Implementing preemptive, multigene, pharmacogenomic testing in the inpatient setting: Preliminary results from a small, rural facility

Abstract

AbstractIntroductionPreemptive pharmacogenomic (PGx) testing is on the rise among United States health care centers, with the majority of testing performed in the primary care setting. For broader implementation, there is a call for descriptions of the implementation and workflow of successful PGx programs in a large variety of health care settings.ObjectiveThe purpose of this study was to describe the implementation and initial outcomes of preemptive PGx (11‐gene, multipanel) testing in inpatient workflow at a Veterans Affairs medical center.MethodsThe inpatient clinical pharmacist incorporated patient screening, informed consent, and PGx lab ordering into their daily workflow in March 2023. Included adult patients had to be enrolled into the facility's primary care program and able to provide informed consent. Patients were excluded if they had a history of bone marrow or liver transplant, were consulted for palliative or hospice care, or had altered mental status at the time of screening. A retrospective chart review was used to collect demographics and PGx results from March to August 2023.ResultsThere were 247 patients screened for PGx testing in the 6‐month study period. Of these, 74 already had PGx performed, 31 declined or deferred testing, and 142 consented to testing. Laboratory blood draw was not performed as ordered on 12 patients, leaving 130 samples with results. Of 130 patients, 129 (99%) had an actionable PGx variant, with most having multiple variants: one variant (6%), two variants (15%), three variants (32%), four variants (24%), five variants (18%), and six variants (3%). At the time of follow‐up, 64 (49%) patients were prescribed an affected medication: one medication (38%), two medications (8%), and three medications (3%).ConclusionIncorporating preemptive PGx testing into inpatient workflow is feasible in a rural facility with a significant proportion of patients being affected by the results.