HCI 3 Genomics

Lock in

A priori adjustment

before treatment initiated

a posterioiri adjustment

after treatment began

What is precision medicine?

Uses genetic, clinical, environmental, lifetyle, and other patient-specific info to better target disease

Is personalized medicine the same as precision medicine?

not necessarily

T/F: Precision medicine can identify groups of patients with shared characteristics snf PGx is used to support this

True

T/F: There is a common standard of utulity of genetic results in pharmacy

False, varies across practices

T/F: PGx testing has demonstrated cost savings across all clinical contexts

False, cost savings are context-dependent.

4 factros that influence PGx clinical utility

• drug-gene pairs and their relevance

• timing of testing

• population characteristics

• practice setting

Take-home message about population characteristics:

Higher prevelance of actionable variants in a population enhances the impact and cost-effectiveness of pharmacogenetic testing

What is pre-emptive testing

prior to start of a med

What is point-of-care testing

ordered at the time of prescribing a medication

what is reactive testing

testing after inadequate response or side effects

In the words of Hassan, personal medicine is how you operationalize on the factors of precision medicine

yes

Benefits of pre-emptive

real-time clinical decision support, avoids delays

Benefits of reactive testing

more targeted, avoids unnecessary tests

What is anticipatory/ near-treatment testing?

testing perfomed because a treatment decision is EXPECTED soon (treatment decision = side effect/ improper response)

Examples shown multiple times as specialties that use PGx:

cardio, psychiatry, oncology

Focus of PGx in hospital/ acute-care setting

timely med selection, efficacy, prevention of adverse outcomes

Implementation considerations of hospital/ acute care

• rapid turnaround times

• integration with EHR

• clear ownership of testing and follow-up

• operational outcomes

focus of PGx in ambulatory/ community

long-term med optimization, tolerability, adherence, chronic disease management

Implementation considerations in ambulatory/ community

• LONGITUDINAL FOLLOW-UP

• access to complete med and clinical history

• communication across pharmacists and prescribers

• test cost and reimbursement

Key stakeholders in PGx Implementation

• health-system leadership

• clinical teams

• lab

• IT/ Clinical informatics

• patients

Key decisions to make for implementation

• clinical use case

• testing infrastructure

• clinical integration

Pros and cons of external lab

• may have longer turnaround times depending on the assay and workflow

• EHR integration may require development of interfaces

• institutional security/ validity

Pros/ cons of in-house lab

• faster turnaround

• may facilitate integration of structured results into EHR

• requires appropriate lab infrastructure