In this study, we aim to evaluate the impact of PGx-guided therapeutic management of hyperpolypharmacy patients using a multidisciplinary approach at Maasstad hospital.
ID
Source
Brief title
Condition
- Other condition
Synonym
Health condition
polyfarmacie
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
This cross-sectional intervention study aims to situate comprehensive
PGx-guided therapeutic management in a clinical setting. To this end, we will
quantify the actionable DGIs in a clinical population. Actionable DGIs are
defined by the currently known literature (i.e. KNMP, DPWG, PharmVAR, CPIC, and
PharmGKB).
Secondary outcome
In addition, the secondary objectives of this study are to evaluate the
resulting pharmacotherapeutic optimizations and the adopted recommendations.
Background summary
Adequate therapeutic management of hyperpolypharmacy patients (concomitant use
of >= 10 drugs), improves patient outcomes. There is extensive evidence that
pharmacogenetic testing improves therapeutic management and therefore
therapeutic outcomes. Over the last 8 years, pharmacogenetic testing has
supported therapeutic management at the Maasstad hospital. In previous studies,
the clinical impact (ie. symptom improvements, reduction of side effects, and
rehospitalization rate) of single and selected combinatory pharmacogenetic
testing in psychiatry and primary care has been well described (1-4). However,
evaluation of comprehensive pharmacogenetic-guided (PGx-guided) therapeutic
management in a complex population, consisting of hospitalized multimorbid
patients with hyperpolypharmacy (concomitant use of >= 10 drugs), is limited.
Study objective
In this study, we aim to evaluate the impact of PGx-guided therapeutic
management of hyperpolypharmacy patients using a multidisciplinary approach at
Maasstad hospital.
Study design
A cross-sectional intervention study.
Intervention
A comprehensive PGx-guided medication review by a multidisciplinary team and
consultation by a clinical pharmacist.
Study burden and risks
Each clinical case will be reviewed by a multidisciplinary team.
Recommendations regarding drug selection and dosing options will be given based
on PGx results. The recommendations are not binding and clinicians can deviate
from the recommendations at all points. Included patients will be subjected to
comprehensive targeted PGx screening, using state-of-the-art technologies
including Illumina MiSeq sequencing. The PGx screening by blood test consist of
a 14-gene panel will examine the genetic variations in a broad spectrum of
relevant pharmacogenetics. One single blood draw will be performed next to
routinized blood tests and is therefore minimally invasive for the patient.
This study hypothesizes that due to the complexity of the hospitalized
population consisting of multimorbid and (hyper)polypharmacy patients,
PGx-guided medication review will optimize pharmacotherapy in >= 20% of the
cases, by providing informed rationales for drug selection and dosing options.
As a result of more adequate pharmacotherapy, this will improve patient
outcomes and in the course of time result in lower healthcare costs.
Maasstadweg 21
Rotterdam 3079 DZ
NL
Maasstadweg 21
Rotterdam 3079 DZ
NL
Listed location countries
Age
Inclusion criteria
- admission to Antes medical psychiatric unit or the internal medicine wards
of the Maasstad hospital
- age >= 18 years
- >= 10 systemic drugs (concomitant use)
- medication reconciliation at admission
- informed consent
Exclusion criteria
- previous whole genome genetic testing
- life expectancy < 6 months
- expected admission duration < 5 days (to facilitate acting upon the PGx
results)
- if the clinician considers the patient to be mentally incompetent in decision
making
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL82587.100.22 |