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Pharmacogenomics‐Based Point‐of‐Care Clinical Decision Support Significantly Alters Drug Prescribing
Author(s) -
O'Donnell PH,
Wadhwa N,
Danahey K,
Borden BA,
Lee SM,
Hall JP,
Klammer C,
Hussain S,
Siegler M,
Sorrentino MJ,
Davis AM,
Sacro YA,
Nanda R,
Polonsky TS,
Koyner JL,
Burnet DL,
Lipstreuer K,
Rubin DT,
Mulcahy C,
Strek ME,
Harper W,
Cifu AS,
Polite B,
PatrickMiller L,
Yeo KTJ,
Leung EKY,
Volchenboum SL,
Altman RB,
Olopade OI,
Stadler WM,
Meltzer DO,
Ratain MJ
Publication year - 2017
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt.709
Subject(s) - pharmacogenomics , medical prescription , medicine , clinical decision support system , personalized medicine , specialty , pharmacogenetics , intensive care medicine , odds , odds ratio , emergency medicine , decision support system , pharmacology , bioinformatics , family medicine , data mining , biochemistry , chemistry , logistic regression , biology , computer science , genotype , gene
Changes in behavior are necessary to apply genomic discoveries to practice. We prospectively studied medication changes made by providers representing eight different medicine specialty clinics whose patients had submitted to preemptive pharmacogenomic genotyping. An institutional clinical decision support (CDS) system provided pharmacogenomic results using traffic light alerts: green = genomically favorable, yellow = genomic caution, red = high risk. The influence of pharmacogenomic alerts on prescribing behaviors was the primary endpoint. In all, 2,279 outpatient encounters were analyzed. Independent of other potential prescribing mediators, medications with high pharmacogenomic risk were changed significantly more often than prescription drugs lacking pharmacogenomic information (odds ratio (OR) = 26.2 (9.0–75.3), P < 0.0001). Medications with cautionary pharmacogenomic information were also changed more frequently (OR = 2.4 (1.7–3.5), P < 0.0001). No pharmacogenomically high‐risk medications were prescribed during the entire study when physicians consulted the CDS tool. Pharmacogenomic information improved prescribing in patterns aimed at reducing patient risk, demonstrating that enhanced prescription decision‐making is achievable through clinical integration of genomic medicine.