Implementing pharmacogenetic testing in rural primary care practices: a pilot feasibility study

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References

• 1 Stanek EJ, Sanders CL, Taber KA et al. Adoption of pharmacogenomic testing by US physicians: results of a nationwide survey. Clin. Pharmacol. Ther. 91(3), 450–458 (2012). •• Seminal article surveyingover 50,000 physicians and finding that education, training, comfort level withinterpreting results and cost of testing are the most common barriers tophysician adoption of pharmacogenomic (PGx) testing.
  Medline CASGoogle Scholar
• 2 Haga SB, Lapointe NM, Cho A et al. Pilot study of pharmacist-assisted delivery of pharmacogenetic testing in a primary care setting. Pharmacogenomics 15(13), 1677–1686 (2014).
  Google Scholar
• 3 Haga SB. Delivering pharmacogenetic testing to the masses: an achievable goal? Pharmacogenomics 15(1), 1–4 (2014).
  CASGoogle Scholar
• 4 Volpi S, Bult C, Chisholm RL et al. Research directions in the clinical implementation of pharmacogenomics – an overview of US programs and projects. Clin. Pharmacol. Ther. 103(5), 778–786 (2018). • This paper summarizes a workshopand describes major US research programs in PGx implementation; reviews andsummarizes many of the barriers to PGx implementation as well as identifyingareas that are gaps in our knowledge base.
  MedlineGoogle Scholar
• 5 Dunnenberger HM, Biszewski M, Bell GC et al. Implementation of a multidisciplinary pharmacogenomics clinic in a community health system. Am. J. Health Syst. Pharm. 73(23), 1956–1966 (2016).
  MedlineGoogle Scholar
• 6 Lemke AA, Selkirk CGH, Glaser NS et al. Primary care physician experiences with integrated pharmacogenomic testing in a community health system. Per. Med. 14(5), 389–400 (2017).
  CASGoogle Scholar
• 7 Scott SA. Personalizing medicine with clinical pharmacogenetics. Genet. Med. 13(12), 987–995 (2011). •• This review paper delves into a number of barriers to implementation ofclinical pharmacogenetics, with an indepth description of clinical utility, professionaleducation, regulatory and reimbursement concerns.
  MedlineGoogle Scholar
• 8 Abubakar Amina, Olivia B. Precision medicine and pharmacogenomics in community and primary care settings. Pharmacy Today 24(2), 55–68 (2018).
  Google Scholar
• 9 Kean MA, Pritchard D. Emerging models for clinical adoption of personalized medicine. J. Per. Med. 10 52–65 (2017).
  Google Scholar
• 10 Hunt LM, Kreiner MJ. Pharmacogenetics in primary care: the promise of personalized medicine and the reality of racial profiling. Cult. Med. Psychiatry 37(1), 226–235 (2013).
  MedlineGoogle Scholar
• 11 Teng K. Pharmacogenomics for the primary care provider: why should we care? Clev. Clin. J. Med. 78(4), 241–242 (2011).
  MedlineGoogle Scholar
• 12 Teng KA, Longworth DL. Personalized healthcare in the era of value-based healthcare. Per. Med. 10(3), 285–293 (2013).
  CASGoogle Scholar
• 13 Dawes M, Aloise MN, Ang JS et al. Introducing pharmacogenetic testing with clinical decision support into primary care: a feasibility study. CMAJ Open 4(3), E528–E534 (2016).
  MedlineGoogle Scholar
• 14 Bartlett G, Zgheib N, Manamperi A et al. Pharmacogenomics in primary care: a crucial entry point for global personalized medicine? Curr. Pharmacogenomics Person. Med. 10(2), 101–105 (2012).
  Medline CASGoogle Scholar
• 15 Mckinnon RA, Ward MB, Sorich MJ. A critical analysis of barriers to the clinical implementation of pharmacogenomics. Ther. Clin. Risk Manag. 3(5), 751–759 (2007).
  Medline CASGoogle Scholar
• 16 Shuldiner AR, Relling MV, Peterson JF et al. The Pharmacogenomics research network translational pharmacogenetics program: overcoming challenges of real-world implementation. Clin. Pharmacol. Ther. 94(2), 207–210 (2013). • This is a seminar articlefrom leaders in the field about real world implementation through the lens ofthe Pharmacogenomics Research Network, the premier resource for the field.
  Medline CASGoogle Scholar
• 17 Weitzel KW, Aquilante CL, Johnson S, Kisor DF, Empey PE. Educational strategies to provide pharmacogenomics-based care. Am. J. Health Syst. Pharm. 73(23), 1986–1998 (2016).
  Medline CASGoogle Scholar
• 18 Roederer MW, Kuo GM, Kisor DF et al. Pharmacogenomics competencies in pharmacy practice: a blueprint for change. J. Am. Pharm. Assoc. 57(1), 120–125 (2017).
  MedlineGoogle Scholar
• 19 Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement. Sci. 4, 50 (2009).
