Physician Perspectives on CYP2C19 Pharmacogenomic Active Clinical Decision Support

Abstract

Actionable pharmacogenomic (PGx) information is growing exponentially with lowering costs of sequencing technologies, yet the best means to disseminate such data to physicians remains unclear. One method involves alerts triggered when a physician prescribes a medication through a computerized physician order entry for a patient known to have a particular PGx variant. We sought to assess physician perspectives of a prototype alert built for patients with CYP2C19 variants being prescribed clopidogrel through a computer-based simulation and 15-item online questionnaire assessing their perceptions of the alert's design, placement in workflow, and PGx content. A random sample of 55 physicians participated in the study. 89% of participants would modify their prescription based on the alert; only 4% would override the alert. 92% of the sample found the alerts helpful in choosing an appropriate medication. 75% of the physicians were unfamiliar with the PGx interaction of clopidogrel and CYP2C19. In conclusion, this sample of physicians felt that the PGx alert was useful, though many were unfamiliar with the specific drug-gene interaction. Future work should assess the alerts in real settings and identify appropriate educational resources to supplement the alerts.