Abstract
BackgroundIn 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.Methods and findingsThis 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.ConclusionsPharmacogenetic 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 potential health resource utilization savings and improved healthcare.Trial registrationClinicalTrials.gov NCT02378220
Highlights
In 2013, Home Health Agencies (HHAs) provided services to about 3.5 million Medicare beneficiaries, and Medicare spent about $18 billion on home health services [1]
Pharmacogenetic testing of polypharmacy patients aged 50 and older, supported by an appropriate clinical decision support tool (CDST), considerably reduced re-hospitalizations and emergency department (ED) visits at 60 days following enrollment resulting in potential health resource utilization savings and improved healthcare
They are common among polypharmacy patients taking multiple medications and can cause adverse drug reactions (ADRs), which are adverse drug events (ADEs) at normal doses for approved uses
Summary
In 2013, Home Health Agencies (HHAs) provided services to about 3.5 million Medicare beneficiaries, and Medicare spent about $18 billion on home health services [1]. Most patients receiving home health care are elderly, take multiple medications, and experience poor compliance due to a number of issues, primarily adverse drug events (ADEs) This often leads to emergency department (ED) visits, re-hospitalizations, and decreased quality of life. Medication-related problems are defined as circumstances during drug treatment that or potentially interfere with optimal care outcomes [2] They are common among polypharmacy patients taking multiple medications and can cause adverse drug reactions (ADRs), which are adverse drug events (ADEs) at normal doses for approved uses. 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
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