  MedlineGoogle Scholar
• 20 Rogers E. Diffusion of Innovations (4th Edition). The Free Press, NY, USA, 10–35 (1995).
  Google Scholar
• 21 Sanson-Fisher RW. Diffusion of innovation theory for clinical change. Med. J. Aust. 180(6 Suppl.), S55–S56 (2004).
  MedlineGoogle Scholar
• 22 Dressler LG. Integrating personalized genomic medicine into routine clinical care: addressing the social and policy issues of pharmacogenomic testing. N. C. Med. J. 74(6), 509–513 (2013).
  MedlineGoogle Scholar
• 23 Relling MV, Klein TE. CPIC: clinical pharmacogenetics implementation consortium of the pharmacogenomics research network. Clin. Pharmacol. Ther. 89(3), 464–467 (2011).
  Medline CASGoogle Scholar
• 24 Dressler LG, Deal AM, Patel J, Markey J, Riper MV, McLeod HL. Cancer pharmacogenomics, adoption by oncologists and patient benefit. Per. Med. 11(2), 143–153 (2014).
  CASGoogle Scholar
• 25 Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychol. Health 14, 1–24 (1999).
  Google Scholar
• 26 O'Donnell PH, Bush A, Spitz J et al. The 1200 patients project: creating a new medical model system for clinical implementation of pharmacogenomics. Clin. Pharmacol. Ther. 92(4), 446–449 (2012).
  MedlineGoogle Scholar
• 27 McKillip RP, Borden BA, Galecki P et al. Patient perceptions of care as influenced by a large institutional pharmacogenomic implementation program. Clin. Pharmacol. Ther. 102(1), 106–114 (2017).
  Medline CASGoogle Scholar
• 28 Khanna D, Fitzgerald JD, Khanna P, Sangmee B, Singh M. 2012 American College of Rheumatology Guidelines for Management of Gout Part 1: systematic non-pharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res. 64(10), 1431–1446 (2012).
  CASGoogle Scholar
• 29 Randel A. AAO-HNS Guidelines for tonsillectomy in children and adolescents. Am. Fam. Physician 84(5), 566–573 (2011).
  MedlineGoogle Scholar
• 30 WHO. WHO Guidelines (2012) on the pharmacological treatment of persisting pain in children with medical illnesses. https://apps.who.int/iris/bitstream/apps.who.int.
  Google Scholar
• 31 Shuldiner AR, Relling MV, Peterson JF et al. The pharmacogenomics research network translational pharmacogenetics program: overcoming challenges of real-world implementation. Clin. Pharmacol. Ther. 94(2), 207–210 (2013).
  Medline CASGoogle Scholar
• 32 Crews KR, Hicks JK, Pui CH, Relling MV, Evans WE. Pharmacogenomics and individualized medicine: translating science into practice. Clin. Pharmacol. Ther. 92(4), 467–475 (2012). • From one of the leaders in thefield at Mayo Clinic, this articles descirbes a comprehensive system forimplementation and evaluation. Eight major issues are addressed includingresources, governance, cliical practices, education, testing, knowledgetranslation, clinical decision support and translation.
  Medline CASGoogle Scholar
• 33 Levy KD, Decker BS, Carpenter JS et al. Prerequisites to implementing a pharmacogenomics program in a large health-care system. Clin. Pharmacol. Ther. 96(3), 307–309 (2014).
  Medline CASGoogle Scholar
• 34 Danahey K, Borden BA, Furner B et al. Simplifying the use of pharmacogenomics in clinical practice: building the genomic prescribing system. J. Biomed. Informatics 75, 110–121 (2017).
  MedlineGoogle Scholar
• 35 Caraballo PJ, Bielinski SJ, St Sauver JL, Weinshilboum RM. Electronic medical record-integrated pharmacogenomics and related clinical decision support concepts. Clin. Pharmacol. Ther. 102(2), 254–264 (2017).
  Medline CASGoogle Scholar
• 36 Manzi SF, Fusaro VA, Chadwick L et al. Creating a scalable clinical pharmacogenomics service with automated interpretation and medical record result integration – experience from a pediatric tertiary care facility. J. Am. Med. Informatics Assoc. 24(1), 74–80 (2017).
  MedlineGoogle Scholar
• 37 Alanazi A. Incorporating pharmacogenomics into health information technology, electronic health record and decision support system: an overview. J. Med. Syst. 41(2), 19 (2017).
  MedlineGoogle Scholar
• 38 Dunnenberger HM, Crews KR, Hoffman JM et al. Preemptive clinical pharmacogenetics implementation: current programs in five US medical centers. Annu. Rev. Pharmacol. Toxicol. 55, 89–106 (2015). •• The authors focus onprograms that use pre-emptive PGx testing across the US, describing common threads and highlighting processes for implementation. Although many of the programs described are academic, they are still informative in the general community setting.
  Medline CASGoogle Scholar