Pharmacogenomics-Based Point-of-Care Clinical Decision Support Significantly Alters Drug Prescribing
Corresponding Author
PH O'Donnell
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA
Correspondence: PH O'Donnell ([email protected])Search for more papers by this authorN Wadhwa
Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorK Danahey
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Center for Research Informatics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorBA Borden
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorSM Lee
Department of Health Sciences, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorJP Hall
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorC Klammer
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorS Hussain
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorM Siegler
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA
MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorMJ Sorrentino
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorAM Davis
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorYA Sacro
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorR Nanda
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorTS Polonsky
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorJL Koyner
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorDL Burnet
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorK Lipstreuer
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorDT Rubin
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorC Mulcahy
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorME Strek
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorW Harper
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorAS Cifu
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorB Polite
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorL Patrick-Miller
Center for Clinical Cancer Genetics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorK-TJ Yeo
Department of Pathology, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorEKY Leung
Department of Pathology, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorSL Volchenboum
Center for Research Informatics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorRB Altman
Departments of Bioengineering, Genetics, and Medicine, Stanford University, Palo Alto, California, USA
Search for more papers by this authorOI Olopade
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorWM Stadler
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorDO Meltzer
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorMJ Ratain
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorCorresponding Author
PH O'Donnell
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA
Correspondence: PH O'Donnell ([email protected])Search for more papers by this authorN Wadhwa
Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorK Danahey
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Center for Research Informatics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorBA Borden
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorSM Lee
Department of Health Sciences, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorJP Hall
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorC Klammer
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorS Hussain
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorM Siegler
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA
MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorMJ Sorrentino
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorAM Davis
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorYA Sacro
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorR Nanda
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorTS Polonsky
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorJL Koyner
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorDL Burnet
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorK Lipstreuer
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorDT Rubin
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorC Mulcahy
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorME Strek
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorW Harper
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorAS Cifu
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorB Polite
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorL Patrick-Miller
Center for Clinical Cancer Genetics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorK-TJ Yeo
Department of Pathology, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorEKY Leung
Department of Pathology, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorSL Volchenboum
Center for Research Informatics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorRB Altman
Departments of Bioengineering, Genetics, and Medicine, Stanford University, Palo Alto, California, USA
Search for more papers by this authorOI Olopade
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorWM Stadler
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorDO Meltzer
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorMJ Ratain
Department of Medicine, University of Chicago, Chicago, Illinois, USA
Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA
Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA
Search for more papers by this authorAbstract
Changes in behavior are necessary to apply genomic discoveries to practice. We prospectively studied medication changes made by providers representing eight different medicine specialty clinics whose patients had submitted to preemptive pharmacogenomic genotyping. An institutional clinical decision support (CDS) system provided pharmacogenomic results using traffic light alerts: green = genomically favorable, yellow = genomic caution, red = high risk. The influence of pharmacogenomic alerts on prescribing behaviors was the primary endpoint. In all, 2,279 outpatient encounters were analyzed. Independent of other potential prescribing mediators, medications with high pharmacogenomic risk were changed significantly more often than prescription drugs lacking pharmacogenomic information (odds ratio (OR) = 26.2 (9.0–75.3), P < 0.0001). Medications with cautionary pharmacogenomic information were also changed more frequently (OR = 2.4 (1.7–3.5), P < 0.0001). No pharmacogenomically high-risk medications were prescribed during the entire study when physicians consulted the CDS tool. Pharmacogenomic information improved prescribing in patterns aimed at reducing patient risk, demonstrating that enhanced prescription decision-making is achievable through clinical integration of genomic medicine.
Supporting Information
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