title: Introducing pharmacogenetic testing with clinical decision support into primary care: a feasibility study.
abstract: BACKGROUND
  Inappropriate prescribing increases patient illness and death owing to adverse drug events. The inclusion of genetic information into primary care medication practices is one solution. Our aim was to assess the ability to obtain and genotype saliva samples and to determine the levels of use of a decision support tool that creates medication options adjusted for patient characteristics, drug-drug interactions and pharmacogenetics.
  
  
  METHODS
  We conducted a cohort study in 6 primary care settings (5 family practices and 1 pharmacy), enrolling 191 adults with at least 1 of 10 common diseases. Saliva samples were obtained in the physician's office or pharmacy and sent to our laboratory, where DNA was extracted and genotyped and reports were generated. The reports were sent directly to the family physician/pharmacist and linked to an evidence-based prescribing decision support system. The primary outcome was ability to obtain and genotype samples. The secondary outcomes were yield and purity of DNA samples, ability to link results to decision support software and use of the decision support software.
  
  
  RESULTS
  Genotyping resulted in linking of 189 patients (99%) with pharmacogenetic reports to the decision support program. A total of 96.8% of samples had at least 1 actionable genotype for medications included in the decision support system. The medication support system was used by the physicians and pharmacists 236 times over 3 months.
  
