Abstract
Objectives
Assess the potential benefits of identifying drug-gene interactions in nursing home
(NH) residents on multiple medications. Reduce the use of high-risk medications for
residents with reduced drug metabolism.
Design
Open-label, nonrandomized, mixed methods study.
Setting
Four NHs in Ontario.
Measurements
Potential drug therapy problems (DTPs) for study cohort were identified during a medication
review by a pharmacist using pharmacogenetic (PGx) clinical decision support to identify
medication change opportunities. The number of DTPs identified during a standard medication
review was compared with the number of DTPs identified with a PGx clinical decision
support. Analysis of medication dispensing data at enrollment compared with dispensing
in a 60-day window following medication review were compared for the PGx-tested study
cohort with controls.
Results
Prescription patterns of 90 study participants were compared with 895 controls for
the same time period. Study participants were on 7 to 47 drugs, of which drugs with
PGx indications ranged from 1 to 17 medications. The average medication load was 4.6
medications with PGx indications per person, whereas the controls were on 3.5 PGx
drugs. Furthermore, 94% of cases and 84% of controls were on 2 or more drugs with
PGx indication during the study period. Pharmacogenetic analysis identified 114 distinct
DTPs in the 90 study participants, of which 29 were classified as serious. In this
study, over 35% of residents were treated with antidepressants; of these, 64% have
altered CYP2C19 or CYP2D6 metabolism and could benefit from drug dose adjustment or
from a switch to alternative antidepressants. Twenty percent of residents were treated
with hydromorphone, of which 30% have reduced response to opioids because of variations
in the OPRM1 gene.
Conclusions and Implications
This study demonstrated the clinical potential of PGx-based medication optimization
for NH residents, impacting the management of depression, chronic pain, heart disease,
and gastrointestinal symptoms.
Keywords
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Article info
Footnotes
This project was supported by Center for Aging Brain Health Innovation (CABHI) funding. RD, GM, and BK are employees and equity holders at GeneYouIn Inc, provider of Pillcheck pharmacogenetic testing. ZL and MM are clinical pharmacists employed at Think Research, provider of Order Sets deployed across Ontario nursing homes, including the 4 participating sites. Publication and data sharing policies were adhered to in this study.
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
