- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04971902
Pharmacist-led Pharmacogenomic Clinical Service Within the Program of All-inclusive Care for the Elderly
Pharmacist-led Pharmacogenomic Clinical Service Within the Program of All-inclusive Care for the Elderly (PACE)
Study Overview
Status
Intervention / Treatment
Detailed Description
Tabula Rasa HealthCare (TRHC), doing business as CareKinesis, is the first national pharmacy that provides science-based medication risk identification and mitigation technologies and services. CareKinesis utilizes medication decision support tools and pharmacists certified in geriatrics to provide pharmacy services for various healthcare organizations including PACE organizations.
Program of All-inclusive Care for the Elderly (PACE) is a Medicare-Medicaid program that provides comprehensive medical and supportive services to individuals >55 years of age who are certified by their state as needing nursing home care. As an alternative to institutionalization, PACE helps these individuals live safely in their community. The aim of PACE is to improve overall quality of life in four domains (physical, psychological, social, and spiritual) using a multidisciplinary approach. In the United States, the vast majority of PACE organizations collaborate with one pharmacy to dispense drugs, in addition to other pharmacy services, for their population of participants.15 Presently, CareKinesis services more than 35 PACE organizations, including approximately 75 PACE sites, across the country. As a national PACE pharmacy provider since 2011, CareKinesis focuses on improving medication regimens to reduce medication-related risks while enhancing economic, clinical and humanistic outcomes.
Study Design Pharmacist-led pharmacogenomics (PGx) clinical services and medication safety reviews are currently being offered to PACE organizations under the direction of licensed healthcare prescribers by CareKinesis d/b/a Tabula Rasa HealthCare. This project aims to include patients enrolled in PACE organizations with chronic pain and who are prescribed CYP2D6 activated opioids. PGx testing will be performed by a contractual PGx vendor with TRHC. PGx results will be integrated into TRHC's proprietary Clinical Decision Support System (Medication Risk Mitigation™ Matrix, CareKinesis, Moorestown, NJ) that guides pharmacists to identify drug-drug interactions (DDIs), drug-gene interactions (DGIs), and drug-drug-gene interactions (DDGIs).16 Clinical pharmacists will translate PGx results combined with a comprehensive DDI review into actionable clinical decisions. Clinical pharmacists will provide medication therapy management recommendation to address medication problems to the PACE prescriber (physician). PACE prescribers will review the pharmacist's recommendation, and based on their clinical assessment, the prescriber will decide whether or not to implement the opioid therapy recommendation.
The measurement of health-related quality of life (QoL) and pain assessment using the EQ-5D survey, and numerical rating scale (NRS) for pain will be performed during the study by PACE prescribers or the PACE interdisciplinary team (IDT) as follows:
- Health-related quality of life questionnaire (EQ-5D) will be performed at baseline and at the completion of the study (visits 1 and 3, respectively)
- NRS for pain will be performed at baseline (before the PGx testing), 1-2 and 2-3 weeks after TRHC's pharmacist recommendations (visits 1, 2 and 3, respectively) All PACE patients will continue to receive usual medical care throughout the study. Changes to drug regimens will be at the discretion of the patients' PACE prescribers.
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Locations
-
-
Florida
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Orlando, Florida, United States, 32827
- Tabula Rasa HealthCare Precision Pharmacotherapy Research and Development Institute
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Patient enrolled in a PACE organization during the implementation period; and,
- PACE organization contractually receiving pharmacy services from CareKinesis
- Patient prescribed a CYP2D6 activated opioid, namely codeine, hydrocodone, oxycodone and/or tramadol
- Patients with chronic non-cancer pain (CNCP)
- Patient's prescriber orders a PGx test based upon his/her determination that the patient could potentially benefit from PGx testing
- Patient is able to read, understand, and provide informed consent to participate
Exclusion Criteria:
- Patient prescribed an opioid that is not metabolized by CYP2D6 including, but not limited to, oxymorphone, morphine, hydromorphone
- Have taken an investigational product in the last 30 days
- Current use of illicit substances
- Immediate family members of site staff, or site staff may not be enrolled in the study without first obtaining IRB authorization
- Any other medical, cognitive or physical abnormality, disease, or disorder that would prohibit the patient from completing study procedures in the judgement of the investigator
Study Plan
How is the study designed?
Design Details
- Observational Models: Case-Control
- Time Perspectives: Prospective
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Measure the feasibility of Clinical Decision Support System (MedWise(TM)) for CYP2D6 opioid prescription and PGx recommendations by usability and acceptability through physician and pharmacist questionnaire.
Time Frame: 6 months
|
Quantitative data reported via survey
|
6 months
|
Measure the feasibility of Clinical Decision Support System (MedWise(TM)) for PGx recommendations by acceptability through physician and pharmacist questionnaire.
Time Frame: 6 months
|
Quantitative data reported via survey
|
6 months
|
Measure the feasibility of Clinical Decision Support System (MedWise(TM)) for PGx recommendations by usability through physician and pharmacist questionnaire.
Time Frame: 6 months
|
Quantitative data reported via survey
|
6 months
|
Analyze patient medication information for PGx- and DDI-guided recommendations using MedWise(TM) a proprietary clinical decision support system by Tabula Rasa HealthCare.
Time Frame: 6 months
|
Quantitative (software is proprietary and patented)
|
6 months
|
Analyze clinician uptake of PGx- and DDI-guided recommendations using MedWise(TM) a proprietary clinical decision support system by Tabula Rasa HealthCare.
Time Frame: 6 months
|
Quantitative (software is proprietary and patented)
|
6 months
|
Validate patient QOL questionnaire for disease-related information
Time Frame: 6 months
|
Quantitative data measured by percentage of improvement for DDI-guided recommendations based on PGx results
|
6 months
|
Validate patient QOL questionnaire for pharmacogenetics information
Time Frame: 6 months
|
Quantitative data measured by percentage of improvement for DDI-guided recommendations based on PGx results
|
6 months
|
Validate patient QOL questionnaire for medication-related information, and pharmacogenetics information
Time Frame: 6 months
|
Quantitative data measured by percentage of improvement for DDI-guided recommendations based on PGx results
|
6 months
|
Validate patient QOL questionnaire for socio-demographics
Time Frame: 6 months
|
Quantitative data measured by percentage of improvement for DDI-guided recommendations based on PGx results
|
6 months
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Veronique Michaud, PhD, Tabula Rasa HealthCare
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- PGX-PACE-2020-001
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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