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Multi-site investigation of strategies for the clinical implementation of CYP2D6 genotyping to guide drug prescribing
- Source :
- Genetics in medicine : official journal of the American College of Medical Genetics
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Purpose: A number of institutions have clinically implemented CYP2D6 genotyping to guide drug prescribing. We compared implementation strategies of early adopters of CYP2D6 testing, barriers faced by both early adopters and institutions in the process of implementing CYP2D6 testing, and approaches taken to overcome these barriers. Methods: We surveyed eight early adopters of CYP2D6 genotyping and eight institutions in the process of adoption. Data were collected on testing approaches, return of results procedures, applications of genotype results, challenges faced, and lessons learned. Results: Among early adopters, CYP2D6 testing was most commonly ordered to assist with opioid and antidepressant prescribing. Key differences among programs included test ordering and genotyping approaches, result reporting, and clinical decision support. However, all sites tested for copy number variation and 9 common variants, and reported results in the medical record. Most sites provided automatic consultation and had designated personnel to assist with genotype-informed therapy recommendations. Primary challenges were related to stakeholder support, CYP2D6 gene complexity, phenotype assignment, and sustainability. Conclusion: There are specific challenges unique to CYP2D6 testing given the complexity of the gene and its relevance to multiple medications. Consensus lessons learned may guide those interested in pursuing similar clinical pharmacogenetic programs.
- Subjects :
- 0301 basic medicine
Genotype
Process (engineering)
030105 genetics & heredity
Drug Prescriptions
digestive system
Clinical decision support system
Article
03 medical and health sciences
Early adopter
Humans
Relevance (information retrieval)
Genetic Testing
implementation
skin and connective tissue diseases
Genotyping
Genetics (clinical)
Medical education
CYP2D6
Medical record
Stakeholder
opioids
Decision Support Systems, Clinical
Pharmacogenomic Testing
3. Good health
Phenotype
030104 developmental biology
Cytochrome P-450 CYP2D6
Pharmacogenetics
antidepressants
Return of results
Psychology
Subjects
Details
- ISSN :
- 10983600
- Volume :
- 21
- Database :
- OpenAIRE
- Journal :
- Genetics in Medicine
- Accession number :
- edsair.doi.dedup.....f43d767d25d0ec39dc31cf9ad0bf907a
- Full Text :
- https://doi.org/10.1038/s41436-019-0484-3