Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO,USA.
Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO,USA.
Am J Health Syst Pharm. 2021 Jun 7;78(12):1094-1103. doi: 10.1093/ajhp/zxab137.
We describe the implementation of a pharmacist-provided pharmacogenomics (PGx) service in an executive health program (EHP) at an academic medical center.
As interest in genomic testing grows, pharmacists have the opportunity to advance the use of PGx in EHPs, in collaboration with other healthcare professionals. In November 2018, a pharmacist-provided PGx service was established in the EHP at the University of Colorado Hospital. The team members included 3 physicians, a pharmacist trained in PGx, a registered dietitian/exercise physiologist, a nurse, and 2 medical assistants. We conducted 4 preimplementation steps: (1) assessment of the patient population, (2) selection of a PGx test, (3) establishment of a visit structure, and (4) selection of a billing model. The PGx consultations involved two 1-hour visits. The first visit encompassed pretest PGx education, review of the patient's current medications and previous medication intolerances, and DNA sample collection for genotyping. After this visit, the pharmacist developed a therapeutic plan based on the PGx test results, discussed the results and plan with the physician, and created a personalized PGx report. At the second visit, the pharmacist reviewed the PGx test results, personalized the PGx report, and discussed the PGx-guided therapeutic plan with the patient. Overall, the strategy worked well; minor challenges included evaluation of gene-drug pairs with limited PGx evidence, communication of information to non-EHP providers, scheduling issues, and reimbursement.
The addition of a PGx service within an EHP was feasible and provided pharmacists the opportunity to lead PGx efforts and collaborate with physicians to expand the precision medicine footprint at an academic medical center.
我们描述了在学术医疗中心的行政健康计划（EHP）中实施药剂师提供的药物基因组学（PGx）服务。
随着对基因组测试的兴趣不断增加，药剂师有机会与其他医疗保健专业人员合作，在 EHP 中推进 PGx 的使用。2018 年 11 月，科罗拉多大学医院的 EHP 建立了由药剂师提供的 PGx 服务。团队成员包括 3 名医生、一名接受过 PGx 培训的药剂师、一名注册营养师/运动生理学家、一名护士以及 2 名医疗助理。我们进行了 4 项实施前的步骤：（1）评估患者人群，（2）选择 PGx 测试，（3）建立就诊结构，以及（4）选择计费模式。PGx 咨询涉及两次 1 小时的就诊。第一次就诊包括预测试 PGx 教育、回顾患者当前的药物和以前的药物不耐受情况，以及 DNA 样本采集进行基因分型。在这次就诊后，药剂师根据 PGx 测试结果制定治疗计划，与医生讨论结果和计划，并创建个性化的 PGx 报告。在第二次就诊时，药剂师审查 PGx 测试结果，个性化 PGx 报告，并与患者讨论 PGx 指导的治疗计划。总体而言，该策略效果良好；存在的小挑战包括评估具有有限 PGx 证据的基因-药物对、向非 EHP 提供者传达信息、安排问题和报销。
在 EHP 中增加 PGx 服务是可行的，使药剂师有机会领导 PGx 工作，并与医生合作，在学术医疗中心扩大精准医疗的影响力。
