Smith D Max, Wake Dyson T, Dunnenberger Henry M
MedStar Health, Columbia, Maryland, USA.
Georgetown University Medical Center, Washington, District of Columbia, USA.
Clin Pharmacol Ther. 2023 Apr;113(4):803-815. doi: 10.1002/cpt.2711. Epub 2022 Jul 31.
Clinical decision support (CDS) is often cited as an essential part of pharmacogenomics (PGx) implementations. A multitude of strategies are available; however, it is unclear which strategies are effective and which metrics are used to quantify clinical utility. The objective of this scoping review was to aggregate previous studies into a cohesive depiction of the current state of PGx CDS implementations and identify areas for future research on PGx CDS. Articles were included if they (i) described electronic CDS tools for PGx and (ii) reported metrics related to PGx CDS. Twenty of 3,449 articles were included and provided data on PGx CDS metrics from 15 institutions, with 93% of programs located at academic medical centers. The most common tools in CDS implementations were interruptive post-test alerts. Metrics for clinical response and alert response ranged from 12-73% and 21-98%, respectively. Few data were found on changes in metrics over time and measures that drove the evolution of CDS systems. Relatively few data were available regarding support of optimal approaches for PGx CDS. Post-test alerts were the most widely studied approach, and their effectiveness varied greatly. Further research on the usability, effectiveness, and optimization of CDS tools is needed.
临床决策支持（CDS）常被视为药物基因组学（PGx）实施的重要组成部分。有多种策略可供选择；然而，尚不清楚哪些策略是有效的，以及使用哪些指标来量化临床效用。本范围综述的目的是将先前的研究汇总成关于PGx CDS实施现状的连贯描述，并确定PGx CDS未来研究的领域。如果文章（i）描述了用于PGx的电子CDS工具，且（ii）报告了与PGx CDS相关的指标，则纳入该文章。3449篇文章中有20篇被纳入，并提供了来自15个机构的PGx CDS指标数据，其中93%的项目位于学术医疗中心。CDS实施中最常见的工具是干预性检测后警报。临床反应和警报反应的指标分别为12%-73%和21%-98%。关于指标随时间的变化以及推动CDS系统演变的措施，发现的数据很少。关于PGx CDS最佳方法支持的数据相对较少。检测后警报是研究最广泛的方法，其有效性差异很大。需要对CDS工具的可用性、有效性和优化进行进一步研究。
