Background: The pharmacist-guided personalized medicine consult service at the University of Illinois Hospital and Health Sciences System (UI-Health) provides warfarin-dosing recommendations to providers and patients newly initiated on warfarin therapy. Starting in August 2012, CYP2C19, VKORC1, and CYP4F2 genotyping was made mandatory to guide warfarin-dosing recommendations and subsequently became optional starting in April 2014.

Aims: To evaluate the operational feasibility of a pharmacist-guided personalized medicine consult service at an urban academic health center for improving warfarin dosing following transition from mandatory (mPGx) to optional (oPGx) genotyping.

Methods: This was a retrospective observational cohort study consisting of patients newly initiated on warfarin therapy at UI-Health during the mPGx phase (cohort 1) and oPGx phase (cohort 2). Service utilization and feasibility of oPGx compared to mPGx were summarized using quantitative outcomes including frequency of genotype order, acceptance of recommended dose, genotype result turnaround time, and time to pharmacist dose recommendation documentation in the medical record. Multiple bivariate analyses including student t-test, chi-square test, and non-parametric approaches were conducted.

Results: A total of 577 and 528 patients started warfarin during the mPGx and oPGx periods, respectively. Genotyping was ordered for 52.08% of patients during the oPGx phase. The acceptance rate of pharmacist-recommended doses by medical staff improved during the oPGx phase compared to mPGx (from 83.81 to 86.57%, P< 0.01). Significant decreases were observed in median genotype result turnaround time (25.82 to 24.27 hours, p< 0.01) and time to pharmacist dose recommendation documentation during the oPGx phase (5.46 to 2.38 hours, p< 0.01). Over 95% of dose recommendations were available within 24 hours in both phases (96.41% mPGx versus 98.61% oPGx, p< 0.05).

Conclusions: Warfarin dosing recommendations provided by a pharmacist-guided personalized medicine consult service were well accepted by medical staff despite transitioning from mandatory to optional genotyping. Additionally, operational feasibility of the service improved.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/operational-feasibility-of-a-pharmacist-guided-personalized-medicine-consult-service-for-warfarin-in-mandatory-and-optional-testing-settings/