title: Implementation of a multidisciplinary pharmacogenomics clinic in a community health system.
abstract: OBJECTIVE
  The development and implementation of a multidisciplinary pharmacogenomics clinic within the framework of an established community-based medical genetics program are described.
  
  
  CONCLUSIONS
  Pharmacogenomics is an important component of precision medicine that holds considerable promise for pharmacotherapy optimization. As part of the development of a health system-wide integrated pharmacogenomics program, in early 2015 Northshore University Health-System established a pharmacogenomics clinic run by a multidisciplinary team including a medical geneticist, a pharmacist, a nurse practitioner, and genetic counselors. The team identified five key program elements: (1) a billable-service provider, (2) a process for documentation of relevant medication and family histories, (3) personnel with the knowledge required to interpret pharmacogenomic results, (4) personnel to discuss risks, benefits, and limitations of pharmacogenomic testing, and (5) a mechanism for reporting results. The most important program component is expert interpretation of genetic test results to provide clinically useful information; pharmacists are well positioned to provide that expertise. At the Northshore University HealthSystem pharmacogenomics clinic, patient encounters typically entail two one-hour visits and follow a standardized workflow. At the first visit, pharmacogenomics-focused medication and family histories are obtained, risks and benefits of genetic testing are explained, and a test sample is collected; at the second visit, test results are provided along with evidence-based pharmacotherapy recommendations.
  
  
  CONCLUSIONS
  A multidisciplinary clinic providing genotyping and related services can facilitate the integration of pharmacogenomics into clinical care and meet the needs of early adopters of precision medicine.
authors.affiliation: Center for Molecular Medicine, NorthShore University HealthSystem, Evanston, IL. mdunnenberger@northshore.org.
authors.forename: Henry M
authors.initials: HM
authors.lastname: Dunnenberger
authors.affiliation: Thrombosis and Anticoagulation Unit, NorthShore University HealthSystem, Glenview, IL.
authors.forename: Matthew
authors.initials: M
authors.lastname: Biszewski
authors.affiliation: Personalized Medicine, Mission Health, Asheville, NC.
authors.forename: Gillian C
authors.initials: GC
authors.lastname: Bell
authors.affiliation: Center for Molecular Medicine, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Annette
authors.initials: A
authors.lastname: Sereika
authors.affiliation: Center for Medical Genetics, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Holley
authors.initials: H
authors.lastname: May
authors.affiliation: Kaiser Permanente Colorado, Aurora, CO.
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Johnson
authors.affiliation: Center for Medical Genetics, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hulick
authors.affiliation: Center for Molecular Medicine, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Janardan
authors.initials: J
authors.lastname: Khandekar
mesh_terms: D018672:Community Health Planning / Q000379:methods / Q000639:trends*; D003157:Community Pharmacy Services / Q000639:trends*; D005820:Genetic Testing / Q000379:methods / Q000639:trends; D006801:Humans; D010348:Patient Care Team / Q000639:trends*; D010597:Pharmacogenetics / Q000379:methods / Q000639:trends*; D057285:Precision Medicine / Q000379:methods / Q000639:trends; D024382:Professional Role
keywords: clinical implementation; comprehensive medication management; medication therapy management; pharmacogenetics; pharmacogenomics; precision medicine