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Precision health is wave of the future

Genetics, culture, even hobbies can help determine a course of treatment
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By Carole Jakucs, MSN, RN, PHN
EDITOR'S NOTE: Carole Jakucs, MSN, RN, PHN, is a freelance writer.
Seattle Children's believes in a workforce that mirrors the diverse communities it serves
"In precision health, we’re not just talking genetics … we’re also considering where a patient works and lives, what they eat, their hobbies.”
— Usha Menon, RN
When President Obama launched the Precision Medicine Initiative in 2016, dedicating more than $200 million for research into this area of medical science, the term "precision medicine" became more familiar for many people, including nurses. While precision health is a relatively recent concept, it is an area of continued scientific research that is correlated with precision medicine.
What is precision health?
Organizations and staff diving into precision health research have high hopes for accomplishing its objectives. "At Stanford, our vision of precision health is to, ‘Predict, prevent and cure precisely,’” Mahoney said. The goal is to precisely uncover the predictors of disease and the specific responses to treatments. “There are four components of the precision health program at Stanford — genomics, pharmacogenomics, digital health and community engagement,” Mahoney said.
Mahoney described genomics as using a patient’s genetic information to predict disease development and select the best course of prevention and treatment. Pharmacogenomics uses genetic information from a patient regarding their predicted response to medications, so the most effective ones are used for each patient and decreasing the incidence of adverse drug reactions, Mahoney said.
The use of digital health is multifaceted and involves the use of electronic health records, collecting and culling health data for individuals and populations, using technology for remote monitoring of specific conditions and for conducting patient outreach for testing and appointment reminders as some examples, she said.

Engaging communities where patients reside can help them reach their health-related goals, with group classes for diabetes education in an apartment building as an example, she said.
The goals of precision health
Megan Mahoney, MD
The National Institutes of Health said precision medicine is “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person.”

“Precision health focuses on the use of scientific research and genetic testing advances to predict what diseases will most likely occur in patients, then initiate and individualize interventions to prevent these diseases before they strike,” said Megan Mahoney, MD, chief of general primary care, division of primary care and population health, department of medicine at Stanford University. “We’re shifting the focus upstream, to promote health and well-being before a patient becomes ill.”
The science takes into account many aspects in addition to genetics.

“In precision health, we’re not just talking genetics and genetic testing and their influence with regards to a patient’s risk for developing diseases and how a patient responds to medications — we’re also considering where a patient works and lives, what they eat, their hobbies and how they play, their culture, and how these social determinants affect their health risks and health goals,” said Usha Menon, PhD, RN, FAAN, professor and associate dean of research and global advances, and co-principal investigator of the All of Us Research Program at the University of Arizona-Banner Health, and of the National Institutes of Health-funded precision medicine initiative. “With precision health, we tailor prevention, treatment and medication strategies and make them specific to each individual person.”
Menon said precision health research includes behavioral change research.

“We need to better understand who a person is and why they act a certain way,” she said. “This is important so patients can receive education and strategies unique to their situation, culture and set of conditions. If you’re working to encourage a type 2 diabetic to engage in 30 minutes of walking each day, then discover they live in a neighborhood not conducive to walking in the evening after coming home from work, you strategize to help them identify a safe place and time of day that works better for them to exercise.”
Menon said one example illustrating the concept of using precision health techniques are patients being treated for heart conditions. They will receive a specific set of medications and possibly a surgical intervention that is considered the gold standard of care.
For 99% of patients, this treatment plan will be effective and produce a positive outcome. However, for 1% of the patients receiving the same care, this treatment will not work. Why not? “Due to the genetic make-up of the 1% of patients, this group patients would have responded better to the second line of treatment consisting of a different set of medications,” Menon said.
Usha Menon, RN
Menon said improved patient outcomes are key. “When we are able to tailor treatment to individuals and utilize specific healthcare strategies, the patient outcomes are better and accomplished sooner," she said. "This leads to an improved quality of life for more patients which also translates into cost savings for the healthcare system. Improved patient outcomes generally result in shorter hospital stays, fewer hospitalizations and fewer clinic visits.”
Mahoney said precision health provides a window into a patient’s risk for developing a disease before it happens.

“Until now, we’ve come to rely on the analysis of large clinical trials to determine if a treatment is efficacious,” she said. “One example is research findings regarding which blood pressure medication is most effective for the greatest number of patients. Now, we understand that a patient’s genetic makeup will affect their response to medications, including their risk of experiencing adverse drug reactions.”
Mahoney said that at Stanford, the pharmacogenomics program has found that of the patients tested, 80%-90% have had findings that are clinically relevant.

Both Mahoney and Menon said nurses play a pivotal role in the implementation and practice of precision health. From patient teaching regarding prescribed therapies, assisting patients in tracking their health goals and helping patients understand their legal rights with genetic testing in research to patient advocacy, “The need for nurses it tremendous,” Menon said.
Editor’s note: Content courtesy of Seattle Children's.
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