Development of a Multifaceted Program for Pharmacogenetics Adoption at an Academic Medical Center: Practical Considerations and Lessons Learned

Clinical Pharmacology & Therapeutics, Год журнала: 2024, Номер 116(4), С. 914 - 931

Опубликована: Авг. 21, 2024

In 2019, Indiana University launched the Precision Health Initiative to enhance institutional adoption of precision medicine, including pharmacogenetics (PGx) implementation, at university‐affiliated practice sites across Indiana. The overarching goal this PGx implementation program was facilitate sustainable genotype‐guided prescribing into routine clinical care. To accomplish goal, we pursued following specific objectives: (i) integrate testing existing healthcare system processes; (ii) implement drug–gene pairs with high‐level evidence and educate providers pharmacists on established management recommendations; (iii) engage key stakeholders, patients optimize return results for testing; (iv) reduce health disparities through targeted inclusion underrepresented populations; (v) track third‐party reimbursement. This tutorial details our multifaceted program, descriptions interventions, critical challenges faced, major successes. By describing experience, aim assist other teams in achieving their systems.

Язык: Английский

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Approaches and hurdles of implementing pharmacogenetic testing in the psychiatric clinic

Psychiatry and Clinical Neurosciences Reports, Год журнала: 2022, Номер 1(2)

Опубликована: Июнь 1, 2022

Abstract Pharmacogenetic (PGx) testing has emerged as a tool for predicting person's ability to process and react drugs. Despite the growing evidence‐base, enthusiasm, successful efforts implement PGx in psychiatry, consensus on how best into practice not been established numerous hurdles widespread adoption remain be overcome. In this article, we summarize most used approaches commonly encountered when implementing routine psychiatric care. We also highlight effective strategies that have overcome hurdles. These include development of user‐friendly clinical workflows test ordering, use, communication results, establishment standardization reimbursement policies, tailored curriculums educating health‐care providers public. Although knowledge awareness these alone may sufficient implementation, they are necessary ensure spread, scale, sustainability psychiatry other areas medicine.

Язык: Английский

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Mental Health Prescribers’ Perceptions on the Use of Pharmacogenetic Testing in the Management of Depression in the Middle East and North Africa Region

Pharmacogenomics and Personalized Medicine, Год журнала: 2023, Номер Volume 16, С. 503 - 518

Опубликована: Май 1, 2023

Objective: A wide variety of commercial pharmacogenetic (PGx) tools are available worldwide to guide treatment selection for depression based on individuals' genetic profiles. However, the use testing inform psychiatric care has faced challenges due limited training and education mental health clinicians. The aim this study was explore knowledge, level engagement, perspectives PGx when making management decisions among practicing psychiatrists within Middle East North Africa (MENA) region. Methods: This is a qualitative using semi-structured interviews. Consenting were interviewed through an online platform (Skype TM or Microsoft Teams ). Interviews audio recorded, transcribed, thematically analyzed with assistance NVivo ® software. Results: Eighteen interviews from 12 countries have been conducted. Analysis current produced five major themes including: (1) Overall perceptions attitudes; (2) Knowledge awareness; (3) Education, training, professional experience; (4) Facilitators barriers; (5) Ethical dilemmas. These support notion that there limited, mostly basic, education, regarding in depression, although significant interest willingness part prescribers adopt strategy their practice. Conclusion: findings suggest MENA region appear be interested implementing managing people depression. it also important recognize cannot achieved unless more supporting strategies implemented system environment. Keywords: testing, study, region, psychiatry,

Язык: Английский

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Utility of pharmacogenetic testing to optimise antidepressant pharmacotherapy in youth: a narrative literature review

