PATIENT-SPECIFIC PHARMACOGENOMIC RESULTS DELIVERED VIA A GENOMIC PRESCRIBING DECISION SUPPORT SYSTEM STRONGLY INFLUENCE PHYSICIAN MEDICATION DECISION-MAKING AND PRESCRIBING BEHAVIORS

Purpose: Genomic medicine tools, including pharmacogenomics, have the potential to enhance patient-centered care.  We hypothesized that introduction of an electronic decision-support system delivering preemptively-obtained, patient-specific pharmacogenomic results with accompanying prescribing recommendations would improve prescription decision-making and prescribing behaviors at our medical center.

Method: Physician-patient pairs were recruited from our outpatient clinics.  Patients submitted DNA samples for broad clinical pharmacogenomic testing.  Results were provided to physicians at outpatient visits via an electronic genomic prescribing decision-support system.  Patient and physician surveys were administered to examine attitudes and perceptions surrounding receipt of results and medication decisions.

Result: Over 980 patients seeing 16 different physicians have enrolled, and since October 2012, >800 unique outpatient clinic visits at which pharmacogenomic results were available were analyzed.  Physicians accessed patients’ pharmacogenomic results via the genomic delivery system at 84% of encounters.  In total, 221 different medication changes occurred during the evaluable visits, and importantly, physicians reported that 24% of all medication changes were influenced by the available pharmacogenomic results.  Patients taking current medications with cautionary or high-risk pharmacogenomic results had a 2.6 times higher odds of their physician changing the medication at their visit than patients with a favorable pharmacogenomic result.  When using the decision-support system during medication changes, 61% of the time physicians described pharmacogenomic information as enabling a more informed therapeutic decision; in 39% of these instances physicians said pharmacogenomic information helped to choose between multiple medication options; and for 28% of drug changes physicians said the information reduced the likelihood of an adverse reaction.  At 94% of visits after receiving pharmacogenomic decision support, physicians said they would be ‘very likely’ to enroll other patients in the program.  Physicians reported significant increase in their awareness about pharmacogenomic information compared to before availability of results (P=0.009).  Patients overwhelmingly reported that they believed genetics influence therapeutic decisions:  83% said they ‘agree strongly’ or ‘agree somewhat’ with the idea; and 91% said they believe their physician practices personalized medicine.

Conclusion: Physician-patient pairs in an institutional program examining the clinical impact of delivering pharmacogenomic results with decision-support report robust utilization and relevance to prescribing decision-making.  Dissemination to a greater number of physician-patient pairs to examine the impact of prescribing behavior changes on downstream outcomes like medication adherence, adverse events, and drug efficacies, is warranted.