Implementation and evaluation of pharmacogenomics alerts for high-risk drug-gene interactions in a community pharmacy practice setting.
TL;DR
PGx alerts in the medication dispensing module provide an additional safeguard for precision medicine, enabling pharmacists to make targeted interventions and provide patient education.
Abstract
Background
Integration of pharmacogenomics (PGx) into clinical care has primarily occurred within academic medical centers. Clinical decision support (CDS) is vital to the incorporation of PGx into clinical care, however, efforts have not capitalized on the integration within community pharmacy settings.
Objective
To describe the implementation efforts for community pharmacy CDS alerts and assess effectiveness.
Methods
A retrospective manual chart review was conducted to evaluate the effectiveness of deploying PGx alerts across 14 community pharmacies within a single health system. A report was created to capture all PGx CDS alerts generated during the eight-month study period (October 2024-May 2025). Alerts were categorized as actionable when documentation was sparse for medication adjustments based on PGx results from the prescribing clinician upon transmission of the prescription to the community pharmacy.
Results
A total of 74 alerts were generated, of which 36 were unique alerts. Thirty-eight alerts were excluded as duplicates when the pharmacist re-entered the dispensing function. Clinicians adjusted 17 chemotherapy prescriptions prior to order transmission. Additionally, five alerts for chemotherapy medications were considered not actionable as the patient had previously tolerated therapy. The remaining 13 alerts comprised of 11 for clopidogrel and 2 for tramadol. Pharmacists intervened in 8 of the 11 clopidogrel orders which resulted in 3 medication modifications. The overall alert acceptance was 23%.
Conclusion
This study describes one of the first institutions to deploy PGx alerts through the community pharmacy module across a health system's electronic health record. PGx alerts in the medication dispensing module provide an additional safeguard for precision medicine, enabling pharmacists to make targeted interventions and provide patient education. Continuous evaluation of PGx alerts affords opportunities for alert refinement and further optimizing patient care.