Bain Kevin T, Schwartz Emily J, Knowlton Orsula V, Knowlton Calvin H, Turgeon Jacques
J Am Pharm Assoc (2003). 2018 May-Jun;58(3):281-289.e1. doi: 10.1016/j.japh.2018.02.011. Epub 2018 Mar 27.
To determine the feasibility of implementing a pharmacist-led pharmacogenomics (PGx) service for the Program of All-Inclusive Care for the Elderly (PACE).
A national centralized pharmacy providing PGx services to community-based PACE centers.
Individuals 55 years of age and older enrolled in PACE who underwent PGx testing as part of their medical care (n = 296).
Pharmacist-led PGx testing, interpreting, and consulting.
Implementation processes and roles were ascertained by reviewing policies and procedures for the PGx service and documented observations made by pharmacists providing the service. Genetic variants and drug-gene interactions (DGIs) were determined by interpretations of PGx test results. Types of recommendations provided by pharmacists were ascertained from PGx consultations. Prescribers' acceptance of recommendations were ascertained by documented responses or drug changes made after PGx consultations.
Challenges to implementation included lack of systems interoperability, limited access to medical electronic health records, determining prescribers' responses, and knowledge and competency gaps in PGx. Pharmacist roles most essential to overcoming challenges were interpreting and applying PGx data, determining how to disseminate those data to prescribers, advocating for appropriate PGx testing, and educating about the application of test results to clinical practice. Participants frequently used drugs posing DGI risks, with the majority (73.6%) reporting more than 1 interaction. The overwhelming majority (89.0%) of pharmacists' recommendations to mitigate risks were accepted by referring prescribers.
Implementing a pharmacist-led PGx service for PACE is feasible. Implementation of this service highlights the leadership role of pharmacists in moving PGx from research to practice.
确定为老年人全面照护计划（PACE）实施由药剂师主导的药物基因组学（PGx）服务的可行性。
一家为社区PACE中心提供PGx服务的全国性集中药房。
年龄在55岁及以上、参加PACE并作为医疗护理一部分接受PGx检测的个体（n = 296）。
由药剂师主导PGx检测、解读和咨询。
通过审查PGx服务的政策和程序以及提供服务的药剂师的记录观察来确定实施过程和角色。通过对PGx检测结果的解读确定基因变异和药物 - 基因相互作用（DGI）。从PGx咨询中确定药剂师提供的建议类型。通过记录的回复或PGx咨询后做出的药物更改来确定开处方者对建议的接受情况。
实施的挑战包括缺乏系统互操作性、获取医疗电子健康记录受限、确定开处方者的反应以及PGx方面的知识和能力差距。克服挑战最关键的药剂师角色是解读和应用PGx数据、确定如何将这些数据传播给开处方者、倡导进行适当的PGx检测以及就检测结果在临床实践中的应用进行教育。参与者经常使用存在DGI风险的药物，大多数（73.6%）报告有不止一种相互作用。转诊开处方者接受了绝大多数（89.0%）药剂师为降低风险提出的建议。
为PACE实施由药剂师主导的PGx服务是可行的。这项服务的实施凸显了药剂师在将PGx从研究转化为实践中的领导作用。
