ELSIcon2022 • Networking Session • Late-breaking Abstracts • June 2, 2022
Kurt D. Christensen, Catherine Hajek, Joel Van Heukelom, Madison Hickingbotham, Amanda Massmann, Emilie Zoltick, April Schultz
Background: Best practice recommendations for pharmacogenomic programs encourage implementation of clinical decision support (CDS) that informs health care providers about potential drug-gene interactions at the time of a medication order. CDS may be particularly important for preemptive applications, where testing may occur long before medication orders.
Methods: Sanford Health implemented CDS alerts that activate when providers order simvastatin for patients with poor or decreased SLCO1B1 drug transporter function. Alerts inform providers about potential drug-gene interactions, recommend removing simvastatin, and provide options for ordering alternatives. In 2018, the health system launched the Sanford Chip program, an elective service that provides preemptive pharmacogenomic testing, including <em>SLCO1B1</em> genotyping. We examined providers’ responses to simvastatin CDS alerts through September 2021.
Results: CDS alerts activated for 421 simvastatin orders. Providers replaced simvastatin with an alternative statin after 64 alerts (15%) and removed simvastatin without ordering an alternative after 71 others (17%). In response to 204 alerts (48%), simvastatin was fulfilled, but final dosing was in a safe range. For the remaining 82 alerts (19%), simvastatin orders were fulfilled at doses that raised risks for myopathy and rhabdomyolysis. Notably, providers proceeded with the original simvastatin order in only one of 16 orders (6%) that triggered CDS alerts when pharmacogenomic results were available prior to patients’ first simvastatin order.
Conclusion: Health care providers were highly responsive to pharmacogenomic CDS if it activated before a patient’s first order for the medication. Results highlight how pharmacogenomic information can have a powerful influence on medication orders when testing is preemptive.