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Individualized Medication Management in Ontario Long-Term Care Clinical Impact on Management of Depression, Pain, and
Ruslan Dorfman1, Zana London2, Mark Metias2
1GeneYouIn Inc, Toronto, Ontario, Canada; Department of Anesthesia, McMaster University Hamilton, Ontario, Canada.
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.
Insights
Pharmacogenetic (PGx) testing identified significant drug therapy problems in nursing home residents, enabling personalized medication adjustments. This approach optimizes treatment for conditions like depression and chronic pain.
Area of Science:
- Pharmacogenomics
- Geriatric Pharmacy
- Clinical Decision Support
Background:
- Nursing home residents often have multiple medications, increasing the risk of drug therapy problems (DTPs).
- Identifying drug-gene interactions can personalize medication regimens, particularly for individuals with altered drug metabolism.
Purpose of the Study:
- To assess the benefits of pharmacogenetic (PGx) testing in identifying DTPs in nursing home residents.
- To reduce high-risk medication use in residents with impaired drug metabolism.
Main Methods:
- An open-label, nonrandomized study was conducted in four Ontario nursing homes.
- Pharmacists used PGx clinical decision support during medication reviews to identify potential DTPs.
- Medication dispensing data of study participants were compared with controls.
Main Results:
- PGx analysis identified 114 distinct DTPs in 90 participants, with 29 classified as serious.
- Over 35% of residents on antidepressants had altered CYP2C19 or CYP2D6 metabolism, suggesting a need for dose adjustment or alternative medications.
- 30% of residents on hydromorphone showed reduced opioid response due to OPRM1 gene variations.
Conclusions:
- Pharmacogenetic-based medication optimization shows clinical potential for nursing home residents.
- This approach can improve the management of depression, chronic pain, heart disease, and gastrointestinal symptoms in this population.
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