Implementing comprehensive pharmacogenomics in a community hospital–associated primary care setting

Jennifer A. Wick, Tara Schmidlen, Kendra Grande, Chad Moretz, Kristine Ashcraft, Julia Green, Nicolas Moyer, Burns C. Blaxall

Background
Pharmacogenomics (PGx) is an emerging field. Many drug-gene interactions are known but not yet routinely addressed in clinical practice. Therefore, there is a significant gap in care, necessitating development of implementation strategies.

Objective
The objective of the study was to assess the impact of implementing a PGx practice model which incorporates comprehensive pharmacogenomic risk evaluation, testing and medication optimization administered by 7 PGx-certified ambulatory care pharmacists embedded across 30 primary care clinic sites.

Assessment of the Clinical Utility of Pretreatment DPYD Testing for Patients Receiving Fluoropyrimidine Chemotherapy

Daniel L. Hertz

Abstract

Purpose: Patients who carry pathogenic variants in DPYD have higher systemic fluoropyrimidine (FP) concentrations and greater risk of severe and fatal FP toxicity. Pretreatment DPYD testing and DPYD-guided FP dosing to reduce toxicity and health care costs is recommended by European clinical oncology guidelines and has been adopted across Europe, but has not been recommended or adopted in the United States. The cochairs of the National Comprehensive Cancer Network Guidelines for colon cancer treatment explained their concerns with recommending pretreatment DPYD testing, particularly the risk that reduced FP doses in DPYD carriers may reduce treatment efficacy.

A Mixed-Methods Protocol to Identify Best Practices for Implementing Pharmacogenetic Testing in Clinical Settings

Nina R. Sperber, Deborah Cragun, Megan C. Roberts, Lisa M. Bendz, Parker Ince, Sarah Gonzales,
Susanne B. Haga, R. Ryanne Wu, Natasha J. Petry, Laura Ramsey, and Ryley Uber

Abstract

Using a patient’s genetic information to inform medication prescriptions can be clinically effective; however, the practice has not been widely implemented. Health systems need guidance on how to engage with providers to improve pharmacogenetic test utilization. Approaches from the field of implementation science may shed light on the complex factors affecting pharmacogenetic test use in real-world settings and areas to target to improve utilization. This paper presents an approach to studying the application of precision medicine that utilizes mixed qualitative and quantitative methods and implementation science frameworks to understand which factors or combinations consistently account for high versus low utilization of pharmocogenetic testing. This approach involves two phases: (1) collection of qualitative and quantitative data from providers-the cases-at four clinical institutions about their experiences with, and utilization of, pharmacogenetic testing to identify salient factors; and (2) analysis using a Configurational Comparative Method (CCM), using a mathematical algorithm to identify the minimally necessary and sufficient factors that distinguish providers who have higher utilization from those with low utilization. Advantages of this approach are that it can be used for small to moderate sample sizes, and it accounts for conditions found in real-world settings by demonstrating how they coincide to affect utilization.

Keywords: coincidence analysis; configurational comparative methods; health services research; implementation science; mixed methods; pharmacogenomics

Parental Guidance Suggested: Engaging Parents as Partners in Research Studies of Genomic Screening for a Pediatric Population

Sabrina N. Powell, Grace Byfield, Ashley Bennetone, Annabelle M. Frantz, Langston K. Harrison, Erin R. James-Crook, Heather Osborne, Thomas H. Owens, Jonathan L. Shaw, Julianne O’Daniel, and Laura V. Milko

Recent advances in genomic sequencing and genomic medicine are reshaping the landscape of clinical care. As a screening modality, genetic sequencing has the potential to dramatically expand the clinical utility of newborn screening (NBS), though significant barriers remain regarding ethical, legal, and social implications (ELSI) and technical and evidentiary challenges. Stakeholder-informed implementation research is poised to grapple with many of these barriers, and parents are crucial stakeholders in this process. We describe the formation and activities of a Community Research Board (CRB) composed of parents with diverse backgrounds assembled to participate in an ongoing research partnership with genomic and public health researchers at the University of North Carolina. The mission of the CRB is to provide insight into parental perspectives regarding the prospect of adding genomic sequencing to NBS and collaboratively develop strategies to ensure its equitable uptake. We describe how these contributions can improve the accessibility of research and recruitment methods and promote trust and inclusivity within diverse communities to maximize the societal benefit of population genomic screening in healthy children.

