pharmacogenetic testing among home health patients

Conditions: Adverse Drug Events; Adverse Drug Reactions; Drug Interaction Potentiation; Drug Metabolism, Poor, CYP2D6-RELATED; Drug Metabolism, Poor, CYP2C19-RELATED; Cytochrome P450 Enzyme Deficiency; Cytochrome P450 CYP2D6 Enzyme Deficiency; Cytochrome P450 CYP2C9 Enzyme Deficiency; Cytochrome P450 CYP2C19 Enzyme Deficiency; Cytochrome P450 CYP3A Enzyme Deficiency; Poor Metabolizer Due to Cytochrome P450 CYP2C9 Variant; Poor Metabolizer Due to Cytochrome p450 CYP2C19 Variant; Poor Metabolizer Due to Cytochrome P450 CYP2D6 Variant

Summary: patients meeting eligibility criteria will be randomized into two groups, one receiving pharmacogenetic testing and the other not receiving pharmacogenetic testing. in this open-label trial, a pharmacist will make medication therapy recommendations using youscript® personalized prescribing system for patients who receive genetic testing and standard drug information resources per usual for patients who do not undergo pharmacogenetic testing.

both groups will be followed for 60 days. the number of re-hospitalizations and emergency department (ed) visits will be recorded as well as time to first re-hospitalization and time to first ed visit. select outcome and assessment information set (oasis) metrics (e.g. m1034, m1242, m1710, m1720, m1745, m2110) and patient health questionnaire (phq)-2 will be evaluated and documented at time of admission to home health, at 30 days, and at 60 days for improvement in overall status, pain, confusion, anxiety, depression, disruptive behavior, and the need for assistance with activities of daily living (adls) and instrumental activities of daily living (iadls). the number of falls will be collected as well as the proportion of youscript® recommendations accepted by study pharmacist and passed on to clinicians and the proportion of recommendations accepted by clinicians.

Eligibility criteria:
inclusion criteria: * age 50 or older. * willing and able to provide informed consent for study participation either directly or by a legally authorized representative (lar). * presently taking or beginning treatment with at least one of the following oral forms of medication (excluding medications taken prn) (generic name given with major u.s. brand name given in parentheses). these medications are subject to significant drug-gene interactions as defined by fda boxed warning, fda cautionary labeling, clinical literature or a youscript® algorithm-predicted significant effect: amitriptyline (elavil), aripiprazole (abilify), atomoxetine (strattera), carvedilol (coreg), celecoxib (celebrex), citalopram (celexa), clobazam (onfi), clomipramine (anafranil), clopidogrel (plavix), clozapine (clozaril), codeine \[tylenol #3 (combo)\], desipramine (norpramin), dextromethorphan (delsym), diazepam (valium), doxepin (sinequan), escitalopram (lexapro), esomeprazole (nexium), fesoterodine (toviaz), flecainide (tambocor), fluoxetine (prozac), flurbiprofen (ansaid), fluvoxamine (luvox), haloperidol (haldol), hydrocodone , ibuprofen (motrin), iloperidone (fanapt), imipramine (tofranil), indomethacin (indocin), meloxicam (mobic), metoprolol (toprol xl), mexiletine (mexitil), nortriptyline (pamelor), omeprazole (prilosec), oxycodone (oxycontin), paroxetine (paxil), perphenazine (trilafon), phenobarbital (luminal), phenytoin (dilantin), pimozide (orap), piroxicam (feldene), proguanil \[(malarone (combo)\], propafenone (rythmol), propranolol (inderal), risperidone (risperdal), sertraline (zoloft), tetrabenazine (xenazine), thioridazine (mellaril), timolol (apotimol), tolterodine (detrol), torsemide (demadex), tramadol (ultram), trimipramine (surmontil), venlafaxine (effexor), voriconazole (vfend), vortioxetine (brintellix), warfarin (coumadin). exclusion criteria: * previous cyp testing (cpt codes 81225, 81226, 81227, 81355, 81401) * history of organ transplant (199.2; 238.77; 414.06; 414.07; 996.80-996.89; e878.0; v42.0-v42.7; v42.81-v42.84; v42.89; v42.9; v45.87; v49.83; v58.44) * current malabsorption syndrome (579.0), including the following: intestinal malabsorption (579.8, 579.9), postoperative malabsorption (579.3), or short bowel syndrome (579.3) * treatment of invasive solid tumors or hematologic malignancies in the last year, excluding in situ cancers or non-melanoma skin cancer (basal cell carcinoma) * end stage renal disease (esrd) * persistent acute renal failure: complete loss of kidney function \>4 weeks (requiring dialysis) * renal failure by: glomerular filtration rater (gfr): scr \> 3 times baseline or gfr decreased 75% or scr ≥4 mg/dl; acute rise ≥0.5 mg/dl; or urine output (uo): uo \< 0.3 ml/kg/h 24 h (oliguria) or anuria 12 h.

Keywords: home care agencies home health care agencies home health care nursing home health nurses cyp 2d6 cyp 2c9 cyp 2c19 cyp 3a4 cyp 3a5