Bull J, Bice T, Satterwhite W, Massie L, Burpee E, Knotkova H, Portenoy R. Contributors: Turgeon J, Michaud V, Matos A, Bankes D
Context: Pharmacogenomic analysis may improve the efficacy or safety of the drugs used in palliative care. Decision support systems may promote clinical integration of this information.
Objectives: To determine the feasibility and acceptability of a pharmacist-directed pharmacogenomic decision support system in the care of patients with advanced illness and explore the drug–gene and drug–drug interactions that occur in this population.
Methods: Physicians or nurse practitioners from two U.S. hospice agencies identified opioid-treated patients receiving multiple other drugs. Buccal samples and clinical data were obtained from consenting patients. A pharmacist used the proprietary MedWise™ platform to evaluate the current medications in terms of genotype and phenotype, created a standardized report describing potential interactions and recommended actions that may reduce the associated risk. Clinicians could access the report online and completed Likert-type scales to assess use and satisfaction with the system.
Results: Twenty clinicians and 100 patients participated. The reports revealed that 74 drugs were subject to 462 drug–gene interactions and 77 were involved in 691 drug–drug interactions; only 4 and 16 patients, respectively, had no drug–gene or drug–drug interactions. Clinicians routinely checked the reports and used the information to change ≥1 treatments in 55 (55%) patients. Almost all clinicians rated the system likely to improve the quality of care and all “agreed” or “strongly agreed” to recommend the system to colleagues.
Conclusion: This pharmacist-directed pharmacogenomic decision support system was perceived positively and was integrated into practice. Further studies are warranted to its clinical integration and its outcomes.Share this: