Department of Pharmacy and Therapeutics, Center for Clinical Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA.
Department of Medicine, Division of Translational Medicine and Human Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Clin Pharmacol Ther. 2018 Oct;104(4):664-674. doi: 10.1002/cpt.1006. Epub 2018 Jan 30.
CYP2C19 genotype-guided antiplatelet therapy following percutaneous coronary intervention is increasingly implemented in clinical practice. However, challenges such as selecting a testing platform, communicating test results, building clinical decision support processes, providing patient and provider education, and integrating methods to support the translation of emerging evidence to clinical practice are barriers to broad adoption. In this report, we compare and contrast implementation strategies of 12 early adopters, describing solutions to common problems and initial performance metrics for each program. Key differences between programs included the test result turnaround time and timing of therapy changes, which are both related to the CYP2C19 testing model and platform used. Sites reported the need for new informatics infrastructure, expert clinicians such as pharmacists to interpret results, physician champions, and ongoing education. Consensus lessons learned are presented to provide a path forward for those seeking to implement similar clinical pharmacogenomics programs within their institutions.
经皮冠状动脉介入治疗后，CYP2C19 基因型指导的抗血小板治疗在临床实践中得到了越来越多的应用。然而，选择检测平台、沟通检测结果、构建临床决策支持流程、提供患者和医生教育以及整合方法以支持新兴证据转化为临床实践等方面的挑战，阻碍了其广泛应用。在本报告中，我们比较和对比了 12 个早期采用者的实施策略，描述了每个项目常见问题的解决方案和初步绩效指标。项目之间的主要差异包括检测结果的周转时间和治疗改变的时间，这两者都与 CYP2C19 检测模型和使用的平台有关。各站点报告称需要新的信息学基础设施、药剂师等专家临床医生来解读结果、医生拥护者以及持续的教育。我们提出了达成共识的经验教训，为那些希望在其机构内实施类似临床药物基因组学项目的人提供了前进的道路。
