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Pharmacogenomics. 2019 Oct;20(15):1103-1112. doi: 10.2217/pgs-2019-0053.

A stepwise approach to implementing pharmacogenetic testing in the primary care setting.

Author information

1
Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA.
2
Department of Pharmacy, Nemours/Alfred I DuPont Hospital for Children, Wilmington, DE 19803, USA.
3
The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
4
Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
5
Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
6
Department of Medicine & Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
7
National Human Genome Research Institute, Division of Genomic Medicine, Bethesda, MD 20892, USA.
8
Department of Medicine & Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
9
Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27708, USA.
10
Department of Health Policy & Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.

Abstract

Pharmacogenetic testing can help identify primary care patients at increased risk for medication toxicity, poor response or treatment failure and inform drug therapy. While testing availability is increasing, providers are unprepared to routinely use pharmacogenetic testing for clinical decision-making. Practice-based resources are needed to overcome implementation barriers for pharmacogenetic testing in primary care.The NHGRI's IGNITE I Network (Implementing GeNomics In pracTicE; www.ignite-genomics.org) explored practice models, challenges and implementation barriers for clinical pharmacogenomics. Based on these experiences, we present a stepwise approach pharmacogenetic testing in primary care: patient identification; pharmacogenetic test ordering; interpretation and application of test results, and patient education. We present clinical factors to consider, test-ordering processes and resources, and provide guidance to apply test results and counsel patients. Practice-based resources such as this stepwise approach to clinical decision-making are important resources to equip primary care providers to use pharmacogenetic testing.

KEYWORDS:

clinic; implementation; pharmacogenetics; pharmacogenomics; precision medicine; primary care

PMID:
31588877
PMCID:
PMC6854439
[Available on 2020-10-01]
DOI:
10.2217/pgs-2019-0053

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