Frontiers in Pharmacology, Год журнала: 2023, Номер 14

Опубликована: Сен. 19, 2023

Pharmacogenetics (PGx) is the study and application of how interindividual differences in our genomes can influence drug responses. By evaluating individuals’ genetic variability genes related to metabolism, PGx testing has capabilities individualise primary care build a safer prescription model than current “one-size-fits-all” approach. In particular, use psychiatry shown promising evidence improving efficacy as well reducing toxicity adverse reactions. Despite randomised controlled trials demonstrating an base for its use, there are still numerous barriers impeding implementation. This review paper will discuss management mental health conditions with PGx-guided treatment strong focus on youth illness. clinical practice, concerns implementation psychiatry, some inhibiting integration healthcare also be discussed. Overall, this provides comprehensive state knowledge summarises information personalising medicine ill-health youth.

Язык: Английский

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A proposal for reducing maximum target doses of drugs for psychosis: Reviewing dose–response literature

Journal of Psychopharmacology, Год журнала: 2024, Номер 38(4), С. 344 - 352

Опубликована: Март 17, 2024

Background: Presently, there is limited guidance on the maximal dosing of psychosis drugs that based effectiveness rather than safety or toxicity. Current maximum recommendations may far exceed necessary degree dopamine D 2 receptor blockade required to treat psychosis. This lead excess harm through cognitive impairment and side effects. Aims: analysis aimed establish for prescribers by optimally efficacy benefit. Methods: We used data from two dose–response meta-analyses reviewed seven most prescribed in UK. Where were not available, we appropriate comparison techniques occupancy extrapolate our recommendations. Results: found likely threshold dose achieving remission psychotic symptoms was often significantly below currently licensed these drugs. therefore recommend clinicians are cautious about exceeding recommended doses. Individual factors, however, should be accounted for. outline potentially relevant factors including age, ethnicity, sex, smoking status pharmacogenetics. Additionally, therapeutic drug monitoring as a tool determine individual pharmacokinetic variation. Conclusions: In summary, propose new set target doses efficacy. Further research randomised controlled trials undertaken evaluate effect reducing current licensing maximums above However, reductions implemented manner accounts reduces effects withdrawal.

Язык: Английский

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Pharmacogenetic testing in primary care could bolster depression treatment: A value proposition

Clinical and Translational Science, Год журнала: 2024, Номер 17(6)

Опубликована: Июнь 1, 2024

Abstract Pharmacogenetic testing could reduce the time to identify a safe and effective medication for depression; however, it is underutilized in practice. Major depression constitutes most common mental disorder US, while antidepressant therapy can help, current trial –and error approach require patients endure multiple trials before finding one that effective. Tailoring fit of pharmacogenetic with prescribers' needs across variety settings help establish generalizable value proposition improve likelihood adoption. We conducted study explore health systems using medications through real‐world experiences implementation science concepts systematic interviews prescribers administrators from four care systems. To proposition, we organized themes according Triple Aim framework, leading framework policy which asserts high‐value should focus on three key metrics: (1) better quality (2) population‐level outcomes (3) reduced per capita costs. Primary providers whom interviewed said they because would provide more information about prescribe, expanding their ability best‐fit reducing reliance referrals specialists; this capacity meet patients' access primary care. At same time, expressed differing views how whether out‐of‐pocket cost prevent them offering it. Thus, integrating into strategies support interactions patients.

Язык: Английский

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An Overview of Pharmacogenomic Testing for Psychiatric Disorders

Canadian Journal of Health Technologies, Год журнала: 2023, Номер 3(6)

