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Pharmacogenomics and ER Use

By February 17, 2017Commentary

I confess to having a weakness for science and in particular for genomic medicine, cell therapies and other personalized medicine advances.  But the field has taken a long time to show true clinical utility.  One of the first areas where some value is being provided to routine medical care is in pharmacogenomics–the use of a patient’s DNA expression patterns to guide drug therapies.  A study published in the Public Library of Science examines whether use of pharmacogenomics for home health recipients with multiple medications can help avoid admissions and ER use.  (PLOS Study)   The data source is somewhat limited–patient discharges to one hospital’s home health agency from February 2015 to February 2016.  Patients were randomized to either pharmacogenomic profiling or usual care.  In the intervention arm a pharmacist reviewed the pharmacogenomic data and provided recommendations to clinicians.   In the usual care group, pharmacists used standard medication management tools.

Pharmacogenomic analysis can give both general drug metabolizing information, which can help with dosing, and information relevant to specific classes of drugs, which can also help with dosing, and add information useful to avoiding potential drug interactions or other adverse events.  The intervention group had a third fewer readmissions after 30 days and less than half as many after 60 days.  In addition, there were about 40% fewer emergency room visits after both 30 days and 60 days.  The pharmacists gave 124 drug therapy recommendations to clinicians and 96 were followed.  Use of multiple medications is very common among the elderly in particular, and adverse drug events and other therapy problems and common and expensive to the system.  Better medication management is critical and pharmacogenomics clearly can play a role in achieving that.

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