multidisciplinary approaches and training pgxpractitioners

Precision Medicine Conference

KristinWeitzel,PharmD,FAPhAAssociateDirector,UFHealthPersonalizedMedicineProgram

ClinicalAssociateProfessorPharmacotherapyandTranslationalResearch

UniversityofFloridaCollegeofPharmacy

Multidisciplinary Approaches and Training PGx Practitioners

at the University of Florida

https://ufandshands.org/news/2012/uf-delivers-promise-personalized-medicine-heart-patients#!/-1/

UF Health Personalized Medicine Program-Moving Pharmacogenetics to the Clinic

UF IGNITE Project Aims

CurrentUFPMPPgx

Testing

ExtendUFprogram:

newclinical&gene/drug

pairs

Expandtestingtoothersites

Educationofstudents,clinicians,

patients

Aim1 Aim2

Aim3

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IGNITE Provider Survey Data: PGx Providers

77%

70%

32%

30%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

PGxtestingrelevanttomypractice

PGxdatawillimprovemypatientcareability

Icanfind/usereliablesourcesofPGxinfo

IamconfidentinmyabilitytousePGxresults

UnpublishedIGNITENetworkdata.Owusu-ObengA,MountSinaiIcahnSchoolofMedicine,ProviderAdoptionBarriersandEducationWG.

N=77providers• 69%community-based• 79%0-5yrs inpractice

• Lackofappropriatetraininginschoolandcontinuingeducation–Lagtimebetweenrateofevidenceandtechnologydevelopmentandtheirintegrationintoeducationandpractice

• LackofclinicalexperiencewithPGx activitiesandtools–Underrepresentedinclinicaltraining–Howtofind,interpret,andapplyevidence–Howtounderstandandcomparedifferentpharmacogenomicstests

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A Perfect Storm

Plunkett-Rondeau.GenetMed.2015;17:927-34.

KNOWLEDGE APPLICATION

Getting Past the Perfect Storm

• Workingtoaddtotheknowledgebaseabouttheroleofgeneticvariationondrugresponse

• Establishingmodelsandimplementinguseofgeneticinformationtoguideclinicaldecisionsaboutdruguse

• Developingeducationalprogramsandstrategiestoimprovegenomicseducation

UF Health Personalized Medicine Program

Test Drug Numberoftests

OrderingService

CYP2C19 Clopidogrel 1694 Cardiology,UFHealthShands634 Cardiology,UFHealthJacksonville13 Neurology,Neurosurgery

TPMT Thiopurines 43 Hematology/Oncology67 Gastroenterology42 Other*

IFNL3 PEG-interferon-α basedregimens 96 GastroenterologyCYP2D6 Opioids 202 FamilyMedicine

33 InternalMedicine34 ChronicPainClinic3 AdultOncology

CYP2D6 SSRIs 12 PsychiatryCYP2C19 SSRIs 13 PsychiatryCYP2C19 PPIs 40 Gastroenterology

*Dermatology,Rheumatology,Neurology,InternalMedicine,FamilyMedicine,Surgery

Pharmacogenetic Testing at UF Health

Pharmacogenomics2017[Epub aheadofprint].PMID:28346068

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Pharmacogenomics2017[Epub aheadofprint].PMID:28346068

Pharmacogenetic Testing at UF Health

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GrandRoundsCDSEvidenceAnalysesPatientCasesClinicalPGxfellowshipStudentandPractitionergenotypingcase-basedteachingCDSRevisionsPGY2Residency

Non-ResearchgenotypingExpandedPrecisionMedConferencePlanningforGradCertificate

2017

GrandRoundsCDSEvidenceAnalysesPatientCasesClinicalPGxfellowshipStudentandPractitionergenotypingcase-basedteaching

PGY2ResidencyAccreditationPrecisionMedConferenceCDSRevisions

2016

GrandRoundsCDSPGY2PGxResidencyEvidenceAnalysesPatientCasesClinicalPGxfellowshipStudentgenotypingcase-basedteaching

Practitionergenotypingcase-basedteaching

2015

GrandRoundsCDSPGY2PGxResidencyEvidenceAnalysesPatientCasesClinicalPGxfellowship

Studentgenotypingcase-basedteaching

2014

GrandRoundsCDSPGY2PGxResidency

EvidenceAnalysesPatientCasesClinicalPGxpostdocfellowship

2013GrandRoundsCDSPGY2PGXResidency

2012

PGx Education at UF Health

PrecisionMedicineConference

32%

StudentElective18%CEwithGenotyping

5%

GrandRounds/Inservice

43%

Residents/ClincalTrainees

2%

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PGx Education at UF Health

N=~950participants2012to2017

Krynetskiy etal(2009)

Adams etal(2016)

Weitzeletal(2016)

Fricketal(2016)

Surofchy etal(2017)

Remsberg etal(2017)

StudentGenotyping

SingleSNPanalysis(rs1801280)withinNAT2

Commerciallaboratorytesting(23andMe)

Panel-basedtestinginresearchlaboratoryforrelevantclinicalSNPs

Commerciallaboratorytesting(23andMe)

