Taylor Kathryn, Umbreit Audrey, Lea Catherine, Holm Emily, Kosloski Tarpenning Kimberly
Instructor in Pharmacy, Mayo Clinic School of Health Sciences; Mayo Clinic Health System, Eau Claire WI.
Assistant Professor of Pharmacy, Mayo Clinic School of Health Sciences; Mayo Clinic Health System, Mankato MN.
Innov Pharm. 2024 May 31;15(2). doi: 10.24926/iip.v15i2.6178. eCollection 2024.
: Pharmacogenomics (PGx) is a tool to guide optimal medication selection. Increased demand for personalized medicine and the growing occurrence of chronic diseases are drivers for pharmacogenomic medication management services. A review of implementation models identified a paucity of models delivering these services utilizing pharmacists in primary care. Lack of standardization of this process remains a barrier to widespread implementation within health systems. : Describe the process of developing an institutional guidance document and applying it to implement a pharmacogenomics medication management service at clinic sites within an integrated health system in the United States. Measure the growth in the number of PGx visits completed. : A task force of pharmacists reviewed literature, guidelines, and institutional policies to create a comprehensive guidance document. The document included six minimum practice requirements for implementation in the primary care setting, and six additional recommendations. A retrospective chart review of all face to face, phone and eConsult PGx visit types occurring from January 1, 2022 through September 30, 2022 was conducted. : A pharmacist-led pharmacogenomics medication management service is now offered at all primary care sites within the health system. During the study timeframe, 1378 patients had a PGx visit, resulting in 1939 PGx visits. Of those visits, 1777 (92%) were referred by a primary care provider and 1675 (86.7%) were conducted by a primary care pharmacist. Twenty-nine primary care pharmacists offered the PGX service and 25 (89%) completed at least one visit. Patients were referred by providers from 56 of the 64 (87.5%) primary care departments. : Developing an institutional process and guidance document for the implementation of a new pharmacist-led pharmacogenomics medication management service at clinic sites within an integrated health system was beneficial in developing and standardizing the workflow. Dissemination of workflow expectations to the primary care providers and pharmacists resulted in adoption of the service.
药物基因组学(PGx)是指导最佳药物选择的一种工具。对个性化医疗的需求增加以及慢性病发病率的不断上升,是药物基因组学药物管理服务的驱动因素。对实施模式的一项综述发现,利用初级保健中的药剂师提供这些服务的模式很少。这一过程缺乏标准化仍然是在卫生系统中广泛实施的一个障碍。
描述制定一份机构指导文件并将其应用于在美国一个综合卫生系统内的诊所实施药物基因组学药物管理服务的过程。衡量完成的PGx就诊次数的增长情况。
一个药剂师特别工作组审查了文献、指南和机构政策,以创建一份全面的指导文件。该文件包括在初级保健环境中实施的六项最低实践要求以及六项额外建议。对2022年1月1日至2022年9月30日期间发生的所有面对面、电话和电子咨询PGx就诊类型进行了回顾性图表审查。
现在,该卫生系统内的所有初级保健地点都提供由药剂师主导的药物基因组学药物管理服务。在研究期间,1378名患者进行了PGx就诊,共完成了1939次PGx就诊。在这些就诊中,1777次(92%)由初级保健提供者转诊,1675次(86.7%)由初级保健药剂师进行。29名初级保健药剂师提供了PGX服务,其中25名(89%)至少完成了一次就诊。患者由64个初级保健部门中56个部门(87.5%)的提供者转诊。
为在一个综合卫生系统内的诊所实施一项新的由药剂师主导的药物基因组学药物管理服务制定机构流程和指导文件,有助于制定和规范工作流程。向初级保健提供者和药剂师传播工作流程期望导致了该服务的采用。