(P33) Combinatorial Pharmacogenomic Testing a First Step to Reducing Polypharmacy

Objective/Aim:The aim of this quality improvement is to utilize a combinatorial pharmacogenomic (PGx) test to identify residents with actionable gene-drug interactions, gaps in provider knowledge about PGx testing, and best practices for implementing PGx testing to reduce polypharmacy in a long-term care (LTC) setting.

Background: Polypharmacy is common among older adults in LTC settings and may increase the risk of patient falls, harmful drug-drug interactions, adverse side effects, functional impairment, and hospitalizations. The strategic framework to combat polypharmacy, developed as part of the WHO Medication Without Harm Global Patient Safety Challenge, includes education and training for healthcare professionals, patient engagement, and getting the right medication at the point of care. PGx testing may be a useful tool to help APRNs treating geriatric patients reduce polypharmacy by providing information about how genetic variation may impact the efficacy, risk of side effects, or dosing requirements for certain medications.

Quality Improvement

Methods: Utilized three long term care facilities in Ohio. A PGx test that provides information about how genetics may impact outcomes for certain antidepressants, anxiolytics, hypnotics, antipsychotics, mood stabilizers, stimulants, and non-stimulants was used. Cheek swab DNA samples were collected from 69 patients and sent to a CLIA and CAP accredited lab for analysis using a targeted genotyping approach. The PGx test report provides potentially clinically actionable information by categorizing medications based on the predicted impact of gene-drug interactions on clinical outcomes.

Results: Of the 69 patients, 40% were male and 60% were female. Patient age range was 51 to 96 with an average of 73.5 years. Current medications for 64% of the patients fell into a clinically actionable category (Moderate or Significant Gene-drug Interaction). An interprofessional team of APRNs, psychiatrists, physicians, pharmacists, and nurses reviewed patient medication profiles and PGx test results to determine the most appropriate medication adjustments.

Conclusions: PGx testing may be a valuable tool to assist healthcare providers in providing personalized care, safe medications, and reducing polypharmacy in geriatric populations in the LTC setting. Interdisciplinary teams are required to obtain, interpret, and apply PGx testing results to patient medication management. Better education and training for APRNs as well as a systematic work flow is essential to understand PGx science and implementation in the LTC setting. This PGx testing approach will be replicated at other LTC facilities using the plan-do-study-act approach. Future PGx testing could be expanded beyond psychotropic medications to improve patient care and safety across other therapeutic areas with recognized gene-drug interactions.