Abstract
Background
Pharmacogenomics (PGx) assesses how genetic variation influences medication response and can support medication optimization. For patients with substantial medication burden, optimization efforts are essential for improving medication safety. At the Madison VA, Veterans identified through a polypharmacy dashboard receive comprehensive medication reviews to determine opportunities for deprescribing. This quality improvement pilot evaluates the impact of incorporating PGx-guided recommendations into these deprescribing focused reviews.Methods
Veterans at a community‑based ambulatory care clinic identified via the polypharmacy dashboard were included in this pilot if they were taking at least two PGx-impacted medications based on the standard 22-gene panel available within the Veterans Health Administration. PGx Clinical Pharmacist Practitioners (CPPs) consented Veterans for PGx testing, conducted chart reviews, and completed telehealth visits to deprescribe medications based on PGx results if appropriate.Results
Fifty-eight patients met criteria and 50 completed PGx testing. After exclusions, 44 patients were analyzed. Deprescribing recommendations were made for 75% (33/44) of patients, resulting in 15 PGx-guided deprescribing interventions.Conclusion
Incorporating PGx into existing workflows enhances medication optimization and supports deprescribing for Veterans at high risk of polypharmacy.