Опубликована: Июнь 5, 2023

Pharmacogenomic testing is a precision medicine technology that examines genetic variation in medication metabolism. Selected for inclusion CADTH’s 2023 Watch List, pharmacogenomic has the potential to significantly influence landscape of health care Canada over next 5 years. By analyzing an individual’s unique profile, this aims guide personalized treatment strategies improve therapeutic outcomes, optimize selection process, and enhance patient experiences. The integration into clinical practice may pave way more efficient effective delivery mental care. tests psychiatric disorders are available include direct-to-consumer — which paid out pocket offered as laboratory service (which or not be pocket). These quite different from each other, including types number genes examined, cost testing, methods used sample collection analysis. Despite being approximately 20 years numerous guideline-developing groups regulators have issued recommendations about information should prescribing decisions, yet integrated most practices worldwide. Although some studies suggest provides benefits usual, evidence often conflicting limited quality. Concerns related risk bias, inconsistency across studies, reproducibility, generalizability do allow clear consistent interpretation results. This Horizon Scan overview disorders, description published summary important considerations clinician education training, privacy confidentiality data, equity, capacity become widely Canada.

Язык: Английский

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Pharmacogenetic testing and counselling in the community pharmacy: mixed-methods study of a new pharmacist-led service

International Journal of Clinical Pharmacy, Год журнала: 2023, Номер 45(6), С. 1378 - 1386

Опубликована: Июнь 20, 2023

Pharmacogenetic (PGx) testing and counselling (short: PGx service) in the community pharmacy is not routinely practiced. We propose a comprehensive pharmacist-led service where information integrated into medication reviews. To evaluate comprising (PGx from perspective of patients. For this mixed-methods study, we conducted two follow-up interviews F1 F2 with patients recruited for after 1st January 2020. The semi-structured were held by phone call covered understanding PGx, implementation recommendations, handling documents (list concerned substances recommendation), gain knowledge, willingness to pay service. interviewed 25 42 F2. Patients generally able understand use results At least one recommendation was implemented 69% Handling ranged having forgotten about consulting list every medication-related decision; latter often expecting negative effects. Finally, 62% willing future counselling, HCPs should consider patients' health literacy standardized way adequate communication skills enhance patient's attenuate potential expectations.

Язык: Английский

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Pharmacogenomics to support mental health medication therapy management: Clinical practice considerations and a conceptual framework to enhance patient care

JACCP JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY, Год журнала: 2023, Номер 7(2), С. 160 - 170

Опубликована: Ноя. 10, 2023

Abstract Mental illnesses are common and often necessitate the use of medications to improve symptoms. For most conditions, many pharmacologic treatment options available, but there is limited evidence guide selection a specific medication or dose for given patient. Dose‐related side effects common, patients either drop out require multiple trials before finding regimen they can tolerate. This prolongs time remission, increasing suffering risk severe outcomes including disability suicide. A promising approach reduce early discontinuation switching through strategic application pharmacogenomics (PGx), which utilizes an individual's genetic information refine dosing better select optimal medication. Extensive research has established how variation may influence what extent individuals metabolize commonly prescribed mental illnesses. The evidence‐based integration PGx into clinical care necessitates patient‐centered that considers factors. Comprehensive management by pharmacists provides framework incorporate precision in health.

Язык: Английский

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Healthcare provider and patient perspectives on the implementation of pharmacogenetic-guided treatment in routine clinical practice

Pharmacogenetics and Genomics, Год журнала: 2024, Номер unknown

Опубликована: Июнь 18, 2024

Objective This study aims to understand patient and healthcare provider perspectives on the integration application of pharmacogenetics (PGx) testing in routine clinical practice. Methods Two anonymous online surveys were distributed globally for providers patients respectively Qualtrics platform (version 3.24). The through social platforms, email, posters with QR codes from 27 October 2023 7 March 2024. evaluated participant familiarity PGx, previous experience PGx testing, perceived implementation challenges, opinions point-of-care (PoC) devices. Results collected 78 responses 98 patients. results revealed that 64% had some level however, practice was low. primary challenges identified by included limited access lack knowledge test interpretation. In contrast, 52% respondents aware a significant association between awareness positive toward PGx. Both recognized value PoC devices, 98% 71% believing devices would improve accessibility testing. Comparative analysis statistically difference patients, being more informed. Conclusion Improved awareness, training, guidelines, may help promote PGx-guided treatments

Язык: Английский

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