Read the full article in Frontiers in Genetics.

Keywords: genomic sequencing, newborn screening, community research board, engaging parents, stakeholders, public health, equity, accessibility

Effect of Pharmacogenomic Testing for Drug-Gene Interactions on Medication Selection and Remission of Symptoms in Major Depressive Disorder: The PRIME Care Randomized Clinical Trial

David W OslinKevin G LynchMei-Chiung Shih, Erin P IngramLaura O Wray, Sara R Chapman, Henry R KranzlerJoel Gelernter, Jeffrey M PyneAnnjanette StoneScott L DuVallLisa Soleymani LehmannMichael E ThasePRIME Care Research GroupMuhammad AslamSteven L BatkiJames M BjorkFrederic C BlowLisa A BrennerPeijun ChenShivan DesaiEric W DieperinkScott C Fears, Matthew A FullerCourtney S GoodmanDavid P Graham, Gretchen L HaasMark B Hamner, Amy W HelstromRobin A Hurley, Michael S IcardiGeorge J JurjusAmy M KilbourneJulie Kreyenbuhl, Daniel J LacheSteven P LieskeJulie A LynchLaurence J MeyerCristina MontalvoSumitra MuralidharMichael J OstacherGayla Y PaschallPaul N PfeifferSusana PrietoRonald M PrzygodzkiMohini RanganathanMercedes M Rodriguez-SuarezHannah RoggenkampSteven A SchichmanJohn S Schneeweis, Joseph A SimonettiStuart R SteinhauerTrisha SuppesMaria A UmbertJason L VassyDeepak VooraIlse R WiechersAmanda E Wood

A pragmatic implementation research study for In Our DNA SC: a protocol to identify multi-level factors that support the implementation of a population-wide genomic screening initiative in diverse populations

Caitlin G. Allen, Daniel P. Judge, Elissa Levin, Katherine Sterba, Kelly Hunt, Paula S. Ramos, Cathy Melvin, Karen Wager, Kenneth Catchpole, Catherine Clinton, Marvella Ford, Lori L. McMahon, and Leslie Lenert

DOI: 10.1186/s43058-022-00286-2

Lessons Learned from the Pilot Phase of a Population-Wide Genomic Screening Program: Building the Base to Reach a Diverse Cohort of 100,000 Participants

Caitlin G. Allen, Leslie Lenert, Kelly Hunt, Amy Jackson, Elissa Levin, Catherine Clinton, John T. Clark, Kelli Garrison, Sam Gallegos, Karen Wager, Wenjun He, Katherine Sterba, Paula S. Ramos, Cathy Melvin, Marvella Ford, Kenneth Catchpole, Lori McMahon, and Daniel P. Judge

DOI: 10.3390/jpm12081228

Implementing a Pragmatic Clinical Trial to Tailor Opioids for Acute Pain on behalf of the IGNITE ADOPT PGx Investigators

Larisa H CavallariEmily CicaliKristin Wiisanen, Roger B FillingimHrishikesh ChakrabortyRachel A MyersKathryn V BlakeBolanle AsiyanbolaJordan F BayeWesley H BronsonKelsey J CookErica N ElwoodChancellor F GrayYan Gong, Lindsay HinesJoseph KannryNatalie Kucher, Sheryl LynchKhoa A NguyenAniwaa Owusu ObengVictoria M Pratt, Hernan A PrietoMichelle RamosAzita Sadeghpour, Rajbir SinghMarc RosenmanPetr StarostikCameron D ThomasEmma TillmanPaul R Dexter, Carol R Horowitz, Lori A Orlando, Josh F PetersonTodd C SkaarSara L Van DriestSimona Volpi, Deepak VooraHari K ParvataneniJulie A JohnsonThe IGNITE Pragmatic Trials Network