Applicability of Pharmacogenomically Guided Medication Treatment during Hospitalization of At-Risk Minority Patients

Abstract

Known disparities exist in the availability of pharmacogenomic information for minority populations, amplifying uncertainty around clinical utility for these groups. We conducted a multi-site inpatient pharmacogenomic implementation program among self-identified African-Americans (AA; n = 135) with numerous rehospitalizations (n = 341) from 2017 to 2020 (NIH-funded ACCOuNT project/clinicaltrials.gov#NCT03225820). We evaluated the point-of-care availability of patient pharmacogenomic results to healthcare providers via an electronic clinical decision support tool. Among newly added medications during hospitalizations and at discharge, we examined the most frequently utilized medications with associated pharmacogenomic results. The population was predominantly female (61%) with a mean age of 53 years (range 19–86). On average, six medications were newly prescribed during each individual hospital admission. For 48% of all hospitalizations, clinical pharmacogenomic information was applicable to at least one newly prescribed medication. Most results indicated genomic favorability, although nearly 29% of newly prescribed medications indicated increased genomic caution (increase in toxicity risk/suboptimal response). More than one of every five medications prescribed to AA patients at hospital discharge were associated with cautionary pharmacogenomic results (most commonly pantoprazole/suboptimal antacid effect). Notably, high-risk pharmacogenomic results (genomic contraindication) were exceedingly rare. We conclude that the applicability of pharmacogenomic information during hospitalizations for vulnerable populations at-risk for experiencing health disparities is substantial and warrants continued prospective investigation.

Effect Modification by Social Determinants of Pharmacogenetic Medication Interactions on 90-Day Hospital Readmissions within an Integrated U.S. Healthcare System

“…Prescription medications are administered frequently during hospitalizations presenting an opportunity to modify/optimize drug treatment for patients, especially those that may have less access to the health care system and fewer health encounters with prescribing providers. In particular, one study within an African-American patient cohort showed that the time of hospital discharge may present a window of opportunity to evaluate prescribed pharmacogenomic medications and intervene to prevent adverse drug events amongst patient populations more likely to experience health disparities [ 9 ]. Related to pharmacogenomics implementation into clinical practice, it remains heavily debated whether race/ethnicity, which is frequently recorded in EHR’s, can appropriately proxy the range of experiences within and beyond the health system that might inform medical care and improve minority health [ 10 , 11 , 12 , 13 ].…”