Establishing a patient-centered, multidisciplinary pharmacogenomics clinic in an academic health system: Successes, challenges, and future direction

Introduction: Pharmacogenomics (PGx) testing uses a patient's deoxyribonucleic acid (DNA) profile to tailor medications with the goal of preventing adverse drug reactions and improving pharmacotherapy outcomes. Despite the availability of evidence-based guidelines that assist with interpretation of PGx results, PGx testing has not been widely adopted. Objective: To describe how a multidisciplinary PGx clinic was implemented within the University of Pennsylvania Health System (Penn Medicine) including the clinical workflow, challenges to implementation, and future directions.Methods: This project qualified as Quality Improvement by the University of Penn-sylvania's Institutional Review Board and adheres to the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines. Clinic metrics were collected from February 2019 until December 2022. Data collected included patient demographics; the timing of PGx test ordering and appointments; number and frequency of actionable PGx phenotypes; number of current or historical medications impacted by PGx test results; and patient's out-of-pocket cost for PGx test.Results: Of the 69 patients included, the majority were female (58%), white (84%), with a mean age of 48 years. The overall time between the dates of the PGx test order and clinic visit was 37 days. The time between the dates of the PGx test order and the PGx test results were generated was 18 days. All patients had at least one actionable PGx phenotype and 74% had three or more. The most frequent actionable phenotypes were found in the cytochrome P450 PC19 (CYPC19) (60%) and CYP2D6 (58%) genes. The percentage of patients that had drug-gene interactions that affected their current medications and explained historical medication intolerances were 25% and 17%, respectively. Out-of-pocket costs were less than $300 for most patients who had a PGx test ordered by the clinic physician.Conclusion: This paper has established a sustainable PGx clinic workflow with dedi-cated personnel. In the future we intend to increase the availability of our services.