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INTRODUCTION

LEARNING OBJECTIVES

  1. Describe the resources necessary to implement pharmacogenomics services into your practice successfully.

  2. Identify the key personnel needed for implementation of a pharmacogenomics service.

  3. Identify the technology needed for successful pharmacogenomics implementation and maintenance.

  4. Discuss the value of educational activities to support pharmacogenomics implementation efforts.

  5. Recognize potential challenges to implementation and summarize possible approaches to overcome them.

Creating and implementing a pharmacogenomics (PGx) program requires many considerations. Usually, a health system’s main goal is to use PGx information to help improve drug efficacy and/or to reduce side effects in their patient population. However, the motivation of health systems to implement PGx testing may stem from varied priorities. Because of this, the process of implementation will not be uniform across institutions. A framework for implementation is presented in this chapter (Figure 2-1), but each implementing institution will need to decide the order of processes that make sense and work for them. This chapter aims to (1) describe resources needed for those interested in implementing PGx services, (2) suggest key personnel likely needed for PGx implementation, (3) discuss the broad technology and informatics structure involved in PGx implementation, (4) discuss the value of educational activities for successful implementation, and (5) address challenges faced and strategies to overcome. This chapter expands upon the key concepts related to implementing PGx. Examples in various practice settings are highlighted throughout to provide important real-world considerations for the prospective implementers.

FIGURE 2-1

A potential pharmacogenomics service implementation process. Stakeholders and the implementation team select a service to implement and identify the required resources. The implementation team will work with stakeholders to develop the workflow and prepare for launch. The team will launch the service and periodically collect and monitor the quality of the service to further optimize it.

DESIGNING A SERVICE

While planning the details of a program, there are many factors to consider. Logistical factors include consideration of testing strategies, what testing platform will be utilized, where and how testing will be performed, and selection of drug–gene pairs that will benefit your patient population and have strong supporting evidence. Each of these factors will be discussed in detail throughout the chapter, but it is important to realize that each institution’s program may appear very different and the level of support desired around testing is a major factor that will shape the program. For example, does the institution wish to simply make it feasible for providers to order PGx tests, or are interpretation and/or consultation notes desired, or are face-to-face PGx results interpretation visits with the patient desired? The answers to these questions will help determine the workflow and personnel required for the PGx program to be successful.

Testing Approach

Deciding if a preemptive or reactive genotyping strategy will be used ...

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