊所的可行模式。我们描述了在一个大型医疗系统中由药剂师管理的药物基因组学服务的发展情况。临床药物基因组学实施联盟关于HLA-B57:01-阿巴卡韦、HLA-B15:02-卡马西平和TPMT-硫嘌呤（即硫唑嘌呤、巯嘌呤和硫鸟嘌呤）的指南被系统地整合到患者护理中。开发并向EHR部署了63条定制规则和警报（20条针对TPMT-硫嘌呤，8条针对HLA-B57:01-阿巴卡韦，35条针对HLA-B15:02-抗惊厥药），以提供即时护理药物基因组学决策支持。此外，药剂师和医生-遗传学家合作建立了一个药物基因组学门诊诊所。该诊所根据需要提供基因检测、结果解读以及药物治疗建议，并开展患者教育。我们介绍了开发这些药物基因组学服务以及解决实施障碍的方案的过程。
