Joel Van Heukelom Pharm.D., MBA, Max Weaver M.S., Carson Max B.S., Jordan F. Baye Pharm.D., M.A., Ashley Peterson AAS, Andrii Maryniak M.D., Tomsaz P. Stys M.D., Amanda Massmann Pharm.D.
{"title":"早期评估心脏手术区域内的新型警报，以促进基因型指导下的抗血小板治疗","authors":"Joel Van Heukelom Pharm.D., MBA, Max Weaver M.S., Carson Max B.S., Jordan F. Baye Pharm.D., M.A., Ashley Peterson AAS, Andrii Maryniak M.D., Tomsaz P. Stys M.D., Amanda Massmann Pharm.D.","doi":"10.1002/jac5.1956","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>Clopidogrel remains widely utilized in patients undergoing percutaneous coronary intervention despite compelling evidence that genetic variation impacts patient response to clopidogrel. Clinical decision support (CDS) is frequently used to aid in precision medicine; however, limitations within the electronic medical record can hinder reliable CDS. Procedural areas where standard order entry is not utilized create a barrier to CDS implementation.</p>\n </section>\n \n <section>\n \n <h3> Objectives</h3>\n \n <p>We aimed to evaluate the implementation of a novel alerting mechanism on genotype-guided antiplatelet prescribing within the cardiac catheterization laboratory procedural setting.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A retrospective cohort study was conducted to assess the rate of antiplatelet ordering in patients with one or two loss-of-function cytochrome P450 2C19 (<i>CYP2C19</i>) alleles before and after alert implementation. Pharmacogenomic congruence was measured before and after the alert via chart abstraction that included the <i>CYP2C19</i> genotype and antiplatelet medications ordered within that encounter.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 236 patients were included in analyses, 127 encounters within the cohort before alert implementation and 136 encounters in the cohort after alert implementation. Prior to alert implementation, 40.9% (<i>n</i> = 127) were prescribed clopidogrel compared with 25.7% (<i>n</i> = 136) post implementation. After implementing a genotype-guided alert within the cardiac catheterization laboratory procedural setting, providers were 2.22 times more likely to prescribe an alternative antiplatelet (<i>p</i> = 0.024). Clopidogrel-naïve patients were 9.75 times more likely to receive a genotype-guided antiplatelet order following alert implementation (<i>p</i> < 0.05).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Providers were responsive to a novel alert within the cardiac catheterization laboratory procedural setting. Genotype-guided antiplatelet prescribing significantly increased following the alert implementation.</p>\n </section>\n </div>","PeriodicalId":73966,"journal":{"name":"Journal of the American College of Clinical Pharmacy : JACCP","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Early evaluation of a novel alert within cardiac procedural areas to facilitate genotype-guided antiplatelet therapy\",\"authors\":\"Joel Van Heukelom Pharm.D., MBA, Max Weaver M.S., Carson Max B.S., Jordan F. Baye Pharm.D., M.A., Ashley Peterson AAS, Andrii Maryniak M.D., Tomsaz P. Stys M.D., Amanda Massmann Pharm.D.\",\"doi\":\"10.1002/jac5.1956\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>Clopidogrel remains widely utilized in patients undergoing percutaneous coronary intervention despite compelling evidence that genetic variation impacts patient response to clopidogrel. Clinical decision support (CDS) is frequently used to aid in precision medicine; however, limitations within the electronic medical record can hinder reliable CDS. Procedural areas where standard order entry is not utilized create a barrier to CDS implementation.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Objectives</h3>\\n \\n <p>We aimed to evaluate the implementation of a novel alerting mechanism on genotype-guided antiplatelet prescribing within the cardiac catheterization laboratory procedural setting.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>A retrospective cohort study was conducted to assess the rate of antiplatelet ordering in patients with one or two loss-of-function cytochrome P450 2C19 (<i>CYP2C19</i>) alleles before and after alert implementation. Pharmacogenomic congruence was measured before and after the alert via chart abstraction that included the <i>CYP2C19</i> genotype and antiplatelet medications ordered within that encounter.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>A total of 236 patients were included in analyses, 127 encounters within the cohort before alert implementation and 136 encounters in the cohort after alert implementation. Prior to alert implementation, 40.9% (<i>n</i> = 127) were prescribed clopidogrel compared with 25.7% (<i>n</i> = 136) post implementation. After implementing a genotype-guided alert within the cardiac catheterization laboratory procedural setting, providers were 2.22 times more likely to prescribe an alternative antiplatelet (<i>p</i> = 0.024). Clopidogrel-naïve patients were 9.75 times more likely to receive a genotype-guided antiplatelet order following alert implementation (<i>p</i> < 0.05).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Providers were responsive to a novel alert within the cardiac catheterization laboratory procedural setting. Genotype-guided antiplatelet prescribing significantly increased following the alert implementation.</p>\\n </section>\\n </div>\",\"PeriodicalId\":73966,\"journal\":{\"name\":\"Journal of the American College of Clinical Pharmacy : JACCP\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2024-05-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American College of Clinical Pharmacy : JACCP\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/jac5.1956\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American College of Clinical Pharmacy : JACCP","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jac5.1956","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
Early evaluation of a novel alert within cardiac procedural areas to facilitate genotype-guided antiplatelet therapy
Introduction
Clopidogrel remains widely utilized in patients undergoing percutaneous coronary intervention despite compelling evidence that genetic variation impacts patient response to clopidogrel. Clinical decision support (CDS) is frequently used to aid in precision medicine; however, limitations within the electronic medical record can hinder reliable CDS. Procedural areas where standard order entry is not utilized create a barrier to CDS implementation.
Objectives
We aimed to evaluate the implementation of a novel alerting mechanism on genotype-guided antiplatelet prescribing within the cardiac catheterization laboratory procedural setting.
Methods
A retrospective cohort study was conducted to assess the rate of antiplatelet ordering in patients with one or two loss-of-function cytochrome P450 2C19 (CYP2C19) alleles before and after alert implementation. Pharmacogenomic congruence was measured before and after the alert via chart abstraction that included the CYP2C19 genotype and antiplatelet medications ordered within that encounter.
Results
A total of 236 patients were included in analyses, 127 encounters within the cohort before alert implementation and 136 encounters in the cohort after alert implementation. Prior to alert implementation, 40.9% (n = 127) were prescribed clopidogrel compared with 25.7% (n = 136) post implementation. After implementing a genotype-guided alert within the cardiac catheterization laboratory procedural setting, providers were 2.22 times more likely to prescribe an alternative antiplatelet (p = 0.024). Clopidogrel-naïve patients were 9.75 times more likely to receive a genotype-guided antiplatelet order following alert implementation (p < 0.05).
Conclusion
Providers were responsive to a novel alert within the cardiac catheterization laboratory procedural setting. Genotype-guided antiplatelet prescribing significantly increased following the alert implementation.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
