Impact of Automated Best Practice Advisories on Provider Response to CYP2C19 Genotyping Results for Patients on Clopidogrel.
Natasha J PetryBreanna CurtisErica FeldhegeShahjahan KhanDavid D LeedahlJesse L BreidenbachLindsay HinesPublished in: Journal of pharmacy practice (2021)
ObjectiveThe study objective was to examine provider acceptance and genotyping responses to a best practice advisory (BPA) concerning clopidogrel and CYP2C19 intermediate and poor metabolizers within the context of a new pharmacogenomics program at a Midwestern health system. Other secondary objectives analyzed included appropriate BPA firing, the distribution of alleles in study population, indications for clopidogrel use, and impact of indication on therapy change. Methods: In this study, the progress of this program was assessed by quantifying how providers respond to BPAs generated in the electronic medical record (EMR), in the context of a single representative gene-drug-outcome relationship. Patient data was pulled via reports yielding patients with genotyped information in the EMR and cross-referenced with a report evaluating BPA firing occurrences. Results: By capturing antiplatelet therapy changes in response to CYP2C19 genotyping results, 37 patients were found that had 73 BPAs fire. Nine of those patients had alternative antiplatelet therapy ordered. Of these, 6 alternative antiplatelet therapies were ordered from the BPA. Conclusion: Providers utilized BPAs, but responded differently based on individual knowledge of genotypes and indications. Information obtained from this study can be used for provider education and as reference for future design and wording of BPAs.
Keyphrases
- antiplatelet therapy
- acute coronary syndrome
- end stage renal disease
- percutaneous coronary intervention
- primary care
- ejection fraction
- chronic kidney disease
- newly diagnosed
- healthcare
- quality improvement
- genome wide
- prognostic factors
- emergency department
- machine learning
- gene expression
- stem cells
- dna methylation
- deep learning
- case report
- social media
- single cell
- copy number
- big data
- smoking cessation
- genome wide analysis