PGY2 Oncology Pharmacy Resident Dartmouth Health Lebanon, New Hampshire, United States
Poster Abstract:
Background: The clinical application of pharmacogenomics includes utilizing pharmacogenetic information to predict responses to medications. Evaluation of patient-specific pharmacogenetic data is integral to toxicity management or prevention, optimizing therapeutic efficacy, and improving patient outcomes. Both the American Society of Health System Pharmacists (ASHP) and the American College of Clinical Pharmacy (ACCP) endorse the involvement of pharmacists in pharmacogenomic interventions. The Clinical Genomics and Advanced Technologies (CGAT) is a CAP CLIA laboratory in the department of Pathology and Laboratory Medicine which provides clinical genetic and genomic testing to the Dartmouth Health system. AUGMET is a flexible bioinformatics platform developed by Dr. Parth Shah. It has been deployed in the Dartmouth Secure Cloud, Dartmouth Health’s HIPPA compliant AWS environment. At Dartmouth Health, utilization of pharmacogenomic data by clinical oncology pharmacists will ultimately aid in optimizing patient treatment and further clinical practice.
Objectives: The purpose of this quality improvement project is to implement a pharmacist-driven pharmacogenomics dosing program at Dartmouth Health’s Cancer Center through the use of the data acquired through AUGMET. The primary objective of this program will be a composite of pharmacogenomic interventions made by the oncology pharmacist and number of interventions accepted by the provider. Additional outcomes will include evaluation of intervention types.
Methods: Implementation of the program will consist of a review of pharmacogenetic testing results. Pharmacogenetic testing will be conducted outside of this protocol, with results reported through the bioinformatics platform AUGMET. For the initial implementation of this program, pharmacist review will be conducted for patients who have genetic mutations pertaining to drugs affected by alterations in DPYD, TPMT, NUDT15, and UGT1A1. Inclusion characteristics include patients with pharmacogenetic testing results available for review. Pharmacogenomic data will be reviewed for potential drug interventions according to the FDA and CPIC guidelines, and any interventions identified will be recommended to the provider and documented through the use of a note in the EMR. The recommendation will be communicated to the provider in real-time via an EMR staff message for ambulatory patients, and during interdisciplinary rounds or an EMR Secure Chat as applicable for inpatients. The pharmacist reviewer will not be making any changes to the patient’s chart based off of identified interventions through the process of this review.
Results: Results pending, to be presented at the 2024 HOPA Conference.
Discussion/
Conclusion: Conclusion pending, to be presented at the 2024 HOPA Conference.
References (must also be included in final poster): 1. Haidar CE, Petry N, Oxencis C, Douglas JS, Hoffman JM. ASHP Statement on the Pharmacist's Role in Clinical Pharmacogenomics. Am J Health Syst Pharm. 2022;79(8):704-707. doi:10.1093/ajhp/zxab339 2. Hicks JK, Aquilante CL, Dunnenberger HM, et al. Precision Pharmacotherapy: Integrating Pharmacogenomics into Clinical Pharmacy Practice. J Am Coll Clin Pharm. 2019;2(3):303-313. doi:10.1002/jac5.1118 3. O'Shea J, Ledwidge M, Gallagher J, Keenan C, Ryan C. Pharmacogenetic interventions to improve outcomes in patients with multimorbidity or prescribed polypharmacy: a systematic review [published correction appears in Pharmacogenomics J. 2022 Mar 30]. Pharmacogenomics J. 2022;22(2):89-99. doi:10.1038/s41397-021-00260-6
