Clinical impact of pharmacogenetic profiling with a clinical decision support tool in polypharmacy home health patients: A prospective pilot randomized controlled trial

In polypharmacy patients under home health management, pharmacogenetic testing coupled with guidance from a clinical decision support tool (CDST) on reducing drug, gene, and cumulative interaction risk may provide valuable insights in prescription drug treatment, reducing re-hospitalization and emer...

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Bibliographic Details
Published in:PloS one 2017-02, Vol.12 (2), p.e0170905-e0170905
Main Authors: Elliott, Lindsay S, Henderson, John C, Neradilek, Moni B, Moyer, Nicolas A, Ashcraft, Kristine C, Thirumaran, Ranjit K
Format: Article
Language:English
Subjects:
Acceptance tests
Aged
Analysis
Biology and Life Sciences
Clinical trials
Confidence intervals
Consortia
Cytochrome
Decision making
Decision support systems
Decision Support Systems, Clinical
Drug dosages
Drug stores
Drug-Related Side Effects and Adverse Reactions - genetics
Drug-Related Side Effects and Adverse Reactions - prevention & control
Drugs
Emergency medical services
FDA approval
Female
Gene Expression Profiling
Genes
Genotype & phenotype
Health
Health care
Home Care Agencies
Home Care Services
Home health care
Hospitalization
Hospitals
Humans
Information systems
Kidney diseases
Labeling
Male
Management
Medicare
Medicine and Health Sciences
Middle Aged
Older people
Outcome Assessment (Health Care)
Patients
Pharmacists
Pharmacogenomic Variants
Pharmacology
Pharmacy
Polypharmacy
Population
Practice
Prescription drugs
Prescriptions (Drugs)
Profiling
Prospective Studies
Quality of life
R&D
Randomization
Research & development
Resource management
Resource utilization
Therapy
Trends
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Summary:In polypharmacy patients under home health management, pharmacogenetic testing coupled with guidance from a clinical decision support tool (CDST) on reducing drug, gene, and cumulative interaction risk may provide valuable insights in prescription drug treatment, reducing re-hospitalization and emergency department (ED) visits. We assessed the clinical impact of pharmacogenetic profiling integrating binary and cumulative drug and gene interaction warnings on home health polypharmacy patients. This prospective, open-label, randomized controlled trial was conducted at one hospital-based home health agency between February 2015 and February 2016. Recruitment came from patient referrals to home health at hospital discharge. Eligible patients were aged 50 years and older and taking or initiating treatment with medications with potential or significant drug-gene-based interactions. Subjects (n = 110) were randomized to pharmacogenetic profiling (n = 57). The study pharmacist reviewed drug-drug, drug-gene, and cumulative drug and/or gene interactions using the YouScript® CDST to provide drug therapy recommendations to clinicians. The control group (n = 53) received treatment as usual including pharmacist guided medication management using a standard drug information resource. The primary outcome measure was the number of re-hospitalizations and ED visits at 30 and 60 days after discharge from the hospital. The mean number of re-hospitalizations per patient in the tested vs. untested group was 0.25 vs. 0.38 at 30 days (relative risk (RR), 0.65; 95% confidence interval (CI), 0.32-1.28; P = 0.21) and 0.33 vs. 0.70 at 60 days following enrollment (RR, 0.48; 95% CI, 0.27-0.82; P = 0.007). The mean number of ED visits per patient in the tested vs. untested group was 0.25 vs. 0.40 at 30 days (RR, 0.62; 95% CI, 0.31-1.21; P = 0.16) and 0.39 vs. 0.66 at 60 days (RR, 0.58; 95% CI, 0.34-0.99; P = 0.045). Differences in composite outcomes at 60 days (exploratory endpoints) were also found. Of the total 124 drug therapy recommendations passed on to clinicians, 96 (77%) were followed. These findings should be verified with additional prospective confirmatory studies involving real-world applications in larger populations to broaden acceptance in routine clinical practice. Pharmacogenetic testing of polypharmacy patients aged 50 and older, supported by an appropriate CDST, considerably reduced re-hospitalizations and ED visits at 60 days following enrollment resulting in potent
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0170905