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Article

Design and Early Implementation Successes and Challenges of a Pharmacogenetics Consult Clinic

1
Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA
2
Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, 1345 Center Dr, Gainesville, FL 32603, USA
3
Division of General Internal Medicine, College of Medicine, University of Florida, 1329 SW 16th St, Gainesville, FL 32608, USA
4
Clinical and Translational Science Institute, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(7), 2274; https://doi.org/10.3390/jcm9072274
Received: 8 June 2020 / Revised: 13 July 2020 / Accepted: 15 July 2020 / Published: 17 July 2020
(This article belongs to the Special Issue Advances and Challenges in Pharmacogenomics)
Pharmacogenetic testing (PGT) is increasingly being used as a tool to guide clinical decisions. This article describes the development of an outpatient, pharmacist-led, pharmacogenetics consult clinic within internal medicine, its workflow, and early results, along with successes and challenges. A pharmacogenetics-trained pharmacist encouraged primary care physicians (PCPs) to refer patients who were experiencing side effects/ineffectiveness from certain antidepressants, opioids, and/or proton pump inhibitors. In clinic, the pharmacist confirmed the need for and ordered CYP2C19 and/or CYP2D6 testing, provided evidence-based pharmacogenetic recommendations to PCPs, and educated PCPs and patients on the results. Operational and clinical metrics were analyzed. In two years, 91 referred patients were seen in clinic (mean age 57, 67% women, 91% European-American). Of patients who received PGT, 77% had at least one CYP2C19 and/or CYP2D6 phenotype that would make conventional prescribing unfavorable. Recommendations suggested that physicians change a medication/dose for 59% of patients; excluding two patients lost to follow-up, 87% of recommendations were accepted. Challenges included PGT reimbursement and referral maintenance. High frequency of actionable results suggests physician education on who to refer was successful and illustrates the potential to reduce trial-and-error prescribing. High recommendation acceptance rate demonstrates the pharmacist’s effectiveness in providing genotype-guided recommendations, emphasizing a successful pharmacist–physician collaboration. View Full-Text
Keywords: precision medicine; pharmacogenetics; pharmacogenomics; implementation; primary care; internal medicine; CYP2C19; CYP2D6 precision medicine; pharmacogenetics; pharmacogenomics; implementation; primary care; internal medicine; CYP2C19; CYP2D6
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MDPI and ACS Style

Arwood, M.J.; Dietrich, E.A.; Duong, B.Q.; Smith, D.M.; Cook, K.; Elchynski, A.; Rosenberg, E.I.; Huber, K.N.; Nagoshi, Y.L.; Wright, A.; Budd, J.T.; Holland, N.P.; Maska, E.; Panna, D.; Elsey, A.R.; Cavallari, L.H.; Wiisanen, K.; Johnson, J.A.; Gums, J.G. Design and Early Implementation Successes and Challenges of a Pharmacogenetics Consult Clinic. J. Clin. Med. 2020, 9, 2274. https://doi.org/10.3390/jcm9072274

AMA Style

Arwood MJ, Dietrich EA, Duong BQ, Smith DM, Cook K, Elchynski A, Rosenberg EI, Huber KN, Nagoshi YL, Wright A, Budd JT, Holland NP, Maska E, Panna D, Elsey AR, Cavallari LH, Wiisanen K, Johnson JA, Gums JG. Design and Early Implementation Successes and Challenges of a Pharmacogenetics Consult Clinic. Journal of Clinical Medicine. 2020; 9(7):2274. https://doi.org/10.3390/jcm9072274

Chicago/Turabian Style

Arwood, Meghan J., Eric A. Dietrich, Benjamin Q. Duong, D. Max Smith, Kelsey Cook, Amanda Elchynski, Eric I. Rosenberg, Katherine N. Huber, Ying L. Nagoshi, Ashleigh Wright, Jeffrey T. Budd, Neal P. Holland, Edlira Maska, Danielle Panna, Amanda R. Elsey, Larisa H. Cavallari, Kristin Wiisanen, Julie A. Johnson, and John G. Gums. 2020. "Design and Early Implementation Successes and Challenges of a Pharmacogenetics Consult Clinic" Journal of Clinical Medicine 9, no. 7: 2274. https://doi.org/10.3390/jcm9072274

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