Implementation of Standardized Clinical Processes for TPMT Testing in a Diverse Multidisciplinary Population: Challenges and Lessons Learned
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 suppor...
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| Veröffentlicht in: | Clinical and translational science 2018-03, Vol.11 (2), p.175-181 |
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| creator | Weitzel, Kristin W. Smith, D. Max Elsey, Amanda R. Duong, Benjamin Q. Burkley, Benjamin Clare‐Salzler, Michael Gong, Yan Higgins, Tara A. Kong, Benjamin Langaee, Taimour McDonough, Caitrin W. Staley, Benjamin J. Vo, Teresa T. Wake, Dyson T. Cavallari, Larisa H. Johnson, Julie A. |
| description | 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. |
| doi_str_mv | 10.1111/cts.12533 |
| format | Article |
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Max ; Elsey, Amanda R. ; Duong, Benjamin Q. ; Burkley, Benjamin ; Clare‐Salzler, Michael ; Gong, Yan ; Higgins, Tara A. ; Kong, Benjamin ; Langaee, Taimour ; McDonough, Caitrin W. ; Staley, Benjamin J. ; Vo, Teresa T. ; Wake, Dyson T. ; Cavallari, Larisa H. ; Johnson, Julie A.</creator><creatorcontrib>Weitzel, Kristin W. ; Smith, D. Max ; Elsey, Amanda R. ; Duong, Benjamin Q. ; Burkley, Benjamin ; Clare‐Salzler, Michael ; Gong, Yan ; Higgins, Tara A. ; Kong, Benjamin ; Langaee, Taimour ; McDonough, Caitrin W. ; Staley, Benjamin J. ; Vo, Teresa T. ; Wake, Dyson T. ; Cavallari, Larisa H. ; Johnson, Julie A.</creatorcontrib><description>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.</description><identifier>ISSN: 1752-8054</identifier><identifier>EISSN: 1752-8062</identifier><identifier>DOI: 10.1111/cts.12533</identifier><identifier>PMID: 29351371</identifier><language>eng</language><publisher>United States: John Wiley & Sons, Inc</publisher><subject>Adult ; Age Factors ; Antimetabolites, Antineoplastic - pharmacology ; Antimetabolites, Antineoplastic - standards ; Antimetabolites, Antineoplastic - therapeutic use ; Cancer therapies ; Child ; Child, Preschool ; Cytotoxicity ; Decision Support Systems, Clinical ; Dermatology ; Drug dosages ; Education ; Enzyme Assays - methods ; Enzymes ; Female ; Gastroenterology ; Genetic Testing - methods ; Genotype ; Genotype & phenotype ; Genotypes ; Genotyping ; Health care facilities ; Hematology ; Humans ; Inflammatory bowel disease ; Interdisciplinary Communication ; Intubation ; Male ; Metabolites ; Methyltransferase ; Methyltransferases - genetics ; Methyltransferases - metabolism ; Middle Aged ; Neoplasms - drug therapy ; Neoplasms - genetics ; Oncology ; Patient Education as Topic ; Patients ; Pediatrics ; Pharmacists ; Pharmacogenetics - methods ; Phenotype ; Polymorphism, Genetic ; Practice Guidelines as Topic ; Precision Medicine - methods ; Tertiary Care Centers</subject><ispartof>Clinical and translational science, 2018-03, Vol.11 (2), p.175-181</ispartof><rights>2018 The Authors. 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Max</creatorcontrib><creatorcontrib>Elsey, Amanda R.</creatorcontrib><creatorcontrib>Duong, Benjamin Q.</creatorcontrib><creatorcontrib>Burkley, Benjamin</creatorcontrib><creatorcontrib>Clare‐Salzler, Michael</creatorcontrib><creatorcontrib>Gong, Yan</creatorcontrib><creatorcontrib>Higgins, Tara A.</creatorcontrib><creatorcontrib>Kong, Benjamin</creatorcontrib><creatorcontrib>Langaee, Taimour</creatorcontrib><creatorcontrib>McDonough, Caitrin W.</creatorcontrib><creatorcontrib>Staley, Benjamin J.</creatorcontrib><creatorcontrib>Vo, Teresa T.</creatorcontrib><creatorcontrib>Wake, Dyson T.</creatorcontrib><creatorcontrib>Cavallari, Larisa H.</creatorcontrib><creatorcontrib>Johnson, Julie A.