Petry Natasha J, Curtis Breanna, Feldhege Erica, Khan Shahjahan, Leedahl David D, Breidenbach Jesse L, Hines Lindsay
Department of Pharmacy Practice, School of Pharmacy, College of Health Professions, North Dakota State University, Fargo, ND, USA.
Imagenetics, Sanford Health, Sioux Falls, SD, USA.
J Pharm Pract. 2023 Jun;36(3):487-493. doi: 10.1177/08971900211049589. Epub 2021 Oct 8.
ObjectiveThe study objective was to examine provider acceptance and genotyping responses to a best practice advisory (BPA) concerning clopidogrel and intermediate and poor metabolizers within the context of a new pharmacogenomics program at a Midwestern health system Other secondary objectives analyzed included appropriate BPA firing, the distribution of alleles in study population, indications for clopidogrel use, and impact of indication on therapy change. In this study, the progress of this program was assessed by quantifying how providers respond to BPAs generated in the electronic medical record (EMR), in the context of a single representative gene-drug-outcome relationship. Patient data was pulled via reports yielding patients with genotyped information in the EMR and cross-referenced with a report evaluating BPA firing occurrences. By capturing antiplatelet therapy changes in response to genotyping results, 37 patients were found that had 73 BPAs fire. Nine of those patients had alternative antiplatelet therapy ordered. Of these, 6 alternative antiplatelet therapies were ordered from the BPA. Providers utilized BPAs, but responded differently based on individual knowledge of genotypes and indications. Information obtained from this study can be used for provider education and as reference for future design and wording of BPAs.
目的
本研究的目的是在中西部卫生系统的一个新的药物基因组学项目背景下，考察医疗服务提供者对一项关于氯吡格雷以及中间代谢型和慢代谢型的最佳实践建议（BPA）的接受情况和基因分型反应。分析的其他次要目标包括适当触发BPA、研究人群中等位基因的分布、氯吡格雷的使用指征以及指征对治疗改变的影响。在本研究中，通过在单一代表性基因 - 药物 - 结果关系的背景下量化医疗服务提供者对电子病历（EMR）中生成的BPA的反应，来评估该项目的进展情况。通过报告提取患者数据，这些报告产生了EMR中具有基因分型信息的患者，并与一份评估BPA触发情况的报告进行交叉参考。通过捕捉因基因分型结果而发生的抗血小板治疗变化，发现37名患者触发了73次BPA。其中9名患者接受了替代抗血小板治疗。在这些治疗中，6种替代抗血小板治疗是根据BPA开出的。医疗服务提供者利用了BPA，但根据对基因型和指征的个人了解做出了不同反应。从本研究中获得的信息可用于医疗服务提供者教育，并作为未来BPA设计和措辞的参考。
