Emerging roles for pharmacists in clinical implementation of pharmacogenomics. 2014

Aniwaa Owusu-Obeng, and Kristin W Weitzel, and Randy C Hatton, and Benjamin J Staley, and Jennifer Ashton, and Rhonda M Cooper-Dehoff, and Julie A Johnson
The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Pharmacy Department, The Mount Sinai Hospital, New York, New York; Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.

Pharmacists are uniquely qualified to play essential roles in the clinical implementation of pharmacogenomics. However, specific responsibilities and resources needed for these roles have not been defined. We describe roles for pharmacists that emerged in the clinical implementation of genotype-guided clopidogrel therapy in the University of Florida Health Personalized Medicine Program, summarize preliminary program results, and discuss education, training, and resources needed to support such programs. Planning for University of Florida Health Personalized Medicine Program began in summer 2011 under leadership of a pharmacist, with clinical launch in June 2012 of a clopidogrel-CYP2C19 pilot project aimed at tailoring antiplatelet therapies for patients undergoing percutaneous coronary intervention and stent placement. More than 1000 patients were genotyped in the pilot project in year 1. Essential pharmacist roles and responsibilities that developed and/or emerged required expertise in pharmacy informatics (development of clinical decision support in the electronic medical record), medication safety, medication-use policies and processes, development of group and individual educational strategies, literature analysis, drug information, database management, patient care in targeted areas, logistical issues in genetic testing and follow-up, research and ethical issues, and clinical precepting. In the first 2 years of the program (1 year planning and 1 year postimplementation), a total of 14 different pharmacists were directly and indirectly involved, with effort levels ranging from a few hours per month, to 25-30% effort for the director and associate director, to nearly full-time for residents. Clinical pharmacists are well positioned to implement clinical pharmacogenomics programs, with expertise in pharmacokinetics, pharmacogenomics, informatics, and patient care. Education, training, and practice-based resources are needed to support these roles and to facilitate the development of financially sustainable pharmacist-led clinical pharmacogenomics practice models.

UI MeSH Term Description Entries
D010593 Pharmaceutical Services Total pharmaceutical services provided by qualified PHARMACISTS. In addition to the preparation and distribution of medical products, they may include consultative services provided to agencies and institutions which do not have a qualified pharmacist. Pharmaceutic Services,Pharmaceutical Care,Pharmacy Services,Services, Pharmaceutic,Services, Pharmaceutical,Services, Pharmacy,Care, Pharmaceutical,Pharmaceutic Service,Pharmaceutical Service,Pharmacy Service,Service, Pharmaceutic,Service, Pharmaceutical,Service, Pharmacy
D010595 Pharmacists Those persons legally qualified by education and training to engage in the practice of pharmacy. Clinical Pharmacists,Community Pharmacists,Retail Pharmacists,Clinical Pharmacist,Community Pharmacist,Pharmacist,Pharmacist, Clinical,Pharmacist, Community,Pharmacist, Retail,Pharmacists, Clinical,Pharmacists, Community,Pharmacists, Retail,Retail Pharmacist
D010597 Pharmacogenetics A branch of genetics which deals with the genetic variability in individual responses to drugs and drug metabolism (BIOTRANSFORMATION). Pharmacogenomics
D005791 Patient Care The services rendered by members of the health profession and non-professionals under their supervision. Informal care,Care, Patient,Informal cares,care, Informal,cares, Informal
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D019317 Evidence-Based Medicine An approach of practicing medicine with the goal to improve and evaluate patient care. It requires the judicious integration of best research evidence with the patient's values to make decisions about medical care. This method is to help physicians make proper diagnosis, devise best testing plan, choose best treatment and methods of disease prevention, as well as develop guidelines for large groups of patients with the same disease. (from JAMA 296 (9), 2006) Medicine, Evidence-Based,Evidence Based Medicine,Medicine, Evidence Based
D024382 Professional Role The expected function of a member of a particular profession. Professional Roles,Role, Professional,Roles, Professional

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