Prescriber Adoption of SLCO1B1 Genotype-Guided Simvastatin Clinical Decision Support in a Clinical Pharmacogenetics Program.
Prescriber Adoption of SLCO1B1 Genotype-Guided Simvastatin Clinical Decision Support in a Clinical Pharmacogenetics Program.
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处方者在临床药物遗传学计划中采用 SLCO1B1 基因型引导的辛伐他汀临床决策支持。
DOI：
10.1002/cpt.2773
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发表时间：
2023
影响因子：
6.7
通讯作者：
Bottinger,ErwinP
中科院分区：
文献类型：
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作者：
Obeng,AniwaaOwusu;Scott,StuartA;Kaszemacher,Tom;Ellis,StephenB;Mejia,Ana;Gomez,Alanna;Nadukuru,Rajiv;Abul-Husn,NouraS;Vega,Aida;Waite,Eva;Gottesman,Omri;Cho,Judy;Bottinger,ErwinP
药物遗传学的实施方案越来越可行，由于实施研究的临床指南的可用性。这些资源的利用已被报道与选定的药物基因对，但是，很少有人知道处方如何应对他汀类药物治疗的药物遗传学建议。我们前瞻性评估了处方者与床旁临床决策支持（CDS）的互动，以指导临床药物遗传学项目中入组的不同初级保健患者队列的辛伐他汀治疗。在1，639例预先基因分型的患者中，298例（18.2%）具有中等功能（IF）OATP 1B 1表型，25例（1.53%）具有低功能（PF）表型，预测SLCO 1B 1基因中常见的单核苷酸变异（c.521T>C; rs 4149056）。当通过电子健康记录为IF或PF患者开具辛伐他汀时，向临床医生提供CDS。重要的是，64.2%在床旁部署的CDS被处方医生接受，并导致处方变更。发现他汀类药物强度显著影响药物遗传学指导CDS的处方者采用，而患者性别或种族、处方者类型或药物遗传学培训状态对采用无显著影响。这项研究表明，初级保健提供者很容易采用药物遗传学信息，以指导他汀类药物治疗的大部分患者抢先基因型数据。
Pharmacogenetic implementation programs are increasingly feasible due to the availability of clinical guidelines for implementation research. The utilization of these resources has been reported with selected drug–gene pairs; however, little is known about how prescribers respond to pharmacogenetic recommendations for statin therapy. We prospectively assessed prescriber interaction with point‐of‐care clinical decision support (CDS) to guide simvastatin therapy for a diverse cohort of primary care patients enrolled in a clinical pharmacogenetics program. Of the 1,639 preemptively genotyped patients, 298 (18.2%) had an intermediate function (IF) OATP1B1 phenotype and 25 (1.53%) had a poor function (PF) phenotype, predicted by a common single nucleotide variant in theSLCO1B1gene (c.521T>C; rs4149056). Clinicians were presented with CDS when simvastatin was prescribed for patients with IF or PF through the electronic health record. Importantly, 64.2% of the CDS deployed at the point‐of‐care was accepted by the prescribers and resulted in prescription changes. Statin intensity was found to significantly influence prescriber adoption of the pharmacogenetic‐guided CDS, whereas patient gender or race, prescriber type, or pharmacogenetic training status did not significantly influence adoption. This study demonstrates that primary care providers readily adopt pharmacogenetic information to guide statin therapy for the majority of patients with preemptive genotype data.