title: Pharmacogenomics-Based Point-of-Care Clinical Decision Support Significantly Alters Drug Prescribing.
abstract: Changes in behavior are necessary to apply genomic discoveries to practice. We prospectively studied medication changes made by providers representing eight different medicine specialty clinics whose patients had submitted to preemptive pharmacogenomic genotyping. An institutional clinical decision support (CDS) system provided pharmacogenomic results using traffic light alerts: green = genomically favorable, yellow = genomic caution, red = high risk. The influence of pharmacogenomic alerts on prescribing behaviors was the primary endpoint. In all, 2,279 outpatient encounters were analyzed. Independent of other potential prescribing mediators, medications with high pharmacogenomic risk were changed significantly more often than prescription drugs lacking pharmacogenomic information (odds ratio (OR) = 26.2 (9.0-75.3), P < 0.0001). Medications with cautionary pharmacogenomic information were also changed more frequently (OR = 2.4 (1.7-3.5), P < 0.0001). No pharmacogenomically high-risk medications were prescribed during the entire study when physicians consulted the CDS tool. Pharmacogenomic information improved prescribing in patterns aimed at reducing patient risk, demonstrating that enhanced prescription decision-making is achievable through clinical integration of genomic medicine.
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.|Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA.
authors.forename: P H
authors.initials: PH
authors.lastname: O'Donnell
authors.affiliation: Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.
authors.forename: N
authors.initials: N
authors.lastname: Wadhwa
authors.affiliation: Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.|Center for Research Informatics, University of Chicago, Chicago, Illinois, USA.
authors.forename: K
authors.initials: K
authors.lastname: Danahey
authors.affiliation: Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: B A
authors.initials: BA
authors.lastname: Borden
authors.affiliation: Department of Health Sciences, University of Chicago, Chicago, Illinois, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Lee
authors.affiliation: Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Hall
authors.affiliation: Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: C
authors.initials: C
authors.lastname: Klammer
authors.affiliation: Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: S
authors.initials: S
authors.lastname: Hussain
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.|Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA.|MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA.
authors.forename: M
authors.initials: M
authors.lastname: Siegler
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Sorrentino
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Davis
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: Y A
authors.initials: YA
authors.lastname: Sacro
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: R
authors.initials: R
authors.lastname: Nanda
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: T S
authors.initials: TS
authors.lastname: Polonsky
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Koyner
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Burnet
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: K
authors.initials: K
authors.lastname: Lipstreuer
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: D T
authors.initials: DT
authors.lastname: Rubin
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: C
authors.initials: C
authors.lastname: Mulcahy
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.|Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Strek
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: W
authors.initials: W
authors.lastname: Harper
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: A S
authors.initials: AS
authors.lastname: Cifu
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: B
authors.initials: B
authors.lastname: Polite
authors.affiliation: Center for Clinical Cancer Genetics, University of Chicago, Chicago, Illinois, USA.
authors.forename: L
authors.initials: L
authors.lastname: Patrick-Miller
authors.affiliation: Department of Pathology, University of Chicago, Chicago, Illinois, USA.
authors.forename: K-Tj
authors.initials: KT
authors.lastname: Yeo
authors.affiliation: Department of Pathology, University of Chicago, Chicago, Illinois, USA.
authors.forename: Eky
authors.initials: E
authors.lastname: Leung
authors.affiliation: Center for Research Informatics, University of Chicago, Chicago, Illinois, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Volchenboum
authors.affiliation: Departments of Bioengineering, Genetics, and Medicine, Stanford University, Palo Alto, California, USA.
authors.forename: R B
authors.initials: RB
authors.lastname: Altman
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.
authors.forename: O I
authors.initials: OI
authors.lastname: Olopade
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.
authors.forename: W M
authors.initials: WM
authors.lastname: Stadler
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois, USA.
authors.forename: D O
authors.initials: DO
authors.lastname: Meltzer
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.|Center for Personalized Therapeutics, University of Chicago, Chicago, Illinois, USA.|Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Ratain
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D020000:Decision Support Systems, Clinical / Q000592:standards*; D004348:Drug Labeling / Q000379:methods / Q000592:standards; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000592:standards*; D008875:Middle Aged; D010597:Pharmacogenetics / Q000379:methods / Q000592:standards*; D010819:Physician's Role; D019095:Point-of-Care Systems / Q000592:standards*; D011446:Prospective Studies; D055815:Young Adult