Healthy Ageing Pharmacogenics and Polypharmacy
The use of 3 or more prescribed medications is called polypharmacy. Pharmacogenetics is the study of how genes affect an individual’s response to drugs and aims to provide information to improve safety and effectiveness of drug treatment. This project aims to demonstrate the clinical utility and assess the health economic benefit of pharmacogenetic analysis in general practice for patients over 50 years of age taking 3 or more medicines.
About the project
The use of 3 or more prescribed medications is called polypharmacy. In seniors (people \>65 years) the percentage taking 5 or more medications in the UK during the period 1991-2011 almost quadrupled from 12% to 47%. Multiple co-morbidities increase the likelihood of hospital admission, length of stay and likelihood of readmission, raises healthcare costs, reduces quality of life and increases dependency and mortality. Medication-related harms are a significant public health risk in the older population. There are an estimated 237 million “medication errors” per year (NHS England), with 66M of these potentially clinically significant. “Definitely avoidable” adverse drug reactions collectively cost ~£100 million annually, contribute to ~1700 deaths per year and are directly responsible for an additional ~700 deaths per year.
In an ageing population, polypharmacy is frequently associated with adverse drug reactions, falls risk and increased impairment in cognitive, physical and emotional capability and decreased quality of life. Several drug classes are reproducibly associated with fall risk: these drug classes include sedatives, antidepressants, antipsychotics and anti-Parkinson’s drugs. Falls are the largest cause of emergency hospital admissions for older people; in 2017/18 there were around 218,000 emergency hospital admissions related to falls among patients aged 65+. The total cost of fragility fractures to the UK each year has been estimated at £4.4 billion.
Pharmacogenetics is the study of how genes affect an individual’s response to drugs and aims to provide information to improve safety and effectiveness of drug treatment. In a large study of \>7.7 million veterans in the USA, it was projected that 99% of pharmacy users would carry at least 1 actionable pharmacogenetic variant leading to a change in prescribing action.
This project aims to demonstrate the clinical utility and assess the health economic benefit of pharmacogenetic analysis in general practice for patients over 50 years of age taking 3 or more medicines. We will use the outputs to inform the development of a scalable, healthcare system integrated clinical decision support (CDS) platform that uses pharmacogenetics data in polypharmacy patients. The CDS will identify actionable interventions and alert healthcare professionals to implement changes in prescribing (alternative medications, changes in drug dosing) as well as evaluate the effectiveness of medications that could lead to de-prescribing. We will use qualitative and quantitative methods to assess benefits to patients including number of adverse reactions and medication errors, number of falls, hospital admissions and GP visits and improvements in mental and physical well-being