Analyzing the impact of pharmacogenomics-guided nonsteroidal anti-inflammatory drug alerts in clinical practice.

Objectives: This study evaluates response rates of pharmacogenomics (PGx) nonsteroidal anti-inflammatory drugs (NSAIDs) clinical decision support (CDS) alerts at Sanford Health from May 2020 to December 2024.

Materials and methods: A retrospective analysis was conducted on PGx NSAIDs interruptive alerts. Response options were classified into five categories (1) continuation of triggering NSAID order, (2) dose modification, (3) alternative NSAID ordered without PGx implications, (4) alternative analgesic (ie, opioid) ordered, and (5) discontinuation of NSAID without alternative therapy.

Results: The study analyzed 2361 alert instances from 978 patients. The most common response was discontinuing NSAID without alternative therapy (43%). Dose modifications and orders for alternative analgesics comprised 2.57% and 14.67% of responses, respectively. The initial acceptance rate was 62.6%. Prior NSAID use significantly impacted override rates (60% vs 40%, P < .001). A 409-day breaking point was observed to affect alert acceptance rates, with the highest acceptance in NSAID naïve patients (96.1%).

Discussion: PGx NSAIDs CDS alert acceptance rates were higher compared to general CDS acceptance rates. This study highlights opportunities for continuous improvement including optimizing alert modality, modifying alert criteria to include look-back periods, and implementing genetically adapted ordersets.

Conclusion: The initial acceptance rate of PGx NSAIDs CDS alerts was 62.6%, however, with significantly higher acceptance rates in NSAID naïve patients (62.6% vs 96.1%, P < .001). Integration of CDS is vital to the successful implementation of PGx in clinical practice.