Implementation of Pharmacogenomics and Artificial Intelligence Tools for Chronic Disease Management in Primary Care Setting.

Patrick Silva,Asim Abu-Baker,Kenneth Ramos,David Jacobs,Gabriel Neal,George Udeani,John Kriak

doi:10.3390/jpm11060443

Patrick Silva, Asim Abu-Baker + Show 5 more

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https://doi.org/10.3390/jpm11060443

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Abstract

Chronic disease management often requires use of multiple drug regimens that lead to polypharmacy challenges and suboptimal utilization of healthcare services. While the rising costs and healthcare utilization associated with polypharmacy and drug interactions have been well documented, effective tools to address these challenges remain elusive. Emerging evidence that proactive medication management, combined with pharmacogenomic testing, can lead to improved health outcomes and reduced cost burdens may help to address such gaps. In this report, we describe informatic and bioanalytic methodologies that integrate weak signals in symptoms and chief complaints with pharmacogenomic analysis of ~90 single nucleotide polymorphic variants, CYP2D6 copy number, and clinical pharmacokinetic profiles to monitor drug–gene pairs and drug–drug interactions for medications with significant pharmacogenomic profiles. The utility of the approach was validated in a virtual patient case showing detection of significant drug–gene and drug–drug interactions of clinical significance. This effort is being used to establish proof-of-concept for the creation of a regional database to track clinical outcomes in patients enrolled in a bioanalytically-informed medication management program. Our integrated informatic and bioanalytic platform can provide facile clinical decision support to inform and augment medication management in the primary care setting.

Highlights

The management of chronic diseases in the primary care setting often involves polypharmacy challenges that often drive considerable healthcare utilization and costs.While the term polypharmacy is used inconsistently in the literature [1], for the purposes of this report, we are making reference to clinical instances where five or more medications are used concurrently
Patients are not required to consent to the registry to receive the bioanalytic workup and medication management care; registry participation is optional and not a condition of care
The program entails a process of stepwise progression of electronic medical record analysis toward pharmacokinetic ground truth to inform primary care practitioners

Summary

Introduction

The management of chronic diseases in the primary care setting often involves polypharmacy challenges that often drive considerable healthcare utilization and costs.While the term polypharmacy is used inconsistently in the literature [1], for the purposes of this report, we are making reference to clinical instances where five or more medications are used concurrently. The management of chronic diseases in the primary care setting often involves polypharmacy challenges that often drive considerable healthcare utilization and costs. Analysis of the Observational Health Data Sciences and Informatics data set has documented that 10% of diabetes, 24% of hypertension and 11% of depression patients followed a treatment pathway that was unique among 250 million cases [2], yielding a daunting number of permutations in drug combinations. This increasing armamentarium necessitates individualized care plans, a challenging task for primary care practitioners managing complex patient populations. Reduced adherence to drug therapy regimens and heightened incidence of adverse drug reactions (ADRs) represent major challenges for polypharmacy patients, including at-risk patients with multiple comorbid conditions

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