Application of Pharmacogenomics Testing in a Community-based Facility.

This study was designed to examine the use of pharmacogenomics (PGx) testing in a community-based facility, the adoption of the PGx recommendations by providers, and assess challenges and opportunities for pharmacists in using PGx testing in a real-world setting. This was a retrospective study involving chart reviews of 137 patients with mood disorders who underwent PGx testing between September 2017 and December 2017. Eighty-seven patients who met inclusion and exclusion criteria were analyzed to evaluate the impact of PGx testing on psychotropic medication treatment and to evaluate the PGx test process. PGx test results were used by providers to guide their therapeutic modifications based on the gene-drug interactions identified. Patient medication use increased from 125 to 190 (P < .001) prescriptions. Patient medication belonging to no gene-drug interaction significantly increased from 46.4% to 87.4% (P < .001), medications belonging to moderate and significant gene-drug interaction decreased from 32.8% to 7.9% (P < .001) and 11.2% to 2.1% (P = .012), respectively. 88.5% of patients' psychotropic medication treatment after PGx testing was consistent with the PGx test report recommendations. The PGx test lengths of time analysis indicated that patient follow-up exceeded the standard time set by guidelines at multiple steps in the test process. There are multiple opportunities for pharmacists to become involved in the PGx testing process to improve patient care.

Non-fatal disease burden associated with excess body mass index and waist circumference in New Zealand adults.

OBJECTIVE: To describe the relationship between two measures of body fat and selected non-fatal health conditions in the New Zealand adult population in 2003. METHOD: Data were obtained from the 2002/03 New Zealand Health Survey. A total of 10,026 adults aged 25 years and over were classified according to measured body mass index (BMI) and waist circumference (WC). BMI classes were 18.5-24.9, 25.0-29.9, 30.0-34.9, > or = 35.0 kg/m2. WC classes were < 94, 94-102, > 102 centimetres (cm) for males and < 80, 80-88, > 88 cm for females. Prevalence rate ratio estimates for selected self-reported health conditions were calculated for males and females separately, adjusting for age, ethnicity, deprivation and smoking using logistic regression. RESULTS: Increasing BMI or WC class was associated with increasing prevalence of cardiovascular disease, diabetes, high blood pressure, high blood cholesterol, osteoarthritis, asthma and sleep disorders in both males and females. The association with depression was not statistically significant in either gender. Associations were strongest for diabetes and blood pressure, with adults in the highest BMI or WC class at least 3.5 times more likely to have diabetes and 2-3 times more likely to have high blood pressure compared with those in the lowest classes. CONCLUSIONS: Increasing body fatness, defined by either BMI or WC, was associated with increased prevalence of many important health conditions. If the obesity epidemic is not halted or reversed, the impact on both the New Zealand population and health system will be considerable.

Debunking the 'only 50%' myth: prevalence of established risk factors in New Zealanders with self-reported ischaemic heart disease.

OBJECTIVE: To estimate the prevalence of established risk factors for ischaemic heart disease (IHD) in New Zealand adults and compare the prevalence in adults with and without this disease. DESIGN: Data were obtained from the 2002/03 New Zealand Health Survey. Risk factor prevalence was determined by: self-reported doctor diagnosis of high blood pressure, high cholesterol and diabetes; self-report of smoking and physical inactivity; and measurement of obesity. Presence of IHD was based on self-report of heart disease (doctor diagnosed at age 25 years or over) together with current medical or past surgical treatment for this disease. Multiple logistic regression was used to determine prevalence rate ratios (PRRs) for males and females separately, adjusting for age, ethnicity and deprivation. RESULTS: The overall prevalence of IHD was 8%. Overall risk factor prevalences were in the range of 20-25% for each of high blood pressure, high cholesterol, smoking, obesity and physical inactivity, and approximately 5% for diabetes. Overall, 94-97% of adults with IHD had at least one risk factor (depending on how smoking was defined). The PRRs of IHD were highest for cholesterol (about 4.5), followed by blood pressure (about 2.3), with all other risk factors around 1.5. PAF estimates indicate that 80-85% of IHD was attributable to the presence of at least one risk factor for all age, gender and ethnic groups. CONCLUSIONS: Established risk factors account for 80-85% of the non-fatal burden of IHD in New Zealand. Limited research resources would be better used to evaluate which interventions are effective and efficient at reducing exposure of all population groups to known risk factors, rather than on identification of additional risk factors.