Pharmacogenetic Testing Implementation in a Rural Pediatric Psychiatric Hospital

Authors' Names

Tianna Leitch, University of Montana, MissoulaFollow
Shayna Killam, University of Montana, Missoula
Kirk Katseanes, University of Montana, Missoula
Karen Brown, University of Montana, Missoula
Corbin Schwanke, Shodair Children's Hospital and Medical Genetics Facility
Abdallah Elias, Shodair Children’s Hospital and Medical Genetics Facility
Susan Trinidad, University of Washington, Seattle

Presentation Type

Poster Presentation

Category

STEM (science, technology, engineering, mathematics)

Abstract/Artist Statement

Pharmacogenomics is the study of how patients’ genes may affect their response to certain medications. Pharmacogenetic testing enables clinical providers to individualize patient therapies and improve outcomes in clinical settings. Successful implementation strategies for pharmacogenetic testing, however, have been limited to major academic medical centers and large health care systems. By contrast, rural, community-based health systems, common in a state like Montana, have been slow to implement these advancements, threatening to exacerbate existing healthcare disparities. In the field of psychiatry, the effective management of patient medications is of the upmost concern, and pharmacogenetic testing may help clinicians to guide and individualize drug therapy. Shodair Children’s Hospital, the only facility in Montana that provides inpatient and outpatient pediatric psychiatric services, is interested in partnering with the University of Montana Precision Medicine Project to develop a pharmacogenetic testing program utilizing telehealth consultation services and virtual access. In order to create an implementation model that can ensure equitable access to pharmacogenetics for patients living throughout Montana, our research team conducted a qualitative analysis to determine facilitators and barriers at Shodair Hospital for a pharmacogenetic testing implementation effort.

We conducted semi-structured interviews (n = 21) with key stakeholders (e,g, providers, staff, and administrators) at Shodair to identify barriers and facilitators for pharmacogenetic implementation. Interviews were analyzed for common themes using a qualitative analysis software program. Researchers then independently reviewed transcripts, developed a codebook, and extensively revised and evaluated common themes among participants.

Shodair participants perceived pharmacogenetic testing as a potentially beneficial clinical decision-making tool given the unique medication management challenges facing practitioners in pediatric psychiatry. Participants had clear goals and expectations for a pharmacogenetic implementation effort and common needs included education and resources for both providers and patients, protocols for ordering and utilizing the services, as well as a focus on pre-emptive testing in outpatient facilities. Several practitioners identified pharmacists as the primary champions for integration of pharmacogenetic testing into treatment decisions and cited access to pharmacogenetic experts at the University of Montana as a key factor in effective implementation. Overall, Shodair participants were enthusiastic regarding the utility of pharmacist-lead telehealth consultations and resources provided through a centralized service at the University of Montana. Participants described the opportunity to serve as a leader in pharmacogenetic implementation in rural settings as a positive outcome for patients across the state, and felt it aligned with the mission of the institution.

The themes generated from these interviews will provide a framework for implementing a pharmacogenetics delivery model for additional early adopter sites throughout the state of Montana, as well as identifying innovative solutions to ensure access to advancements like pharmacogenetics and precision medicine for patients living in rural communities. This project provided critical insight into the range of potential barriers to a clinical implementation effort, and opportunities for the further expansion of pharmacogenetic testing and precision medicine services across the state of Montana.

Mentor Name

Erica Woodahl

Personal Statement

We are fortunate to be living in a time where healthcare is progressively changing and improving due to an increased focus on patient outcomes and advanced research. There have been several projects pushing for a more preventative, yet personalized approaches to disease management. Our work is centered around the idea that medicine can be precise and tailored to the individual patient, rather than falling into a “one size fits all” approach to treatment. This type of custom care is referred to as precision medicine, and our work focuses more specifically on pharmacogenomics. Pharmacogenomics is the study of how an individual’s genes can determine and potentially impact the way they respond to specific medications. Pharmacogenetic testing, a tool of precision medicine, is the process of looking for changes or variations in a person’s genetic information that can be utilized to predict the therapeutic response, potential side effects, or efficacy of a drug therapy for that individual. While precision medicine and the field of pharmacogenetics possess great promise for the future of preventative medicine, this cutting-edge technology has only been studied and put to practice in large, urban health systems or academic research hospitals. We believe that rural, under-served patients should be provided with the same quality care that an individual living in a larger city would receive, including access to cutting edge advancements in precision medicine. Our research, built upon collaboration with Montana health systems like Shodair Children’s Hospital, will work to determine the best ways to implement pharmacogenetic testing and provide resources for precision medicine efforts. However, there are many unique barriers to this implementation effort in the rural, geographically isolated healthcare centers across the state of Montana. It is our goal is to successfully establish a centralized pharmacogenetic testing program that will provide access to pharmacogenetic testing, interpretation of the results, and serve as a resource for pharmacogenetic expertise for clinicians and patients across Montana, at the University of Montana Skaggs School of Pharmacy. This centralized resource for clinicians across the state will utilize telehealth consultation services to provide rural patients and their physicians with counseling, recommendations, and result interpretation from trained pharmacogenetic specialists through a telehealth model. Our hope is that this work could then provide a framework for other rural states or communities to implement similar programs at their respective facilities. It is our hope that in collaboration with Shodair Children’s Hospital, we will be able to identify key barriers and facilitators for a pharmacogenetic testing implementation effort utilizing a telehealth delivery model. As students in pharmacy school, the opportunity to develop these clinical implementation strategies and gain insight into how changes can be carried out withing health systems across our state has been invaluable as future clinicians. Throughout the last year, we have witnessed the incredible adaptability of our healthcare system in the face of adversity. We look forward to a future in which we can continue to merge clinical expertise with cutting-edge technologies and implement research like pharmacogenetics with innovative telemedicine delivery systems in order to best serve patients across our great state – no matter their location or access to specialized services.