Our goal was to summarize and compare implementation experiences of early adopters of CYP2C19 pharmacogenomic testing to guide antiplatelet medication selection. The study population included 12 large academic institutions within the IGNITE Network Pharmacogenetics Working Group (five funded institutions and seven affiliate members)1 (link) who have tested 6340 patients for CYP2C19 alleles (see Table S1 for a breakdown by site).
Data collection was completed at each site through a structured electronic spreadsheet disseminated to each site leader. Specific data elements were selected and definitions were refined through open discussions at several in-person meetings and conference calls from September 2016 to May 2017. The tool was then pilot-tested for feasibility prior to dissemination to all sites. Areas of focus included the baseline genetics testing landscape at each site, stakeholder involvement, the design of each implementation program, testing approaches, informatics setup, return of results procedures, and any education provided. Eight of the 12 sites also provided data on antiplatelet medication use after genotyping (1858 total patients). Data cleaning was accomplished iteratively through direct follow-up communications. All data elements collected were reported.
Program performance metrics including testing turnaround times, reported predicted phenotype frequencies, and drug prescribing patterns were also sought from local EHRs or research study data sources when available. All data abstraction and reporting was approved by local institutional review board at each site. Descriptive statistics were reported by institution and proportions of patients with specific test results prescribed alternative therapy were compared using chi square testing. Finally, common challenges that must be overcome and recommendations (lessons learned) for those considering similar implementations in the future were solicited from site investigators and aggregated to a consensus lists through multiple rounds of telephone conference call discussions.
Data collection was completed at each site through a structured electronic spreadsheet disseminated to each site leader. Specific data elements were selected and definitions were refined through open discussions at several in-person meetings and conference calls from September 2016 to May 2017. The tool was then pilot-tested for feasibility prior to dissemination to all sites. Areas of focus included the baseline genetics testing landscape at each site, stakeholder involvement, the design of each implementation program, testing approaches, informatics setup, return of results procedures, and any education provided. Eight of the 12 sites also provided data on antiplatelet medication use after genotyping (1858 total patients). Data cleaning was accomplished iteratively through direct follow-up communications. All data elements collected were reported.
Program performance metrics including testing turnaround times, reported predicted phenotype frequencies, and drug prescribing patterns were also sought from local EHRs or research study data sources when available. All data abstraction and reporting was approved by local institutional review board at each site. Descriptive statistics were reported by institution and proportions of patients with specific test results prescribed alternative therapy were compared using chi square testing. Finally, common challenges that must be overcome and recommendations (lessons learned) for those considering similar implementations in the future were solicited from site investigators and aggregated to a consensus lists through multiple rounds of telephone conference call discussions.
