Pharmacogenomics
Olunife Akinmolayan, PharmD
Arecent report published online July 21, 2023, in the American Journal of Health-System Pharmacy highlighted what it takes to put a pharmacist-driven pharmacogenomics model into practice.
The aim of the report by Mitaly and colleagues was to give pharmacy leadership an idea of what’s needed to create a pharmacogenomics program led by a pharmacist. A Mayo Clinic model created a process for pharmacists to interpret pharmacogenomics results and provide electronic consults to providers while determining staffing needs. According to the authors, an important factor to consider when implementing any model is the expected patient volume, “as this greatly impacts estimated hiring needs.”
A total of 395 pharmacists were trained using this program model, also known as the Mayo Clinic experience. Pharmacists completed over 2,500 e-consults with an average time spent per consult of around 24 minutes. The pharmacist’s time was self-documented and was a requirement of consultation completion. Over the course of 11 months, the average number of e-consults per pharmacist was 7 with the most common gene pair for semi-urgent consultation being CYP2C19-clopidogrel.
To put this model into practice, the clinic used biobank samples from the RIGHT 10K Study to get pharmacogenomic results, which sequenced 77 genes from 10,077 patients making it easier to determine which consults were deemed semi-urgent and clinically actionable. Semi-urgent phenotypes were defined as those with the potential to cause serious harm while clinically actionable phenotypes were defined as those with the potential to affect the risk of adverse drug reactions or drug therapy effectiveness.
Each pharmacist had 5 days to complete a clinically actionable consult and 48 hours to complete a semi-urgent consult. Over the course of the study, there were a total of 61 semi-urgent and 2,782 clinically actionable consults completed. The total amount of time spent on completing all consults was 1,159 hours over the course of the entire study.
Training the trainer
Typically, the interpretation of pharmacogenomic results is completed by a pharmacogenomic pharmacist, but new models can open the door to training more pharmacists to provide these services in multiple practice settings.
Pharmacogenomic pharmacists developed a quick reference guide and a series of competency modules to make training of the trainer a more structured process. The Mayo Clinic experience offers a 16-hour continuing education pharmacogenomics online certification course based on lessons learned and training activities.
An effective training experience can be created in other institutions by using an internal resource that provides specific recommendations for guidelines based on pertinent gene–drug pairs, supported by routine updates and reevaluation, according to study authors.
The authors go on to say that pharmacy leadership will need to evaluate how to overcome common program barriers including lack of financial resources, infrastructure, and staff to provide services. Although the model outlined in the report is better suited for “institutions looking to expand pharmacogenomics implementation system-wide,” the authors said there are still many takeaways for various interested institutions who are looking to start programs.
Tailored response
“[Pharmacists’] knowledge of pharmacogenomics impacts patient medications and adeptness in offering alternative therapies consistent with patient needs and have made them a ready resource in clinical application of the science,” said study authors.
Delivery of personalized health care is not a new concept, but the role of the most accessible health care provider—the pharmacist—is evolving rapidly. Pharmacists are well known as medication experts with backgrounds in pharmacokinetics, pharmacodynamics, and now pharmacogenomics. Pharmacists can add more value to the health care team by increasing communication with a patient’s primary care provider. ■