ஆராய்ச்சி மற்றும் மேம்பாட்டு இதழ்
திறந்த அணுகல்
ஐ.எஸ்.எஸ்.என்: 2311-3278
ஐ.எஸ்.எஸ்.என்: 2311-3278
Sergey Suchkov
Healthcare delivery is transitioning away from a volume-based reimbursement model to an efficiency-and-quality-oriented model. The balance among huge quality, evidence-based and value-based care is posing a challenge for healthcare systems. Reducing the risk of patient harm throughout the process of healthcare delivery is at the forefront of policy and practice. The current health care model is in a political, financial and social crisis. Personalized and Precision Medicine (PPM) provides an opportunity to reframe and reassess the control over patient morbidity, mortality and disabling outcome rates as well as significantly optimize the cost and efficacy of treatment for those who have fallen ill. PPM is a latest model of healthcare services that illustrates how we can apply new sets of thinking for the population, community, and individual citizen. Implementing a PPM framework into the daily practice of a complex healthcare care delivery system requires a new strategy based upon subclinical and/or predictive recognition of biomarkers for the hidden imbalances and defects long before the illness manifests clinically. This prevention strategy offers an opportunity to implement preventive, prophylactic, therapeutic and rehabilitative measures to help drive care improvement and patient-centered outcomes while the reducing costs of care. PPM can assist in forecasting, predicting and ultimately preventing diseases. PPM is rooted in the new sciences generated by the achievements of Systems Biology and Translational Medicine (TraMed) PPM integrates and consolidates the platforms of OMICS (basic) technologies and bioinformatics and utilizes in realworld artificial intelligence (AI).
The key objectives of PPM are: 1. Screening for subclinical imbalances and genetic defects with a pre-selection of suitable targets to secure the next steps of an applied PPM protocol, i.e., prevention, therapy and rehabilitation; 2. Repair of the imbalances and defects to restore the function and to prevent the clinical illness manifestation and/or to get defects and imbalances repaired. For instance, genetic testing (including canonical diagnostic testing, gene carrier testing, prenatal testing, preimplantation testing, pre-symptomatic and predictive testing, etc.,) can provide information about a person’s genes, their products, and chromosomes. Moreover, a subset of mutations may also be targeted for potential drugs, i.e., be potential biomarkers and targets for future therapeutic development. DNA and RNA sequencing technologies now allow whole-genome, exome, transcriptome and epigenome sequencing at rates that are dramatically faster, and much more productive and cheaper than traditional methods. Meanwhile, having access to genomic information will become increasingly important as healthcare providers become progressively receptive to incorporating genomics into their daily clinical practice. Translational Innovations today are accompanied by the development of predominantly genomic-and proteomicbased technologies, in general, and diagnostics, in particular. Meanwhile, PPM will require the integration of clinical information, stable and dynamic genomics, and molecular phenotyping. Bioinformatics and its applications and tools are in huge demand by applying mathematical modeling to maintain unified biobanks and databanks necessary for personal health monitoring based on principles of genotyping and phenotyping. Who will patients (and persons-at-risk) and their healthcare providers trust to store and interpret the data?: Healthcare information technology offers potential solutions to address these barriers since the patient or person-at-risk is a data carrier, while learning about possible risks of a disease, and physicians can reasonably select a kind of preventive and personalized protocol based on the predictive assays. It is becoming clear that further development of 1) molecular technologies; 2) risk prediction algorithms and 3) clinical decision support (CDS) are needed. PPM is an evolving field in which physicians use diagnostic and predictive tests to identify specific simple and combinatorial biomarkers that help determine which medical treatments and procedures will work best for each patient or person at risk. Individuals will be under regular monitoring that will detect pathological shifts at subclinical stages. This means that society could save more than US$20,000- 40,000 per person annually. At the community level, the annual savings from each individual may vary from several thousand to several tens of thousands U.S. dollars. All healthcare professionals will need to be educated to deliver patient-centric care as members of interdisciplinary teams, emphasizing patient safety, evidence-based practice, risk management, quality improvement approaches and bioinformatics. The present model of the “physician-patient” dyad could have to be gradually displaced by a “medical advisor-healthy personsat-risk” model. And thus the opportunities would exist at every stage of disease initiation and progression to grow a Personalized Health Plan (PHP) addressing lifestyle, risk modification and disease management, and next, Personalized Health Management & Wellness Program (PHMWP).
Note: This work is partly presented at 21st European Biotechnology Congress on October 11-12, 2018 held at Moscow, Russia