Dawes Martin, Aloise Martin N, Ang J Sidney, Cullis Pieter, Dawes Diana, Fraser Robert, Liknaitzky Gideon, Paterson Andrea, Stanley Paul, Suarez-Gonzalez Adriana, Katzov-Eckert Hagit
Department of Family Practice (M. Dawes); GenXys Health Care Systems (M. Dawes, Aloise, Ang, Cullis, D. Dawes, Fraser, Liknaitzky, Stanley, Suarez-Gonzalez, Katzov-Eckert); Personalized Medicine Initiative (Cullis, Fraser); Department of Physical Therapy (D. Dawes); Faculty of Pharmaceutical Sciences (Paterson); Clinicare Pharmacists Inc. (Paterson); Department of Botany (Suarez-Gonzalez); Department of Biochemistry and Molecular Biology (Cullis), University of British Columbia, Vancouver, BC.
CMAJ Open. 2016 Sep 21;4(3):E528-E534. doi: 10.9778/cmajo.20150070. eCollection 2016 Jul-Sep.
Inappropriate prescribing increases patient illness and death owing to adverse drug events. The inclusion of genetic information into primary care medication practices is one solution. Our aim was to assess the ability to obtain and genotype saliva samples and to determine the levels of use of a decision support tool that creates medication options adjusted for patient characteristics, drug-drug interactions and pharmacogenetics.
We conducted a cohort study in 6 primary care settings (5 family practices and 1 pharmacy), enrolling 191 adults with at least 1 of 10 common diseases. Saliva samples were obtained in the physician's office or pharmacy and sent to our laboratory, where DNA was extracted and genotyped and reports were generated. The reports were sent directly to the family physician/pharmacist and linked to an evidence-based prescribing decision support system. The primary outcome was ability to obtain and genotype samples. The secondary outcomes were yield and purity of DNA samples, ability to link results to decision support software and use of the decision support software.
Genotyping resulted in linking of 189 patients (99%) with pharmacogenetic reports to the decision support program. A total of 96.8% of samples had at least 1 actionable genotype for medications included in the decision support system. The medication support system was used by the physicians and pharmacists 236 times over 3 months.
Physicians and pharmacists can collect saliva samples of sufficient quantity and quality for DNA extraction, purification and genotyping. A clinical decision support system with integrated data from pharmacogenetic tests may enable personalized prescribing within primary care. ClinicalTrials.gov, NCT02383290.
不恰当的用药处方会因药物不良事件增加患者患病风险和死亡率。将基因信息纳入初级保健用药实践是一种解决方案。我们的目的是评估获取唾液样本并进行基因分型的能力，以及确定一种决策支持工具的使用水平，该工具可根据患者特征、药物相互作用和药物遗传学生成调整后的用药方案。
我们在6个初级保健机构（5个家庭诊所和1个药房）进行了一项队列研究，招募了191名患有10种常见疾病中至少一种的成年人。在医生办公室或药房采集唾液样本，并送至我们的实验室，在那里提取DNA并进行基因分型，然后生成报告。报告直接发送给家庭医生/药剂师，并与基于证据的处方决策支持系统相关联。主要结果是获取样本并进行基因分型的能力。次要结果是DNA样本的产量和纯度、将结果与决策支持软件关联的能力以及决策支持软件的使用情况。
基因分型使189名患者（99%）的药物遗传学报告与决策支持程序相关联。共有96.8%的样本针对决策支持系统中包含的药物至少有1个可采取行动的基因型。医生和药剂师在3个月内使用药物支持系统236次。
医生和药剂师可以采集到数量和质量足以用于DNA提取、纯化和基因分型的唾液样本。一个整合了药物遗传学测试数据的临床决策支持系统可能有助于在初级保健中实现个性化处方。ClinicalTrials.gov，NCT02383290。