Single geneencodingdrugmetabolizingenzymeorpharmacodynamics-relevantprotein

Single genetestingofTAS2R38 withphenotypetesting

Effect onAttitudesandBeliefs

ImprovedunderstandingofPGx analysis

↑importanceofthistopictofuturepractice

↑ confidence

↑student’sself-perceivedabilitytoempathize

↑self-reportedunderstanding

↑comfortlevelandconfidence

↑ confidence

↑students’reflectionsandattitudestowardPGx

PositivelyimpactedattitudetowardsPGx pre- vs. post

↑ perceptionsofandconfidenceinabilitiesinPGxpatientcareskills

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Personal Genotyping: Knowledge, Attitudes and Beliefs

Krynetskiy etal.AmJPharmEd.2009;73(4):71.;Adamsetal.AmJPharmEd.2016;80(1):3.;Weitzeletal.AmJPharmEd.2016;80(7):122.;Fricketal.FrontPharmacol.2016;7:241.;Surofchy etal.InnovationsPharm.2017;8(1):2.;Remsberg etal.AmJPharmEd.2017;81(1):11.

*Studentknowledgeimprovedpre- vs.postcourseacrossallstudies

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Effects of Active Learning/Personal Genotyping on Student Knowledge and Self-Efficacy

Control (CTR)Students enrolled in Required PGx

Course

Intervention (INT)

Students enrolled in both Required PGx Course and Elective Clinical

PGx Course

Option to undergo panel-based genotyping and used genetic data in

patient cases

Arwoodetal.DatapresentedatTranslationalScienceMeeting:Washington DC;April2016.

Knowledge-basedmetricswerecomparedbetweentheCTRandINTgroup.

Collectedviapre- andpost-coursesurvey

TeachingstrategiesdifferedbetweentheCTRandINTgroup

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Teaching StrategiesElective Clinical PGx Course Required PGx Course

Teaching strategies

Didactic, Interactive, Case-Based Teaching Strategies; Emphasis on Clinical Applications

Didactic Teaching Strategies; Emphasis on Foundations

Activities • Pre-recorded lectures• Required readings• Regularly scheduled quizzes• Exams• Discussion board

assignments• Journal evaluation

assignments• Patient cases prior to in-class

discussions

• Patient case discussion in class with faculty

• Optional personal genotyping during the class

• Option to use personalgenotype results to solve patient cases

• Pre-recorded lectures• Required readings• Regularly scheduled

quizzes• Exams


Pre- and Post-Course Knowledge Results

Pre-Course: No difference in test scores between INT and CTR (6.8 vs 6.3; p=0.3407)

Post-Course:Higher post-course knowledge test score in INT vs CTR group (10 vs 7.5; p=0.0001)


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Correlation of Confidence andKnowledgeCTR Group:No correlation between students’ confidence and knowledge for pre-course (r=0.22, p=0.23) or post-course (adjusted r=0.07, p=0.70)

INT Group:Students’ confidence and knowledge were not correlated pre-course (r=0.34, p=0.13), but did correlate post-course (adjusted r=0.46, p=0.04)


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Correlation of Confidence and Knowledge

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UF Precision Medicine Conference 2016-2017

2016150attendees30states;2countries

2017165attendees32states;5countries

BackgroundGenetics/PGx,

45%

PatientCases,22%

HowtoImplement,16%

HowtoTeach,17%

2016

19


27%

PatientCases,22%

HowtoImplement,43%

HowtoTeach,8%

2017Precision Medicine Conference Content


45%

PatientCases,22%

HowtoImplement,16%

HowtoTeach,17%

2016

20


27%

PatientCases,22%

HowtoImplement,43%

HowtoTeach,8%

2017

38%Interactive

62%Didactic

65%Interactive

35%Didactic

• 2018PrecisionMedicineConference– Interprofessional– Focusonimplementation,currentissues

• PrecisionMedicineGraduateCertificateinconjunctionwithCollegeofMedicine– FoundationsofPrecisionMedicine– FoundationsofPrecisionMedicineTechnology–ApplicationsofPrecisionMedicineinPractice–Pharmacogenomics:IndividualizingDrugTherapyThroughPrecisionMedicine–ApplicationsofPrecisionMedicineinSusceptibilityGenomics– EthicalConsiderationsinPrecisionMedicine–PrecisionMedicineSeminar

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Next steps

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www.ignite-genomics.org

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• UFPMPLeadership:JulieA.Johnson,PharmD(Director);LarisaCavallari,PharmD(Assoc Director);AmandaElsey,MHA(Asst Director);MichaelClare-Salzler,MD;DavidNelson,MD

• Trainees/Faculty:DysonWake,PharmD,D.MaxSmith,PharmD,MeghanArwood,PharmD,Issam Hamadeh,PharmD,AniwaaOwusu-Obeng,PharmD,Oyunbileg Magvanjav,MS,ScottMosley,PharmD,TeresaVo,PharmD,BenKong,PharmD

• FundedbyNIHgrants U01GM074492andU01HL105198(aspartofTPPprojectinPGRN);NIH/NCATSUFCTSAUL1TR000064,IGNITENetworkgrantU01HG007269andsubstantialinstitutionalsupportfromUFandUFHealth

UF Health Personalized Medicine Program Acknowledgements

multidisciplinary approaches and training pgxpractitioners

Documents