Critical Care Pharmacy Specialist Veterans Health Care System of the Ozarks Fayetteville
Introduction: Preemptive pharmacogenetic (PGx) testing is on the rise among US healthcare centers with the majority of testing performed in the primary care setting. For broader implementation, there is a call for descriptions of implementation and workflow of successful PGx programs in a large variety of healthcare settings. Previous acute care PGx programs have been limited to trigger-based testing in the inpatient setting. The purpose of the present study was to describe the implementation and initial outcomes of preemptive PGx (11-gene, multi-panel) testing in acute care workflow at a single center.
Methods: The inpatient clinical pharmacist incorporated patient screening, informed consent, and PGx lab ordering into daily workflow in March 2023. Included adult patients had to be enrolled into the facility’s primary care program and able to provide informed consent. Patients were excluded if they had a history of bone marrow or liver transplant, were consulted for palliative or hospice care, or had altered mental status at the time of screening. A retrospective chart review was used to collect demographics and PGx results from March to July 2023.
Results: There were 180 patients screened for PGx testing in the 5-month study period. Of these, 47 already had PGx performed, 133 were counseled and offered testing, 25 declined or deferred testing. A total of 108 PGx labs were ordered, 7 were not drawn, leaving 101 patients with PGx results. Of 101 patients, 100 (99%) had an actionable PGx variant with most having multiple variants: 1 variant (8%), 2 variants (19%), 3 variants (28%), 4 variants (24%), 5 variants (17%), 6 variants (4%). At the time of follow up, 52 (51%) patients were prescribed an affected medication: 1 medication (34%), 2 medications (9%), 3 medications (4%).
Conclusions: Incorporating preemptive PGx testing into acute care workflow is feasible with a significant proportion of patients being affected by results.
