Unlike traditional drug interaction alerts that pop up the pharmacy system, pharmacogenetics takes into account how an individual metabolism processes a drug. With more accessible test kits, it’s possible to record the unique molecular structure of each person, and how drugs not only interact with each other, but interact with a person’s specific drug receptors. Working with patients who have the tests done, pharmacy can now load the information into their system and elevate the risks associated with not just drug-to-drug, but drug to person. Robert Alesiania, Pharm.D., BCGP, is chief pharmacotherapy officer at Tabula Rasa Healthcare,explained in our Jan/Feb issue how viewing each patient as “normal” when it comes to metabolizing drugs, is telling only half the picture. He explains that the assumption everyone metabolizes drugs the same way can lead to poor outcomes and increase cost to the healthcare system.
“For example, the drug codeine is used for pain control. Codeine is a prodrug and it needs an enzyme, CYP2D6, to convert approximately 8% of the dose into morphine. If you have ‘normal’ 2D6 genes from both parents, you should get an appropriate response from the drug. If you got a bad gene from one parent and a good gene from the other, you will have a partial response. Bad genes from both would be no response, but you are still stuck with the side effects. It is also possible to have an exaggerated response to the drug — rapid or ultrarapid metabolism — by converting too much codeine into morphine.”
This is cutting edge and could mean another avenue to provide tangible clinical benefits to your patients, and to doctors. If in reviewing a patient’s risk report, you see the example that Alesiania outlines in the article, you can call the doctor and make recommendations that better suit the specific patient. Think about the value here.
Will it require thinking differently about workflow and counseling? Yes, it will. Yet many of the pharmacists we feature in our magazine find that they can implement change around a new service when they are clear on their goals. Technology vendors, in particular the pharmacy management companies, can support pharmacists in these efforts. It’s also good to consider vendor partners who specialize in a service that can enhance your pharmacy management system. Updox is one vendor that supports independents interested in pharmacogenetics for the pharmacy’s most at-risk patients. Enhanced care coordination services, for example, support pharmacists-prescriber collaboration and a direct referral network lets pharmacists coordinate care and test results with physicians, communicate medical and prescription records, and become a prescriber’s preferred referral source. Secure direct messaging will be necessary to facilitate communication between pharmacy and providers, and all this will put pharmacists in the medical home as a patient advocate, growing stronger patient loyalty. Updox provided ComputerTalk readers a resource guide that’s available here.
Clinical care is the theme, and tied into that is the technology that makes it easier for you to implement. Ketan Mehta at Micro Merchant Systems is eloquent on this matter. “The business of pharmacy is changing, and so are the ways that pharmacies operate,” he says. “We provide all the tools the pharmacy needs through the use of technology and automation so that patient outcome is the pharmacy’s number one priority.” CT
Maggie Lockwood is VP, director of production, at ComputerTalk. Her pharmacy profiles serve as case studies on the power of technology to keep community pharmacists competitive.