Dr. Christine E. Kistler of the UNC School of Medicine has dedicated her entire career to improving the care of older adults, especially those in nursing homes.
She said evidence suggests that two-thirds of nursing home residents in the United States experience an adverse event from a medication in any four-year period. One in seven of those adverse events leads to a hospitalization.
“Seeing the harms of adverse events from medications, I have wondered if pharmacogenomics might improve safe prescribing and reduce patient harm,” she said.
That’s where a team of researchers at the UNC Eshelman School of Pharmacy come in. Kistler, along with her colleague Adrian Austin, MD, MSCR, enlisted the help of Tim Wiltshire, Ph.D., and Daniel Crona, Pharm.D., Ph.D., CPP, from the School’s Division of Pharmacotherapy and Experimental Therapeutics.
With Kistler leading the way, the team will conduct a study called “The Feasibility of Using a Pharmacogenetic Assay in Nursing Home Residents to Reduce Adverse Events (FOGI-NH).” The PGx1 assay, developed by the Wiltshire lab, evaluates 23 genes in a patient to determine how they will respond to more than 100 drugs.
In the pilot study, Wiltshire said Kistler will collect about 50 saliva swabs from nursing home residents in the Triangle Area and have their genetic makeups analyzed. Wiltshire and Crona will then receive reports on each patient and cross-check those findings with the patient’s current medication list.
“Many are on multiple medications and are seen by so many physicians,” Wiltshire said. “By looking at the genetics of a person, you can tell what medications may or may not work for them. I think we are going to be surprised by the sheer number of medications people are on.”
Kistler will evaluate the ability to conduct a larger trial to examine the effectiveness of the study with nursing home residents and determine how it can be most effectively utilized in the nursing home setting.
“As a geriatrician and health services researcher, I am an expert in the care of older adults. I am not an expert in pharmacogenomics,” Kistler said. “Dr. Wiltshire and Dr. Crona understand the impact of genetics on medication safety. They help provide the pharmacologic and genetics background, while I provide an understanding of nursing home care and complex medical decision making. I could not do the work without them.”
The team’s work is being supported by a pilot grant from the UNC Program for Precision Medicine in Health Care, which aims to transform patient care through evidence-based precision medicine, and the North Carolina Translational and Clinical Sciences Institute at The University of North Carolina at Chapel Hill.
“I hope that someday an older adult might be admitted to a nursing home, have their pharmacogenomic profile analyzed within 48 hours, and their medications adjusted to safer doses as indicated by their individual genomics,” Kistler said. “The ability to tailor medication prescribing based on an individual patient’s genome could improve patient care immensely.”