129 United States Emergency Department Use of Medications with Pharmacogenetic Recommendations

Abstract

A number of medications have pharmacogenetic recommendations indicating more or less effectiveness of a drug depending on the patient’s genotype. Up to 35% of patients may have a relevant genotype. We sought to determine via a cross sectional analysis the proportion and associated characteristics of emergency department (ED) visits that would be impacted by medications with pharmacogenetic recommendations. We used data from the 2010-2015 National Hospital Ambulatory Medical Care Survey (NHAMCS), to estimate the number of ED visits in which there was an order for at least one medication with Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines with evidence of Level A or B, indicating potentially altered dosing or drug recommendations. We examined demographic and clinical information, reasons for visit, and ED and hospital diagnoses, and calculated national-level estimates (95% confidence intervals [CI]) of these characteristics. From a total of 165,155 entries representing 805,726,000 United States (US) ED visits in the 2010-2015 National Hospital Ambulatory Medical Care Survey (NHAMCS), there were 148,243,000 ED visits (18.4%) in which medications with CPIC guidelines recommendations were ordered. The most common CPIC medication was tramadol (6.3%) (Table 1). Visits involving CPIC medications had significantly higher proportions of patients who were female, had private insurance and self-pay, and were discharged from the ED. They also involved significantly lower proportions of patients with Medicare and Medicaid. Almost 1 in 5 US ED visits involve a medication with a pharmacogenetic recommendation. Acute care systems should consider means to provide decision support to optimize such pharmacological therapy.Tabled 1Top 10 Most Common ED Medications with CPIC GuidelinesMedicationCPIC Guideline LevelEstimate (95% CI)Weighted Patient # (in 1000s)Any CPIC Medications18.4% (17.6%, 19.2%)148243TRAMADOLA6.3% (5.9%, 6.6%)50575ONDANSETRONA4.0% (3.6%, 4.4%)32223OXYCODONEA3.5% (3.0%, 3.9%)27847LIDOCAINEB3.0% (2.8%, 3.2%)24336CODEINEA1.0% (0.9%, 1.1%)8381OMEPRAZOLEB0.6% (0.5%, 0.6%)4526PANTOPRAZOLEB0.5% (0.4%, 0.6%)4241CIPROFLOXACINB0.5% (0.4%, 0.6%)4147SULFAMETHOXAZOLE/TRIMETHOPRIMB0.3% (0.3%, 0.4%)2650CPIC assigns CPIC levels to gene/drug pairs (A, B, C, and D) representing the strength of evidence. Open table in a new tab