By offering patients a pharmacogenomic test, physicians can often determine which medications a patient is most likely to respond well to. When Genesys PHO in Michigan decided to pilot pharmacogenomics in its family medicine practices over two years ago, Theresa Thomas, M.D., an associate medical director, volunteered right away.
“Part of why I was so interested in being part of the pilot group for this testing was because I had a patient, a young female, who was 17 years old, and she was struggling with anxiety and depression, and it was quite severe,” Thomas explained. “She had been to several specialists and tried numerous medications. And every time she came in, she kept saying it wasn’t working and she wasn’t feeling any better.” Thomas wanted to be able to help her by doing pharmacogenomic testing. “When the data came back, it showed that every single medication that they had tried, even though they were correct medicines to use, were not medicines that she was able to metabolize and have success with. To me, that was just such an eye-opening moment. And I was so excited, because then we were able to change her medication regimen. And we're now two years out from that, and she is doing great.”
The 65-physician Genesys PHO is part of the much larger Ascension Medical Group. Thomas and colleagues worked to understand the best way to build the discussion with patients, ordering and results into their work flow. “We had to figure out how to have the application tool within the electronic record, and see if it was going to be user friendly for the physician and allow for easy interpretation of these results,” she said.
Genesys is working with a solution from 2bPrecise, a precision medicine data subsidiary of Allscripts. A typical genomics report would traditionally be pages and pages long, Thomas said, “so the nice thing is 2bPrecise has given us this tool where we can actually make it more interactive and search specific things or medications. Or we can also see medications that are currently on the patient's medication list that automatically pop up at the forefront, so that we're not inundated with all of the different medications that may be in within that results.”
“First we needed a tool and the next step was learning how to identify which patients might benefit from testing or how to roll that out individually with within office itself,” she added.
So how do they identify which patients to consider for testing?
“It depends on the flow of the practice,” Thomas explained. “If someone is really busy, then I typically recommend that they look at their schedule for the week ahead and identify some patients that may be having therapeutic failures in the areas of mental health, cardiac results or who might be having persistent gastrointestinal issues because that's another area where we tend to benefit. I suggest they try to pick out a few patients that week who may benefit so that they're not feeling overwhelmed or something they need to introduce to every person. But in offices that are running a little bit slower, they might be able to identify patients any patient that has a mental health diagnosis, any patient that may have a cardiac diagnosis and they can utilize their EHR to identify those patients.”
Now that the pilot phase is complete, Genesys PHO is just starting to roll it out more broadly. “The physicians who are lagging behind a little bit are those physicians who don't feel as comfortable with the EHR in general — the technology is a little bit overwhelming to them,” Thomas said. “So we're going to look to work with them, to serve as a mentor on utilizing that tool because we've seen such a great benefit. And for those physicians that are fully engaged, they agree that this is something that we should probably utilize throughout our entire group.”
Are payers increasingly willing to pay for pharmacogenomic tests? “I have seen increased reimbursement for this,” Thomas said. “And as of now I have yet to have a patient tell me that they have been denied coverage or that the cost hasn't been reasonable to them. And like anything that we do in medicine, the more we utilize something improved that it's beneficial, the more than insurers are willing to cover it.”
Thomas stressed that doing this type of testing makes sense, not just in primary care, but also like in specialists office, such as cardiology. “There are patients who do not respond appropriately to Plavix, which is a medicine that is used very often for our cardiac patients,” she said. “Some patients will actually over-metabolize that and become too thin. And I have a patient where that was the case.He was on Plavix; he needed to have his gallbladder removed on a rather urgent basis. And he sat in the hospital for a week waiting for the effects of the Plavix to wear off for him to be safe to have surgery. So we utilized the pharmacogenetic testing and were able to pick up on the fact that Plavix was just not a good match for him and that he was likely to have an exaggerated response to it.”
Although practices like hers that have incorporated pharmacogenomics are still the exception rather than the rule, Thomas said she believes that this is something that everyone can easily integrate into their regular practice. “I really do think this is the future of medicine.”
