TY - JOUR
T1 - Implementation of Standardized Clinical Processes for TPMT Testing in a Diverse Multidisciplinary Population
T2 - Challenges and Lessons Learned
AU - Weitzel, Kristin W.
AU - Smith, D. Max
AU - Elsey, Amanda R.
AU - Duong, Benjamin Q.
AU - Burkley, Benjamin
AU - Clare-Salzler, Michael
AU - Gong, Yan
AU - Higgins, Tara A.
AU - Kong, Benjamin
AU - Langaee, Taimour
AU - McDonough, Caitrin W.
AU - Staley, Benjamin J.
AU - Vo, Teresa T.
AU - Wake, Dyson T.
AU - Cavallari, Larisa H.
AU - Johnson, Julie A.
N1 - Publisher Copyright:
© 2018 The Authors. Clinical and Translational Science published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics
PY - 2018/3
Y1 - 2018/3
N2 - Although thiopurine S-methyltransferase (TPMT) genotyping to guide thiopurine dosing is common in the pediatric cancer population, limited data exist on TPMT testing implementation in diverse, multidisciplinary settings. We established TPMT testing (genotype and enzyme) with clinical decision support, provider/patient education, and pharmacist consultations in a tertiary medical center and collected data over 3 years. During this time, 834 patients underwent 873 TPMT tests (147 (17%) genotype, 726 (83%) enzyme). TPMT tests were most commonly ordered for gastroenterology, rheumatology, dermatology, and hematology/oncology patients (661 of 834 patients (79.2%); 580 outpatient vs. 293 inpatient; P < 0.0001). Thirty-nine patients had both genotype and enzyme tests (n = 2 discordant results). We observed significant differences between TPMT test use and characteristics in a diverse, multispecialty environment vs. a pediatric cancer setting, which led to unique implementation needs. As pharmacogenetic implementations expand, disseminating lessons learned in diverse, real-world environments will be important to support routine adoption.
AB - Although thiopurine S-methyltransferase (TPMT) genotyping to guide thiopurine dosing is common in the pediatric cancer population, limited data exist on TPMT testing implementation in diverse, multidisciplinary settings. We established TPMT testing (genotype and enzyme) with clinical decision support, provider/patient education, and pharmacist consultations in a tertiary medical center and collected data over 3 years. During this time, 834 patients underwent 873 TPMT tests (147 (17%) genotype, 726 (83%) enzyme). TPMT tests were most commonly ordered for gastroenterology, rheumatology, dermatology, and hematology/oncology patients (661 of 834 patients (79.2%); 580 outpatient vs. 293 inpatient; P < 0.0001). Thirty-nine patients had both genotype and enzyme tests (n = 2 discordant results). We observed significant differences between TPMT test use and characteristics in a diverse, multispecialty environment vs. a pediatric cancer setting, which led to unique implementation needs. As pharmacogenetic implementations expand, disseminating lessons learned in diverse, real-world environments will be important to support routine adoption.
UR - https://www.scopus.com/pages/publications/85040744356
U2 - 10.1111/cts.12533
DO - 10.1111/cts.12533
M3 - Article
C2 - 29351371
AN - SCOPUS:85040744356
SN - 1752-8054
VL - 11
SP - 175
EP - 181
JO - Clinical and Translational Science
JF - Clinical and Translational Science
IS - 2
ER -