Department of Veterans Affairs
Durham, NC
Variations in certain genes that encode proteins involved in medication metabolism, transport, targets, and immune response affect drug disposition and can lead to variation from the expected response to medication. Evidence supporting application of pharmacogenomics (PGx) data to optimize medication use continues to grow; however, utilization of this tool in practice has not kept pace with scientific advancement.1-3 There are substantial opportunities with the use of PGx to minimize adverse drug events (ADE) and PGx CPP specialists are the ideal professional to close system gaps that pose a barrier to large scale PGx implementation.
Eighty-five CPP who exclusively focus on PGx clinical practice were hired to accelerate the implementation of PGx across a large, integrated health care system caring for over 9 million patients. This workforce deployment initiative aimed to further enhance PGx testing capabilities by leveraging CPPs to foster the integration of PGx test results into clinical care for all patients and bridge provider knowledge gaps. PGx CPP specialists were empowered and positioned in leadership roles to function as change agents who provide PGx based patient care to all patients and diffuse PGx across the health system to providers of all disciplines. This enterprise-wide initiative included the establishment of supporting roles such as the PGx pharmacy technician (PGx CPhT).
Integration of PGx testing as part of routine care includes education, testing capabilities, metrics for tracking patients who may benefit from PGx, and the ability to provide test result interpretation that is specific to each patient. Ninety-three percent (n=154) of the health system facilities have implemented or are in the process of implementing PGx testing capabilities versus only 27% (n=45) at baseline. Eighty-one percent of facilities enterprise-wide have PGx CPP specialist coverage. The remaining 19% of sites are centrally covered through telehealth care by a PGx CPP specialist. Over 31,000 patients have been provided with PGx-based care. Total educational outreach includes over 9,600 visits documented with roughly 6,800 unique clinicians. PGx testing rates associated with implemented workflows were significantly higher in those regions and facilities with PGx CPP specialist coverage compared to those with none (i.e., fluoropyrimidines, clopidogrel, interventional psychiatry, and antidepressants in primary care). Over a two-month period, PGx population health management identified 193 high-priority drug-gene interactions, 94.8% of which were addressed in less than 14 days.
To the authors’ knowledge, this project is the largest integrated implementation of PGx CPP specialists to date and the only program that includes a novel advanced PGx CPhT role. This approach illustrates how innovative organizational models using pharmacists as force multipliers can enhance medication safety and deliver the transformative promise of personalized medicine to diverse populations within a large health system.
References
- Guchelaar HJ, van der Wouden CH, Manson LEN, Abdullah-Koolmees H, Blagec K, Blagus T, Böhringer S, Cecchin E, Cheung KC, Deneer VHM, Jonsson S, Joefield-Roka C, Just KS, Karlsson MO, Konta L, Koopmann R, Kriek M, Lehr T, Mitropoulou C, Rollinson V, Roncato R, Samwald M, Schaeffeler E, Skokou M, Schwab M, Steinberger D, Stingl JC, Tremmel R, Turner RM, van Rhenen MH, Dávila-Fajardo CL, Dolžan V, Patrinos GP, Pirmohamed M, Sunder-Plassmann G, Toffoli G, Swen JJ; Ubiquitous Pharmacogenomics Consortium. Pharmacogenetic Implementation Studies-Lessons Learned From the PREPARE Study. Clin Pharmacol Ther. 2025 Jun 24. doi: 10.1002/cpt.3749. Epub ahead of print. PMID: 40552566.
- Krebs, K., Milani, L. Translating pharmacogenomics into clinical decisions: do not let the perfect be the enemy of the good. Hum Genomics 13, 39 (2019).
- Dong OM, Roberts MC, Wu RR, et al. Evaluation of the Veterans Affairs Pharmacogenomic Testing for Veterans (PHASER) clinical program at initial test sites. Pharmacogenomics. Nov 2021;22(17):1121-1133. doi:10.2217/pgs-2021-0089
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