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Reflect in writing/ Ask speakers regarding new and emerging roles and responsibilities of pharmacists and how they may be incorporated into their practice.
Pharmacists are uniquely qualified to play essential roles in the clinical implementation of pharmacogenomics. However, specific responsibilities and resources needed for these roles have not been defined. We describe roles for pharmacists that emerged in the clinical implementation of genotype-guided clopidogrel therapy in the University of Florida Health Personalized Medicine Program, summarize preliminary program results, and discuss education, training, and resources needed to support such programs. Planning for University of Florida Health Personalized Medicine Program began in summer 2011 under leadership of a pharmacist, with clinical launch in June 2012 of a clopidogrel-CYP2C19 pilot project aimed at tailoring antiplatelet therapies for patients undergoing percutaneous coronary intervention and stent placement. More than 1000 patients were genotyped in the pilot project in year 1. Essential pharmacist roles and responsibilities that developed and/or emerged required expertise in pharmacy informatics (development of clinical decision support in the electronic medical record), medication safety, medication-use policies and processes, development of group and individual educational strategies, literature analysis, drug information, database management, patient care in targeted areas, logistical issues in genetic testing and follow-up, research and ethical issues, and clinical precepting. In the first 2 years of the program (1 year planning and 1 year postimplementation), a total of 14 different pharmacists were directly and indirectly involved, with effort levels ranging from a few hours per month, to 25–30% effort for the director and associate director, to nearly full-time for residents. Clinical pharmacists are well positioned to implement clinical pharmacogenomics programs, with expertise in pharmacokinetics, pharmacogenomics, informatics, and patient care. Education, training, and practice-based resources are needed to support these roles and to facilitate the development of financially sustainable pharmacist-led clinical pharmacogenomics practice models.
Pharmacists have provided unique value in the health care system in recent decades through optimizing medication use to improve outcomes and decrease adverse events. During this time, specialized roles for clinical pharmacists have emerged and become the standard of care in a number of practice areas, including pharmacokinetics, critical care, anticoagulation, medication therapy management, and others.19–22 It is our experience that novel opportunities are emerging for pharmacists to provide clinical value in the area of pharmacogenomics as a new standard of care. A 2013 national survey of pharmacy practice settings confirmed that pharmacists already provide similar services in United States hospitals, including formally advising on dosage adjustment (98%), drug information (93%), and pharmacokinetics (92%).23 In a draft policy position statement, the American Society of Health-Systems Pharmacists further reinforced that distinctive knowledge, skills, and abilities make pharmacists “uniquely positioned to lead interdisciplinary efforts to develop processes for ordering, interpreting, and reporting pharmacogenomic test results and for guiding optimal drug selection and drug dosing based on those results, as well as efforts to implement and improve those processes.”24
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