Pharmacogenomics-Based Point-of-Care Clinical Decision Support Significantly Alters Drug Prescribing

P H O'Donnell; N Wadhwa; K Danahey; B A Borden; S M Lee; J P Hall; C Klammer; S Hussain; M Siegler; M J Sorrentino; A M Davis; Y A Sacro; R Nanda; T S Polonsky; J L Koyner; D L Burnet; K Lipstreuer; D T Rubin; C Mulcahy; M E Strek; W Harper; A S Cifu; B Polite; L Patrick-Miller; K-Tj Yeo; Eky Leung; S L Volchenboum; R B Altman; O I Olopade; W M Stadler; D O Meltzer; M J Ratain

doi:10.1002/cpt.709

Pharmacogenomics-Based Point-of-Care Clinical Decision Support Significantly Alters Drug Prescribing

Clin Pharmacol Ther. 2017 Nov;102(5):859-869. doi: 10.1002/cpt.709. Epub 2017 Jun 15.

Authors

P H O'Donnell^{1

2

3}, N Wadhwa⁴, K Danahey^{2

5}, B A Borden², S M Lee⁶, J P Hall², C Klammer², S Hussain², M Siegler^{1

2

3

7}, M J Sorrentino^{1

2}, A M Davis^{1

2}, Y A Sacro^{1

2}, R Nanda^{1

2}, T S Polonsky^{1

2}, J L Koyner^{1

2}, D L Burnet^{1

2}, K Lipstreuer^{1

2}, D T Rubin^{1

2}, C Mulcahy^{1

2}, M E Strek^{1

2

3}, W Harper^{1

2}, A S Cifu^{1

2}, B Polite^{1

2}, L Patrick-Miller⁸, K-Tj Yeo⁹, Eky Leung⁹, S L Volchenboum⁵, R B Altman¹⁰, O I Olopade¹, W M Stadler^{1

2}, D O Meltzer^{1

11}, M J Ratain^{1

2

3}

Affiliations

¹ Department of Medicine, University of Chicago, Chicago, Illinois, USA.
² Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
³ Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA.
⁴ Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.
⁵ Center for Research Informatics, University of Chicago, Chicago, Illinois, USA.
⁶ Department of Health Sciences, University of Chicago, Chicago, Illinois, USA.
⁷ MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA.
⁸ Center for Clinical Cancer Genetics, University of Chicago, Chicago, Illinois, USA.
⁹ Department of Pathology, University of Chicago, Chicago, Illinois, USA.
¹⁰ Departments of Bioengineering, Genetics, and Medicine, Stanford University, Palo Alto, California, USA.
¹¹ Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois, USA.

PMID: 28398598
PMCID: PMC5636653
DOI: 10.1002/cpt.709

Abstract

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.

MeSH terms

Adult
Aged
Aged, 80 and over
Cohort Studies
Decision Support Systems, Clinical / standards*
Drug Labeling / methods
Drug Labeling / standards
Drug Prescriptions / standards*
Female
Humans
Male
Medical Order Entry Systems / standards*
Middle Aged
Pharmacogenetics / methods
Pharmacogenetics / standards*
Physician's Role*
Point-of-Care Systems / standards*
Prospective Studies
Young Adult

Abstract

MeSH terms

Grants and funding