</creatorcontrib><title>Implementation of Standardized Clinical Processes for TPMT Testing in a Diverse Multidisciplinary Population: Challenges and Lessons Learned</title><title>Clinical and translational science</title><addtitle>Clin Transl Sci</addtitle><description>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. 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As pharmacogenetic implementations expand, disseminating lessons learned in diverse, real‐world environments will be important to support routine adoption.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Antimetabolites, Antineoplastic - pharmacology</subject><subject>Antimetabolites, Antineoplastic - standards</subject><subject>Antimetabolites, Antineoplastic - therapeutic use</subject><subject>Cancer therapies</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cytotoxicity</subject><subject>Decision Support Systems, Clinical</subject><subject>Dermatology</subject><subject>Drug dosages</subject><subject>Education</subject><subject>Enzyme Assays - methods</subject><subject>Enzymes</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Genetic Testing - methods</subject><subject>Genotype</subject><subject>Genotype & phenotype</subject><subject>Genotypes</subject><subject>Genotyping</subject><subject>Health care facilities</subject><subject>Hematology</subject><subject>Humans</subject><subject>Inflammatory bowel disease</subject><subject>Interdisciplinary Communication</subject><subject>Intubation</subject><subject>Male</subject><subject>Metabolites</subject><subject>Methyltransferase</subject><subject>Methyltransferases - genetics</subject><subject>Methyltransferases - metabolism</subject><subject>Middle Aged</subject><subject>Neoplasms - drug therapy</subject><subject>Neoplasms - genetics</subject><subject>Oncology</subject><subject>Patient Education as Topic</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Pharmacists</subject><subject>Pharmacogenetics - methods</subject><subject>Phenotype</subject><subject>Polymorphism, Genetic</subject><subject>Practice Guidelines as Topic</subject><subject>Precision Medicine - methods</subject><subject>Tertiary Care Centers</subject><issn>1752-8054</issn><issn>1752-8062</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp1kc9uFSEUh4nR2Fpd-AKGxI1d3HaAYWZwYWKm_mlyG2_ScU0YBm5pGJjCTE19Bh_aY2-9URPZHBI-Pn6Hg9BLUpwQWKd6zieEcsYeoUNSc7pqioo-3u95eYCe5XxdFBWrGv4UHVDBOGE1OUQ_zsfJm9GEWc0uBhwtvpxVGFQa3Hcz4Na74LTyeJOiNjmbjG1MuNtcdLgzeXZhi13ACp-5W5OywReLn93gsnYTXFXpDm_itPh7-1vcXinvTdiCBh7BazDGkKGqFMzwHD2xymfz4qEeoa8fP3Tt59X6y6fz9v16pcuSsZUpraWEUUaaQRdaW0ZE04vaWKEE5WXZ9zXRNWmsorTSoma26jlVVHBleV-yI_Ru552WfjSDhu6T8nJKboTAMion_z4J7kpu463kTVUXtAHBmwdBijcLfIMcoWPjvQomLllCHsFFVbAa0Nf_oNdxSQHakxCuYkJwXgF1vKN0ijknY_dhSCF_zVjCjOX9jIF99Wf6Pfl7qACc7oBvzpu7_5tk213ulD8B7lmzag</recordid><startdate>201803</startdate><enddate>201803</enddate><creator>Weitzel, Kristin W.</creator><creator>Smith, D. 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Max ; Elsey, Amanda R. ; Duong, Benjamin Q. ; Burkley, Benjamin ; Clare‐Salzler, Michael ; Gong, Yan ; Higgins, Tara A. ; Kong, Benjamin ; Langaee, Taimour ; McDonough, Caitrin W. ; Staley, Benjamin J. ; Vo, Teresa T. ; Wake, Dyson T. ; Cavallari, Larisa H. ; Johnson, Julie A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4433-e4ff2132318dc0ccf3198b97ef9a92544bb71c718fa226c973f6b52a295af5b43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Antimetabolites, Antineoplastic - pharmacology</topic><topic>Antimetabolites, Antineoplastic - standards</topic><topic>Antimetabolites, Antineoplastic - therapeutic use</topic><topic>Cancer therapies</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cytotoxicity</topic><topic>Decision