事件记录
面试官: 通过基因检测来管理药物，下一期《大发娱乐》.
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面试官: 我正在和医生谈话. 戴安娜Brixner, Professor of Pharmacotherapy and Director of the Outcomes Research Center, and Director of Outcomes for the Programs and Personalized Health at the University of Utah. I wanted to talk today about a study that you led recently looking at the elderly who, amazingly, 平均每年至少服用14种处方药. 对此有哪些担忧?
Dr. Brixner: 大发娱乐每个人都有不同的药物代谢酶, 这将对药物的数量产生影响, in fact, 代谢. 你们可以想象, in individuals where you are not aware of what the drug metabolizing enzymes can do, 你可能会给一个人用药不足或过量. 这可能会导致药物不良反应. It could also lead to increased drug interactions where two drugs may be overactive where you did not anticipate that.
老年人, they do, in fact, 多吃点药, 因为他们服用了更多的药物, then the risk of drug-drug interactions or drug-gene interactions between the drugs that are on is much higher. 因此, using a test to determine their variants in drug metabolizing enzymes can be very valuable.
面试官: 你对他们做了什么测试? 我是说，这不仅仅是一次测试.
Dr. Brixner: 是的，这就是这个产品非常有趣的地方. 这是测试的组合, 这是通过口腔拭子来完成的吗, 然后基因分析在经过认证的实验室进行. But the results of that test then are run through a clinical decision support tool, and the combination of the test and the support tool is called YouScript, 由西雅图Genelex公司生产.
And what the clinical decision support tool does is it takes in account not only the drugs susceptible to these enzymes, 但事实上, 病人服用的所有药物. 因此，你可以得到一个非常完整的药物-药物相互作用的图像, 药物-基因相互作用和药物-药物-基因相互作用. 让我给你举个例子, 如果病人服用的药物有相互作用, 然后有一种药物代谢酶影响另一种药物, it's very likely that that could lead to a drug-drug interaction you would not have ordinarily expected without knowing the genetic information from the patient.
面试官: And so, by taking together the results of the test with the results of this clinical support tool, you can modify somebody's drug regimen based on what you think will be least likely to have adverse reactions for that patient?
Dr. Brixner: Yes, 这就是最终的想法, and that, again, 回到临床药师的概念上来, and the role that the clinical pharmacist can play in actually interpreting the results of the clinical decisions support tool with the provider and the patient, to then make the appropriate modifications in their therapy regimens so that the patient gets the best benefit with the least exposure to adverse events.
面试官: 所以你从这项研究中得到了一些非常惊人的结果.
Dr. Brixner: 大发娱乐的发现是, 在被测试的小组中, there were significantly lower emergency department visits and hospitalizations than in the group that was matched and not tested. What's interesting is that we also saw actually an increase of outpatient visits in the patients that were tested, 这在一开始是违反直觉的. However, when you think about it, in fact, these results make a lot of sense. 如果病人提前接受检测, it's likely that patients would come in to the provider and have additional outpatient visits then, 不仅要回顾结果, 但要对他们的治疗方案做出适当的改变.
面试官: And the decrease in hospitalizations and emergency department visits that you saw actually took place over a pretty short follow-up period, right?
Dr. Brixner: 是的，这是一个非常有趣的问题. 大发娱乐的研究观察了四个月的随访. And, in fact, 大发娱乐现在正在研究9个月的数据, and we would anticipate that the impact of the savings would be even greater at nine months out to a year, 诚然，存在一个没有额外储蓄的点. 但另一个有趣的地方是，你只需要测试一次, 然后这些信息就可以放进老年病人的档案里, 然后当他们研发新药的时候, 或者在他们的余生中改变药物, 这些信息可用于指导适当的治疗.
面试官: 你还谈到了储蓄. 你是说节约成本吗？?
Dr. Brixner: 节省下来的钱是, in fact, 有检测费用和临床决策支持, but there is also then cost savings by the emergency department visits and hospitalizations avoided. 大发娱乐所做的就是用一些国家成本数据来证明, in fact, the majority of the cost of the test is offset by the savings and fewer emergency department visits and hospitalizations.
面试官: 这是一个测试, 此时此刻, 可能不包括在大多数保险政策中, 或者至少是医疗保险, 这些病人大多会和谁在一起.
Dr. Brixner: And that was exactly why we set out to do this study in the first place. It is a very dynamic environment right now with when looking at how data should be considered for making reimbursement decisions around diagnostic tests. 这包括大发娱乐今天要讨论的测试, 先发制人的药物遗传学检测, 以及靶向药物治疗的基因检测. It's a different process to look at reimbursement for diagnostic test than it is for drugs. And Medicare and other insurance companies are struggling with how this evidence should be evaluated.
Our hope was to generate enough evidence that would look potentially favorably at the inclusion of this type of a test and clinic decision support tool in managing elderly patients on several drugs or polypharmacy, that we would then go ahead and validate our findings in a larger prospective randomized trial design. 这正是大发娱乐正在进行的研究, based on our preliminary results to demonstrate the validity of our results in a unified population within one health care system.
面试官: 你对这类工作的发展有什么希望?
Dr. Brixner: 这个问题问得好. What I would love to see is that when we do the validation study that we see trends along the same line as what we saw with our preliminary results. I then think it would really be worth considering that when the elderly come in for their annual well visit, 因为他们进入了医疗保险体系, 他们应该, in fact, 这个测试做过一次吗, 这样他们的档案就能指导他们未来的治疗方案. To me this would be a great step forward in improving care for the elderly, and greater involving clinical pharmacists in the role of medication management.
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