Integrating Pharmacogenomics into Clinical Practice: Promise vs Reality.

BACKGROUND Limited information is available regarding primary care clinicians' response to pharmacogenomic clinical decision support (PGx-CDS) alerts integrated in the electronic health record. METHODS In February 2015, 159 clinicians in the Mayo Clinic primary care practice were sent e-mail surveys to understand their perspectives on the implementation and use of pharmacogenomic testing in their clinical practice. Surveys assessed how the clinicians felt about pharmacogenomics and whether they thought electronic PGx-CDS alerts were useful. Information was abstracted on the number of CDS alerts the clinicians received between October 2013 and the date their survey was returned. CDS alerts were grouped into 2 categories: the alert recommended caution using the prescription, or the alert recommended an alternate prescription. Finally, data were abstracted regarding whether the clinician changed their prescription in response to the alert recommendation. RESULTS The survey response rate was 57% (n = 90). Overall, 52% of the clinicians did not expect to use or did not know whether they would use pharmacogenomic information in their future prescribing practices. Additionally, 53% of the clinicians felt that the alerts were confusing, irritating, frustrating, or that it was difficult to find additional information. Finally, only 30% of the clinicians that received a CDS alert changed their prescription to an alternative medication. CONCLUSIONS Our results suggest a lack of clinician comfort with integration of pharmacogenomic data into primary care. Further efforts to refine PGx-CDS alerts to make them as useful and user-friendly as possible are needed to improve clinician satisfaction with these new tools.

[1]  Eric J Topol,et al.  Direct-to-consumer pharmacogenomic testing is associated with increased physician utilisation , 2013, Journal of Medical Genetics.

[2]  Kensaku Kawamoto,et al.  Clinical decision support for genetically guided personalized medicine: a systematic review , 2013, J. Am. Medical Informatics Assoc..

[3]  K. J. Johansen Taber,et al.  Pharmacogenomic knowledge gaps and educational resource needs among physicians in selected specialties , 2014, Pharmacogenomics and personalized medicine.

[4]  R. Weinshilboum,et al.  Pharmacogenomics: bench to bedside , 2004, Nature Reviews Drug Discovery.

[5]  Dean F Sittig,et al.  Clinical decision support alert appropriateness: a review and proposal for improvement. , 2014, The Ochsner journal.

[6]  Cloann Schultz,et al.  Evaluation of the use of clinical decision support and online resources for pharmacogenomics education. , 2015, Pharmacogenomics.

[7]  L. Cavallari,et al.  Stakeholder Views on Pharmacogenomic Testing , 2014, Pharmacotherapy.

[8]  G. Willis,et al.  Health Care Provider Surveys in the United States, 2000–2010 , 2013, Evaluation & the health professions.

[9]  Kristi J. Sorensen,et al.  A Comprehensive Information Technology System to Support Physician Learning at the Point of Care , 2015, Academic medicine : journal of the Association of American Medical Colleges.

[10]  Samuel G. Johnson,et al.  Improving Genetics Education in Graduate and Continuing Health Professional Education: Workshop Summary , 2015 .

[11]  R. Verbrugge,et al.  Adoption of Pharmacogenomic Testing by US Physicians: Results of a Nationwide Survey , 2012, Clinical pharmacology and therapeutics.

[12]  Richard M Weinshilboum,et al.  Genomics and drug response. , 2011, The New England journal of medicine.

[13]  Jeremy M Grimshaw,et al.  Changing physicians' behavior: what works and thoughts on getting more things to work. , 2002, The Journal of continuing education in the health professions.

[14]  Joan Scott,et al.  What works in genomics education: outcomes of an evidenced-based instructional model for community-based physicians , 2015, Genetics in Medicine.

[15]  Joshua C. Denny,et al.  Attitudes of Clinicians Following Large-Scale Pharmacogenomics Implementation , 2015, The Pharmacogenomics Journal.

[16]  Marc Berg,et al.  Overriding of drug safety alerts in computerized physician order entry. , 2006, Journal of the American Medical Informatics Association : JAMIA.

[17]  David W. Bates,et al.  Review Paper: What Evidence Supports the Use of Computerized Alerts and Prompts to Improve Clinicians' Prescribing Behavior? , 2009, J. Am. Medical Informatics Assoc..

[18]  Peter Tarczy-Hornoch,et al.  Usability evaluation of pharmacogenomics clinical decision support aids and clinical knowledge resources in a computerized provider order entry system: A mixed methods approach , 2014, Int. J. Medical Informatics.

[19]  Jeanette J McCarthy,et al.  Genomic Medicine: A Decade of Successes, Challenges, and Opportunities , 2013, Science Translational Medicine.

[20]  Jon W. McKeeby,et al.  Integrating pharmacogenetic information and clinical decision support into the electronic health record , 2014, J. Am. Medical Informatics Assoc..

[21]  Primary care physicians' knowledge of and experience with pharmacogenetic testing , 2013 .

[22]  J. Peterson,et al.  Clinician Perspectives on Using Pharmacogenomics in Clinical Practice. , 2015, Personalized medicine.

[23]  Casey Lynnette Overby,et al.  Making pharmacogenomic-based prescribing alerts more effective: A scenario-based pilot study with physicians , 2015, J. Biomed. Informatics.

[24]  R. Weinshilboum.  Inheritance and drug response. , 2003, The New England journal of medicine.

[25]  M. Relling,et al.  Development and use of active clinical decision support for preemptive pharmacogenomics , 2013, Journal of the American Medical Informatics Association : JAMIA.

[26]  R. Weinshilboum,et al.  Pharmacogenetics and pharmacogenomics: development, science, and translation. , 2006, Annual review of genomics and human genetics.

[27]  Christopher G Chute,et al.  Preemptive genotyping for personalized medicine: design of the right drug, right dose, right time-using genomic data to individualize treatment protocol. , 2014, Mayo Clinic proceedings.

[28]  Andy Anderson,et al.  Physicians' preparedness for integration of genomic and pharmacogenetic testing into practice within a major healthcare system. , 2013, Genetic testing and molecular biomarkers.