Lessons from clinical implementation of a preemptive pharmacogenetic panel as part of a testing pilot program with an employer-sponsored medical plan

Madeline Norris; Rachel Dalton; Benish Alam; Elizabeth Eddy; Khoa A Nguyen; Larisa H Cavallari; Jill Sumfest; Kristin Wiisanen; Emily J Cicali

doi:10.3389/fgene.2023.1249003

Lessons from clinical implementation of a preemptive pharmacogenetic panel as part of a testing pilot program with an employer-sponsored medical plan

Front Genet. 2023 Aug 23:14:1249003. doi: 10.3389/fgene.2023.1249003. eCollection 2023.

Authors

Madeline Norris¹, Rachel Dalton¹, Benish Alam¹, Elizabeth Eddy¹, Khoa A Nguyen^{1

2}, Larisa H Cavallari^{1

2}, Jill Sumfest³, Kristin Wiisanen^{1

2}, Emily J Cicali^{1

2}

Affiliations

¹ Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, United States.
² Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, United States.
³ GatorCare Health Management Corporation, University of Florida Health, Gainesville, FL, United States.

Abstract

Introduction: This manuscript reports on a pilot program focused on implementing pharmacogenetic testing within the framework of an employer-sponsored medical plan at University of Florida (UF) Health. The aim was to understand the challenges associated with program implementation and to gather insights into patient attitudes towards PGx testing. Methods: The pilot program adopted a partially preemptive approach, targeting patients on current prescriptions for medications with relevant gene-drug associations. Patients were contacted via phone or through the MyChart system and offered pharmacogenetic testing with no additional direct costs. Results: Of 244 eligible patients, 110 agreed to participate. However, only 61 returned the mailed DNA collection kits. Among these, 89% had at least one potentially actionable genotype-based phenotype. Post-test follow-up revealed that while the majority viewed the process positively, 71% preferred a consultation with a pharmacogenetic specialist for better understanding of their results. Barriers to implementation ranged from fatigue with the healthcare system to a lack of understanding of the pharmacogenetic testing and concerns about privacy and potential misuse of genetic data. Conclusion: The findings underscore the need for clearer patient education on pharmacogenetic results and suggest the importance of the role of pharmacogenetic-trained pharmacists in delivering this education. They also highlight issues with relying on incomplete or inaccurate medication lists in patients' electronic health record. The implementation revealed less obvious challenges, the understanding of which could be beneficial for the success of future preemptive pharmacogenetic implementation programs. The insights from the pilot program served to bridge the information gap between patients, providers, and pharmacogenetic -specialists, with the ultimate goal of improving patient care.

Keywords: implementation; patient perspective; pharmacogenetic panel; pharmacogenomics; precision medicine; preemptive testing.

Grants and funding

This project is part of the University of Florida’s “Creating the Healthiest Generation” Moonshot initiative, which is supported by the UF Office of the Provost, UF Office of Research, UF Health, UF College of Medicine, and UF Clinical and Translational Science Institute, and is also supported in part by the NIH National Center for Advancing Translational Sciences under award number UL1 TR001427.