title: Implementation of inpatient models of pharmacogenetics programs.
abstract: OBJECTIVE
  The operational elements essential for establishing an inpatient pharmacogenetic service are reviewed, and the role of the pharmacist in the provision of genotype-guided drug therapy in pharmacogenetics programs at three institutions is highlighted.
  
  
  CONCLUSIONS
  Pharmacists are well positioned to assume important roles in facilitating the clinical use of genetic information to optimize drug therapy given their expertise in clinical pharmacology and therapeutics. Pharmacists have assumed important roles in implementing inpatient pharmacogenetics programs. This includes programs designed to incorporate genetic test results to optimize antiplatelet drug selection after percutaneous coronary intervention and personalize warfarin dosing. Pharmacist involvement occurs on many levels, including championing and leading pharmacogenetics implementation efforts, establishing clinical processes to support genotype-guided therapy, assisting the clinical staff with interpreting genetic test results and applying them to prescribing decisions, and educating other healthcare providers and patients on genomic medicine. The three inpatient pharmacogenetics programs described use reactive versus preemptive genotyping, the most feasible approach under the current third-party payment structure. All three sites also follow Clinical Pharmacogenetics Implementation Consortium guidelines for drug therapy recommendations based on genetic test results.
  
  
  CONCLUSIONS
  With the clinical emergence of pharmacogenetics into the inpatient setting, it is important that pharmacists caring for hospitalized patients are well prepared to serve as experts in interpreting and applying genetic test results to guide drug therapy decisions. Since genetic test results may not be available until after patient discharge, pharmacists practicing in the ambulatory care setting should also be prepared to assist with genotype-guided drug therapy as part of transitions in care.
authors.affiliation: Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, FL. lcavallari@cop.ufl.edu.
authors.forename: Larisa H
authors.initials: LH
authors.lastname: Cavallari
authors.affiliation: Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC.|Center for Pharmacogenomics and Individualized Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Lee
authors.affiliation: Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL.|Personalized Medicine Program, University of Illinois Hospital and Health Science System, Chicago, IL.
authors.forename: Julio D
authors.initials: JD
authors.lastname: Duarte
authors.affiliation: Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL.|Personalized Medicine Program, University of Illinois Hospital and Health Science System, Chicago, IL.
authors.forename: Edith A
authors.initials: EA
authors.lastname: Nutescu
authors.affiliation: Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, FL.
authors.forename: Kristin W
authors.initials: KW
authors.lastname: Weitzel
authors.affiliation: Division of Cardiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: George A
authors.initials: GA
authors.lastname: Stouffer
authors.affiliation: Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, FL.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Johnson
mesh_terms: D005838:Genotype; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D010348:Patient Care Team / Q000639:trends; D010597:Pharmacogenetics / Q000379:methods / Q000639:trends*; D010607:Pharmacy Service, Hospital / Q000379:methods / Q000639:trends*; D024382:Professional Role; D016730:Program Development / Q000379:methods
keywords: clopidogrel; genotype; inpatient; pharmacists; pharmacogenetics; warfarin