Towards implementation of pharmacogenomic-guided medicines optimisation for older patients in secondary care
David, Victoria
David, Victoria
Publication Date
End of Embargo
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The University of Bradford theses are licenced under a Creative Commons Licence.
Peer-Reviewed
Open Access status
Accepted for publication
Institution
University of Bradford
Department
School of Pharmacy and Medical Science. Faculty of Life Sciences
Awarded
2023
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Additional title
A mixed-methods exploration of the potential use of pharmacogenomics with patients and healthcare professionals
Abstract
This research explores the potential of pharmacogenomic (PGx)-guided care for older patients in secondary care. Using a mixed methods approach, the study demonstrates the efficacy of PGx-guided care for patients aged 65 and above, identifies behaviour change techniques for healthcare professionals to successfully adopt PGx-guided medicines optimisation, and paves the way for future implementation strategies. The research adopted a convergent parallel design, comprised of a systematic review, secondary data analysis of hospital admissions data for older patients and a qualitative interview study with older patients and healthcare professionals. This research provides a proof-of-concept for the use of PGx testing in medicines optimisation, leading to a potential decrease in hospitalisations. Notably, the research showed that 22% of medicines that older hospitalised patients use are PGx-influenced, and exposure to such medicines can help predict the length of hospital stay, unplanned admission and repeat hospitalisation, especially among highly frail patients. The study identified factors critical for implementing PGx, including knowledge, role identity, optimism, intentions, context, and capability beliefs. It highlighted prioritised change techniques such as information about health consequences, behaviour instruction, social support, and outcome goal review as essential guides for PGx champions driving implementation efforts in hospital settings. These findings significantly enhance the understanding of PGx's role in geriatric medicine, providing strategies to overcome potential barriers and suggesting necessary alterations to facilitate its implementation. The study underscores the potential of PGx-guided care to enhance medicines optimisation for older individuals, offering valuable insights to shape policy, practice, and direct future research in this field.
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Type
Thesis
Qualification name
PhD