Practical Aspects of Clinical Implementation

What is the highest level of PharmGKB evidence?

1A

Any difference between the sequence of two individuals' genome or a reference genome is... (2)

A variant or A SNP

What are the FOUR pre-implementation steps?

Align with the goals and priorities of stakeholder Select PGx testing method, model and return of patient results within the EKR system Prioritize patient population Educate providers, clinicians

Which of the following statements is true about PGx implementation and key personnel? A) PGx implementation can only be done preemptively to optimize patient care B) All gene-drug pairs should be implemented to capture all potential interventions C) Any clinician can be identified as the champion for the implementation process D) The only key personnel required for implementation are a geneticist, a genetic counselor, and a pharmacist

C) Any clinician can be identified as the champion for the implementation process

Which of the following are considered barriers to the wide adoption of PGx implementation? A) Lack of guidance on PGx B) Lack of evidence C) Lack of clinician knowledge and confidence D) Logistics related to integration within EHRs E) Reimbursement

C) Lack of clinician knowledge and confidence D) Logistics related to integration within EHRs E) Reimbursement

What is the MOST important aspect of a sustainable implementation?

DOCUMENTING the clinical outcomes of PGx testing

What are challenges to reactive testing? (2)

Delay in turn around time May lose opportunity to make changes

What is the best way to handle PGx data in electronic health records (EHRs)?

Discreet data

What steps are critical PRIOR to implementation of PGx? A) Obtaining the approval of the state pharmacy board B) Obtaining stakeholder buy-in C) Deciding which clinical area to focus E) B and C

E) B and C

How can pharmacists be involved in the implementation of PGx? (3)

Educate providers/patients Review and present the evidence Help in prioritizing implementation areas

What are the benefits to preemptive testing? (3)

Efficient May be cost effective/saving Decreased test burden

Which of the following is considered a current barrier to wide adoption of PGx implementation? A) Lack of guidance on pharmacogenetic guided prescribing B) Lack of literature support C) Lack of clinician knowledge on how to order and what to do with the information D) Logistics related to integration within the electronic health record E) Reimbursement of pharmacogenetics testing F) 3, 4 and 5

F) 3, 4 and 5

T or F: Only large academic centers implement Pgx testing.

FALSE - St. E does!! *Must outsource testing

Groups of DNA variation that tend to be inherited as a set are...

Haplotypes

What are some ways to overcome Pgx implementation barriers? (5)

Having physician champion(s) that are interested in genetic-guided prescribing Educate providers and clinicians Integrate the genetic information within the EHR Effective clinician decision support Generate clinical and economic outcomes to support coverage

What is the MOST important aspect of implementation of PGx?

Integrating PGx into EHRs

What are the cited barriers of PGx implementation? (4)

Lack of provider/clinician knowledge PGx evidence and guidance Integration within the clinical workflow and EHR Insurance coverage

What is reactive PGx testing?

Order the PGx test at the time of prescribing

Carla is a 60-year old Caucasian female. She came for a well visit and check-up. Work-up reveals signs and symptoms of depression, for which she may benefit from antidepressant treatment. You will assess if she will benefit from PGx testing. What information would you want to collect? (6)

Patient's past response to antidepressants Family's past response to antidepressants Current medication used Adverse events Lab values Clinical risk factors

Which database specifically house the star allele designation system and include information on core SNPs?

PharmVar

What is preemptive PGx testing?

Testing before the medication is prescribed