Physician perspectives of CYP2C19 and clopidogrel drug-gene interaction active clinical decision support alerts

Int J Med Inform. 2016 Feb;86:117-25. doi: 10.1016/j.ijmedinf.2015.11.004. Epub 2015 Nov 11.

Abstract

Objective: To determine if physicians find clinical decision support alerts for pharmacogenomic drug-gene interactions useful and assess their perceptions of usability aspects that impact usefulness.

Materials and methods: 52 physicians participated in an online simulation and questionnaire involving a prototype alert for the clopidogrel and CYP2C19 drug-gene interaction.

Results: Only 4% of participants stated they would override the alert. 92% agreed that the alerts were useful. 87% found the visual interface appropriate, 91% felt the timing of the alert was appropriate and 75% were unfamiliar with the specific drug-gene interaction. 80% of providers preferred the ability to order the recommended medication within the alert. Qualitative responses suggested that supplementary information is important, but should be provided as external links, and that the utility of pharmacogenomic alerts depends on the broader ecosystem of alerts.

Principal conclusions: Pharmacogenomic alerts would be welcomed by many physicians, can be built with minimalist design principles, and are appropriately placed at the end of the prescribing process. Since many physicians lack familiarity with pharmacogenomics but have limited time, information and educational resources within the alert should be carefully selected and presented in concise ways.

Keywords: Clinical decision support; Clinical informatics; Electronic medical records; Genomic medicine; Pharmacogenomics.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Adverse Drug Reaction Reporting Systems / statistics & numerical data
  • Clopidogrel
  • Cytochrome P-450 CYP2C19 / genetics
  • Cytochrome P-450 CYP2C19 / metabolism*
  • Decision Support Systems, Clinical / statistics & numerical data*
  • Drug Interactions
  • Drug Therapy, Computer-Assisted / statistics & numerical data
  • Drug-Related Side Effects and Adverse Reactions / prevention & control*
  • Female
  • Humans
  • Male
  • Medical Order Entry Systems / statistics & numerical data*
  • Medication Errors / prevention & control*
  • Middle Aged
  • Pharmacogenetics
  • Platelet Aggregation Inhibitors / metabolism
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Reminder Systems
  • Ticlopidine / analogs & derivatives*
  • Ticlopidine / metabolism
  • User-Computer Interface
  • Young Adult

Substances

  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Cytochrome P-450 CYP2C19
  • Ticlopidine