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Implementation of a pharmacist-led pharmacogenomics service for the Program of All-Inclusive Care for the Elderly (PHARM-GENOME-PACE)

Published:March 05, 2018DOI:https://doi.org/10.1016/j.japh.2018.02.011

      Abstract

      Objectives

      To determine the feasibility of implementing a pharmacist-led pharmacogenomics (PGx) service for the Program of All-Inclusive Care for the Elderly (PACE).

      Setting

      A national centralized pharmacy providing PGx services to community-based PACE centers.

      Practice description

      Individuals 55 years of age and older enrolled in PACE who underwent PGx testing as part of their medical care (n = 296).

      Practice innovation

      Pharmacist-led PGx testing, interpreting, and consulting.

      Evaluation

      Implementation processes and roles were ascertained by reviewing policies and procedures for the PGx service and documented observations made by pharmacists providing the service. Genetic variants and drug-gene interactions (DGIs) were determined by interpretations of PGx test results. Types of recommendations provided by pharmacists were ascertained from PGx consultations. Prescribers' acceptance of recommendations were ascertained by documented responses or drug changes made after PGx consultations.

      Results

      Challenges to implementation included lack of systems interoperability, limited access to medical electronic health records, determining prescribers' responses, and knowledge and competency gaps in PGx. Pharmacist roles most essential to overcoming challenges were interpreting and applying PGx data, determining how to disseminate those data to prescribers, advocating for appropriate PGx testing, and educating about the application of test results to clinical practice. Participants frequently used drugs posing DGI risks, with the majority (73.6%) reporting more than 1 interaction. The overwhelming majority (89.0%) of pharmacists' recommendations to mitigate risks were accepted by referring prescribers.

      Conclusion

      Implementing a pharmacist-led PGx service for PACE is feasible. Implementation of this service highlights the leadership role of pharmacists in moving PGx from research to practice.
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      Biography

      Kevin T. Bain, MPH, PharmD, Vice President of Medication Risk Mitigation, Department of Research and Development, Tabula Rasa HealthCare, Moorestown, NJ; Department of Pharmacy, University of the Sciences, Philadelphia, PA

      Biography

      Emily J. Schwartz, PharmD, Research Pharmacist, Department of Research and Development, Tabula Rasa HealthCare, Moorestown, NJ; Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL

      Biography

      Orsula V. Knowlton, MBA, PharmD, President, Tabula Rasa HealthCare, Moorestown, NJ

      Biography

      Calvin H. Knowlton, BPharm, MDiv, PhD, Chief Executive Officer, Tabula Rasa HealthCare, Moorestown, NJ

      Biography

      Jacques Turgeon, BPharm, PhD, Chief Scientific Officer, Department of Research and Development, Tabula Rasa HealthCare, Moorestown, NJ; Department of Pharmaceutics, University of Florida, Gainesville, FL