Pharmacogenomic (PGx) testing allows healthcare providers to make more informed, evidence-based decisions for their patients. To take advantage of this new clinical tool, we’ve recently seen several large healthcare organizations launch their own PGx testing programs. But even with the latest PGx tech in place, many of these new programs have failed to gain traction.
Organizations are finding that simply building a new PGx program and dropping it into the laps of their healthcare providers isn’t enough to prompt patient engagement. Instead, you’ll need to strike a balance between the technology, practical implementation, and provider and patient education. Here’s how you can avoid the most common pitfalls and launch a sustainable PGx program that engages your patients.
Why Do So Many PGx Testing Programs Struggle?
In recent years, consumers have ordered over 26 million genetic tests. But when it comes to PGx testing, there seems to be a complete disconnect between consumer demand and the healthcare industry’s ability to meet that demand.
Why do so many PGx programs miss the mark?
Inertia, plain and simple
Change is never easy, especially for larger organizations. Instituting a new PGx program from scratch presents a long list of logistical hurdles such as selecting an appropriate testing platform, building institutional support, and creating an optimal workflow between patients, testing laboratory, and healthcare providers.
Another significant hurdle is reimbursement. With the risk of an unexpected and burdensome medical bill, doctors won’t be willing to prescribe PGx tests and patients will be less likely to participate in a new testing program. For more insight into reimbursement, check out our webinar exploring the issue from the viewpoint of the payer.
In a perfect world, all physicians and pharmacists would be able to stay on top of the latest drug-gene interaction discoveries. But in reality, many healthcare providers simply don’t know how to use the information that PGx testing provides.
Key Ingredients for Launching a Successful PGx Program
Now that you know what you’re up against, here’s what you can do to make sure your PGx program hits the mark.
1. Identify and recruit key influencers
It’s critical to find influential organizational leaders who understand the utility of PGx testing. These influencers can help you win administrative and institutional support for your program.
2. Establish continuing education programs for healthcare providers
To run a successful PGx program, you need to get all of your healthcare providers up to speed so they understand the benefits of PGx testing for their specialties—Provider understanding and test result utilization is key, so engage a physician champion to work alongside clinicians who order the test early in the process and follow up with continuing education programs. Be ready and willing to incorporate user feedback along the way to build the best possible program.
The Mayo Clinic has had success with a point-of-care educational tool that allows doctors to easily access the latest PGx developments while consulting with patients.
3. Implement patient-directed PGx testing
Patient-directed programs focus on educating and empowering the patients to seek testing from their healthcare providers.
This delivery model has several advantages. First, it helps spark the PGx testing conversation between patients and doctors. Second, with patients coming to the clinic and requesting PGx testing, doctors will be motivated to stay up to date and educated. Provider involvement is essential to help address patient concerns about privacy and discrimination. Lastly, it removes the reimbursement issue—informed patients won’t be caught off guard by a surprise bill. If you’re looking to start a PGx program that engages your patients, we’d love to talk you.
4. Design your PGx testing program with your existing patient population in mind
Patient populations can vary from region to region. It’s important to consider the unique healthcare needs of your population when designing a new PGx testing program.
One way to do this is by targeting integrated delivery networks (IDNs). IDNs offer access to a large integrated pool of healthcare sites, providers, and patients. They have a keen understanding of the healthcare and prescription medication needs of their local population such as cardiovascular, psychiatry, pain management and geriatrics. Sanford Health is an example of one IDN that has leveraged its healthcare network to successfully implement a PGx program.
5. Partner with third-party vendors for scalable IT
Implementing a new PGx program requires a hefty amount of technical expertise. Many organizations limit themselves by relying on their in-house IT. Partnering with a third-party vendor allows your organization to easily bypass common hurdles and maintain a scalable and up-to-date PGx program.
Program Pitfalls to Avoid
Those are the ingredients that will make your PGx program stand out, but what should you avoid?
1. Overloading doctors with too much information
We talked about the importance of education for providers, but too much education can be just as detrimental. Don’t overload doctors with every nitty-gritty detail about PGx science. Give them only the distilled information they need to make decisions for their patients. If you’d like to make more detailed PGx information available, consider integrating it into existing clinical workflows and facilitating partnerships with pharmacists who can answer clinicians inquiries.
2. Including predicted drug-gene interactions with little clinical evidence
When choosing which drug-gene interactions to include, stick with interactions that have the most robust clinical evidence. Avoid using “black box” algorithmically predicted interactions. These interactions are theoretical and aren’t based on peer-reviewed, clinical evidence. Once you’ve chosen the highest evidence gene-pairs, make sure your healthcare providers know how to choose the most meaningful tests for their patients—
It’s best to partner with interpretation services who stay abreast of scientific developments in the PGx field.
3. Choosing the wrong population
Make sure you’re picking a clinical area and patient cohorts that could clearly benefit from PGx testing. If your patient population isn’t a good target for any PGx-affected drugs, you’ll have a hard time gaining traction with a new PGx program. Consider instituting pre-emptive PGx testing to identify patients that could benefit. Consider putting in place a protocol for measuring the utility and cost effectiveness of implemented programs.
Designing a successful PGx program is far from simple. You’ll need institutional support, a strong logistical framework, and an informed team of healthcare providers. But with these key ingredients, you can create a thriving PGx program that enriches the care of your patients.