  
  CONCLUSIONS
  Physicians and pharmacists can collect saliva samples of sufficient quantity and quality for DNA extraction, purification and genotyping. A clinical decision support system with integrated data from pharmacogenetic tests may enable personalized prescribing within primary care.Trial registration:ClinicalTrials.gov, NCT02383290.
authors.affiliation: Department of Family Practice (M. Dawes); GenXys Health Care Systems (M. Dawes, Aloise, Ang, Cullis, D. Dawes, Fraser, Liknaitzky, Stanley, Suarez-Gonzalez, Katzov-Eckert); Personalized Medicine Initiative (Cullis, Fraser); Department of Physical Therapy (D. Dawes); Faculty of Pharmaceutical Sciences (Paterson); Clinicare Pharmacists Inc. (Paterson); Department of Botany (Suarez-Gonzalez); Department of Biochemistry and Molecular Biology (Cullis), University of British Columbia, Vancouver, BC.
authors.forename: Martin
authors.initials: M
authors.lastname: Dawes
authors.affiliation: Department of Family Practice (M. Dawes); GenXys Health Care Systems (M. Dawes, Aloise, Ang, Cullis, D. Dawes, Fraser, Liknaitzky, Stanley, Suarez-Gonzalez, Katzov-Eckert); Personalized Medicine Initiative (Cullis, Fraser); Department of Physical Therapy (D. Dawes); Faculty of Pharmaceutical Sciences (Paterson); Clinicare Pharmacists Inc. (Paterson); Department of Botany (Suarez-Gonzalez); Department of Biochemistry and Molecular Biology (Cullis), University of British Columbia, Vancouver, BC.
authors.forename: Martin N
authors.initials: MN
authors.lastname: Aloise
authors.affiliation: Department of Family Practice (M. Dawes); GenXys Health Care Systems (M. Dawes, Aloise, Ang, Cullis, D. Dawes, Fraser, Liknaitzky, Stanley, Suarez-Gonzalez, Katzov-Eckert); Personalized Medicine Initiative (Cullis, Fraser); Department of Physical Therapy (D. Dawes); Faculty of Pharmaceutical Sciences (Paterson); Clinicare Pharmacists Inc. (Paterson); Department of Botany (Suarez-Gonzalez); Department of Biochemistry and Molecular Biology (Cullis), University of British Columbia, Vancouver, BC.
authors.forename: J Sidney
authors.initials: JS
authors.lastname: Ang
authors.affiliation: Department of Family Practice (M. Dawes); GenXys Health Care Systems (M. Dawes, Aloise, Ang, Cullis, D. Dawes, Fraser, Liknaitzky, Stanley, Suarez-Gonzalez, Katzov-Eckert); Personalized Medicine Initiative (Cullis, Fraser); Department of Physical Therapy (D. Dawes); Faculty of Pharmaceutical Sciences (Paterson); Clinicare Pharmacists Inc. (Paterson); Department of Botany (Suarez-Gonzalez); Department of Biochemistry and Molecular Biology (Cullis), University of British Columbia, Vancouver, BC.
authors.forename: Pieter
authors.initials: P
authors.lastname: Cullis
authors.affiliation: Department of Family Practice (M. Dawes); GenXys Health Care Systems (M. Dawes, Aloise, Ang, Cullis, D. Dawes, Fraser, Liknaitzky, Stanley, Suarez-Gonzalez, Katzov-Eckert); Personalized Medicine Initiative (Cullis, Fraser); Department of Physical Therapy (D. Dawes); Faculty of Pharmaceutical Sciences (Paterson); Clinicare Pharmacists Inc. (Paterson); Department of Botany (Suarez-Gonzalez); Department of Biochemistry and Molecular Biology (Cullis), University of British Columbia, Vancouver, BC.
authors.forename: Diana
authors.initials: D
authors.lastname: Dawes
authors.affiliation: Department of Family Practice (M. Dawes); GenXys Health Care Systems (M. Dawes, Aloise, Ang, Cullis, D. Dawes, Fraser, Liknaitzky, Stanley, Suarez-Gonzalez, Katzov-Eckert); Personalized Medicine Initiative (Cullis, Fraser); Department of Physical Therapy (D. Dawes); Faculty of Pharmaceutical Sciences (Paterson); Clinicare Pharmacists Inc. (Paterson); Department of Botany (Suarez-Gonzalez); Department of Biochemistry and Molecular Biology (Cullis), University of British Columbia, Vancouver, BC.
authors.forename: Robert
authors.initials: R
authors.lastname: Fraser
authors.affiliation: Department of Family Practice (M. Dawes); GenXys Health Care Systems (M. Dawes, Aloise, Ang, Cullis, D. Dawes, Fraser, Liknaitzky, Stanley, Suarez-Gonzalez, Katzov-Eckert); Personalized Medicine Initiative (Cullis, Fraser); Department of Physical Therapy (D. Dawes); Faculty of Pharmaceutical Sciences (Paterson); Clinicare Pharmacists Inc. (Paterson); Department of Botany (Suarez-Gonzalez); Department of Biochemistry and Molecular Biology (Cullis), University of British Columbia, Vancouver, BC.
authors.forename: Gideon
authors.initials: G
authors.lastname: Liknaitzky
authors.affiliation: Department of Family Practice (M. Dawes); GenXys Health Care Systems (M. Dawes, Aloise, Ang, Cullis, D. Dawes, Fraser, Liknaitzky, Stanley, Suarez-Gonzalez, Katzov-Eckert); Personalized Medicine Initiative (Cullis, Fraser); Department of Physical Therapy (D. Dawes); Faculty of Pharmaceutical Sciences (Paterson); Clinicare Pharmacists Inc. (Paterson); Department of Botany (Suarez-Gonzalez); Department of Biochemistry and Molecular Biology (Cullis), University of British Columbia, Vancouver, BC.
authors.forename: Andrea
authors.initials: A
authors.lastname: Paterson
authors.affiliation: Department of Family Practice (M. Dawes); GenXys Health Care Systems (M. Dawes, Aloise, Ang, Cullis, D. Dawes, Fraser, Liknaitzky, Stanley, Suarez-Gonzalez, Katzov-Eckert); Personalized Medicine Initiative (Cullis, Fraser); Department of Physical Therapy (D. Dawes); Faculty of Pharmaceutical Sciences (Paterson); Clinicare Pharmacists Inc. (Paterson); Department of Botany (Suarez-Gonzalez); Department of Biochemistry and Molecular Biology (Cullis), University of British Columbia, Vancouver, BC.
authors.forename: Paul
authors.initials: P
authors.lastname: Stanley
authors.affiliation: Department of Family Practice (M. Dawes); GenXys Health Care Systems (M. Dawes, Aloise, Ang, Cullis, D. Dawes, Fraser, Liknaitzky, Stanley, Suarez-Gonzalez, Katzov-Eckert); Personalized Medicine Initiative (Cullis, Fraser); Department of Physical Therapy (D. Dawes); Faculty of Pharmaceutical Sciences (Paterson); Clinicare Pharmacists Inc. (Paterson); Department of Botany (Suarez-Gonzalez); Department of Biochemistry and Molecular Biology (Cullis), University of British Columbia, Vancouver, BC.
authors.forename: Adriana
authors.initials: A
authors.lastname: Suarez-Gonzalez
authors.affiliation: Department of Family Practice (M. Dawes); GenXys Health Care Systems (M. Dawes, Aloise, Ang, Cullis, D. Dawes, Fraser, Liknaitzky, Stanley, Suarez-Gonzalez, Katzov-Eckert); Personalized Medicine Initiative (Cullis, Fraser); Department of Physical Therapy (D. Dawes); Faculty of Pharmaceutical Sciences (Paterson); Clinicare Pharmacists Inc. (Paterson); Department of Botany (Suarez-Gonzalez); Department of Biochemistry and Molecular Biology (Cullis), University of British Columbia, Vancouver, BC.
authors.forename: Hagit
authors.initials: H
authors.lastname: Katzov-Eckert