2025 Southeastern Residency Conference

Title: Assessing Academic Detailing on Pharmacogenomic Utilization in the Primary Care and Menth Health Settings
Authors: Jenna K. Brophy, Justin Davis
James H. Quillen VA Medical Center (JHQVAMC) PGY1– Mountain Home, TN
Background/Purpose:  Pharmacogenomics is the study of how interindividual variations in genes can influence the response to medications.  Pharmacogenomic (PGx) testing is a clinical tool to improve the safety and efficacy of medication prescribing. The Food and Drug Administration (FDA) currently has 397 medications with genomic testing discussed in their package insert, 58 medications with data supporting pharmacogenomic associations, 20 with potential pharmacogenomic impact on safety and response, and 40 that may have pharmacogenomic impact on kinetics.  A 2019 cross-sectional study of 7.7 million veterans across VHA determined that roughly 55% of patients were prescribed at least one actionable, level A medication informed by PGx testing. Despite published guidance to facilitate implementation of pharmacogenomic information, it can take as many as 17 years for research to be incorporated into clinical practice.   Surveys of schools and colleges of medicine in the United States show efforts in recent years to increase the incorporation of pharmacogenomics within their curriculum; however, the depth and extent of education varies, and most respondents believe that physicians and other healthcare professionals do not possess an appropriate level of knowledge in this area.  Academic detailing (AD) is an outreach intervention that delivers non-biased education to bridge the gap between provider knowledge, prescribing practices, and evidence-based, recommended clinical guidance.  In a clinical trial assessing Technology Enabled Academic Detailing (TEAD), it was perceived as effective in terms of content delivery as traditional AD interventions (as determined by end-user feedback); however, there is limited information whether TEAD is as effective as traditional AD in promoting change in clinical practice.  This quality improvement initiative aims to assess the receptiveness and impact of academic detailing on pharmacogenomic utilization in the primary care and mental health settings.
Methodology: This is a prospective cohort study that enrolled healthcare providers in the primary care and mental health settings at the James H Quillen VA Medical Center between April 2024 and December 2024. All providers were enrolled after delivery of service-level educational outreach on the availability of PGx testing.  Written education was disseminated quarterly to provide updates and facilitate implementation of pharmacogenomics within these respective practice areas. During the study period, three attempts were made to offer individualized academic detailing (AD) sessions to all providers. Options for in-person and TEAD were made available.  Providers could self-schedule through a calendar link or contact the academic detailer if alternative scheduling options were required.  The primary outcome was to compare the utilization of pharmacogenomics between AD-exposed v. non-exposed providers. Secondary endpoints aimed to evaluate differences in acceptance of detailing between services (mental health v. primary care) and providers (physician vs. non-physician provider). A survey was utilized to identify barriers associated with academic detailing and PGx implementation.  
Results: In progress
Conclusions: In progress