Support Systems, Clinical</topic><topic>Dermatology</topic><topic>Drug dosages</topic><topic>Education</topic><topic>Enzyme Assays - methods</topic><topic>Enzymes</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Genetic Testing - methods</topic><topic>Genotype</topic><topic>Genotype & phenotype</topic><topic>Genotypes</topic><topic>Genotyping</topic><topic>Health care facilities</topic><topic>Hematology</topic><topic>Humans</topic><topic>Inflammatory bowel disease</topic><topic>Interdisciplinary Communication</topic><topic>Intubation</topic><topic>Male</topic><topic>Metabolites</topic><topic>Methyltransferase</topic><topic>Methyltransferases - genetics</topic><topic>Methyltransferases - metabolism</topic><topic>Middle Aged</topic><topic>Neoplasms - drug therapy</topic><topic>Neoplasms - genetics</topic><topic>Oncology</topic><topic>Patient Education as Topic</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Pharmacists</topic><topic>Pharmacogenetics - methods</topic><topic>Phenotype</topic><topic>Polymorphism, Genetic</topic><topic>Practice Guidelines as Topic</topic><topic>Precision Medicine - methods</topic><topic>Tertiary Care Centers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Weitzel, Kristin W.</creatorcontrib><creatorcontrib>Smith, D. 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Max</au><au>Elsey, Amanda R.</au><au>Duong, Benjamin Q.</au><au>Burkley, Benjamin</au><au>Clare‐Salzler, Michael</au><au>Gong, Yan</au><au>Higgins, Tara A.</au><au>Kong, Benjamin</au><au>Langaee, Taimour</au><au>McDonough, Caitrin W.</au><au>Staley, Benjamin J.</au><au>Vo, Teresa T.</au><au>Wake, Dyson T.</au><au>Cavallari, Larisa H.</au><au>Johnson, Julie A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Implementation of Standardized Clinical Processes for TPMT Testing in a Diverse Multidisciplinary Population: Challenges and Lessons Learned</atitle><jtitle>Clinical and translational science</jtitle><addtitle>Clin Transl Sci</addtitle><date>2018-03</date><risdate>2018</risdate><volume>11</volume><issue>2</issue><spage>175</spage><epage>181</epage><pages>175-181</pages><issn>1752-8054</issn><eissn>1752-8062</eissn><abstract>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. 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| ispartof | Clinical and translational science, 2018-03, Vol.11 (2), p.175-181 |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Access via Wiley Online Library; EZB-FREE-00999 freely available EZB journals; Wiley Online Library (Open Access Collection); PubMed Central |
| subjects | Adult Age Factors Antimetabolites, Antineoplastic - pharmacology Antimetabolites, Antineoplastic - standards Antimetabolites, Antineoplastic - therapeutic use Cancer therapies Child Child, Preschool Cytotoxicity Decision Support Systems, Clinical Dermatology Drug dosages Education Enzyme Assays - methods Enzymes Female Gastroenterology Genetic Testing - methods Genotype Genotype & phenotype Genotypes Genotyping Health care facilities Hematology Humans Inflammatory bowel disease Interdisciplinary Communication Intubation Male Metabolites Methyltransferase Methyltransferases - genetics Methyltransferases - metabolism Middle Aged Neoplasms - drug therapy Neoplasms - genetics Oncology Patient Education as Topic Patients Pediatrics Pharmacists Pharmacogenetics - methods Phenotype Polymorphism, Genetic Practice Guidelines as Topic Precision Medicine - methods Tertiary Care Centers |
| title | Implementation of Standardized Clinical Processes for TPMT Testing in a Diverse Multidisciplinary Population: Challenges and Lessons Learned |
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