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      Physician-Reported Benefits and Barriers to Clinical Implementation of Genomic Medicine: A Multi-Site IGNITE-Network Survey

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          Abstract

          Genetic medicine is one of the key components of personalized medicine, but adoption in clinical practice is still limited. To understand potential barriers and provider attitudes, we surveyed 285 physicians from five Implementing GeNomics In pracTicE (IGNITE) sites about their perceptions as to the clinical utility of genetic data as well as their preparedness to integrate it into practice. These responses were also analyzed in comparison to the type of study occurring at the physicians’ institution (pharmacogenetics versus disease genetics). The majority believed that genetic testing is clinically useful; however, only a third believed that they had obtained adequate training to care for genetically “high-risk” patients. Physicians involved in pharmacogenetics initiatives were more favorable towards genetic testing applications; they found it to be clinically useful and felt more prepared and confident in their abilities to adopt it into their practice in comparison to those participating in disease genetics initiatives. These results suggest that investigators should explore which attributes of clinical pharmacogenetics (such as the use of simplified genetics-guided recommendations) can be implemented to improve attitudes and preparedness to implement disease genetics in care. Most physicians felt unprepared to use genetic information in their practice; accordingly, major steps should be taken to develop effective clinical tools and training strategies for physicians.

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          Most cited references44

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          CPIC: Clinical Pharmacogenetics Implementation Consortium of the Pharmacogenomics Research Network.

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            Pharmacogenetics: from bench to byte--an update of guidelines.

            Currently, there are very few guidelines linking the results of pharmacogenetic tests to specific therapeutic recommendations. Therefore, the Royal Dutch Association for the Advancement of Pharmacy established the Pharmacogenetics Working Group with the objective of developing pharmacogenetics-based therapeutic (dose) recommendations. After systematic review of the literature, recommendations were developed for 53 drugs associated with genes coding for CYP2D6, CYP2C19, CYP2C9, thiopurine-S-methyltransferase (TPMT), dihydropyrimidine dehydrogenase (DPD), vitamin K epoxide reductase (VKORC1), uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1), HLA-B44, HLA-B*5701, CYP3A5, and factor V Leiden (FVL).
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              Using the Consolidated Framework for Implementation Research (CFIR) to produce actionable findings: a rapid-cycle evaluation approach to improving implementation

              Background Much research does not address the practical needs of stakeholders responsible for introducing health care delivery interventions into organizations working to achieve better outcomes. In this article, we present an approach to using the Consolidated Framework for Implementation Research (CFIR) to guide systematic research that supports rapid-cycle evaluation of the implementation of health care delivery interventions and produces actionable evaluation findings intended to improve implementation in a timely manner. Methods To present our approach, we describe a formative cross-case qualitative investigation of 21 primary care practices participating in the Comprehensive Primary Care (CPC) initiative, a multi-payer supported primary care practice transformation intervention led by the Centers for Medicare and Medicaid Services. Qualitative data include observational field notes and semi-structured interviews with primary care practice leadership, clinicians, and administrative and medical support staff. We use intervention-specific codes, and CFIR constructs to reduce and organize the data to support cross-case analysis of patterns of barriers and facilitators relating to different CPC components. Results Using the CFIR to guide data collection, coding, analysis, and reporting of findings supported a systematic, comprehensive, and timely understanding of barriers and facilitators to practice transformation. Our approach to using the CFIR produced actionable findings for improving implementation effectiveness during this initiative and for identifying improvements to implementation strategies for future practice transformation efforts. Conclusions The CFIR is a useful tool for guiding rapid-cycle evaluation of the implementation of practice transformation initiatives. Using the approach described here, we systematically identified where adjustments and refinements to the intervention could be made in the second year of the 4-year intervention. We think the approach we describe has broad application and encourage others to use the CFIR, along with intervention-specific codes, to guide the efficient and rigorous analysis of rich qualitative data. Trial registration NCT02318108 Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0550-7) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                J Pers Med
                J Pers Med
                jpm
                Journal of Personalized Medicine
                MDPI
                2075-4426
                24 July 2018
                September 2018
                : 8
                : 3
                : 24
                Affiliations
                [1 ]The Charles Bronfman Institute for Personalized Medicine and Department of Genetics and Genomic Sciences, The Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
                [2 ]Pharmacy Department, The Mount Sinai Hospital, New York, NY 10029, USA
                [3 ]Center for Health Equity and Community-Engaged Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; kezhen.fei@ 123456mountsinai.org (K.F.); carol.horowitz@ 123456mountsinai.org (C.R.H.)
                [4 ]Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
                [5 ]Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, 950 W. Walnut Street, Indianapolis, IN 46202, USA; kdlevy@ 123456iu.edu
                [6 ]Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL 32640, USA; aelsey@ 123456cop.ufl.edu (A.R.E.); kweitzel@ 123456cop.ufl.edu (K.W.W.)
                [7 ]Program for Personalized and Genomic Medicine, Departments of Medicine and Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA; tpollin@ 123456som.umaryland.edu
                [8 ]Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; andrea.h.ramirez@ 123456vanderbilt.edu
                Author notes
                Author information
                https://orcid.org/0000-0003-4043-7306
                https://orcid.org/0000-0002-6460-0182
                Article
                jpm-08-00024
                10.3390/jpm8030024
                6163471
                30042363
                98d497f2-bcf3-480e-ad3d-45c08ad55685
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 27 April 2018
                : 18 July 2018
                Categories
                Article

                genetic medicine,pharmacogenetics,chronic disease,genetic testing,physician attitudes,barriers,clinical implementation,clinical utility,physician education

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