Current approaches to assessing medication exposure fail to capture the complexity of the phenomenon and the context in which it occurs. This study’s purpose was to develop a typology of subgroups of patients who share common patterns of medication exposure. To create the typology, we used an exemplar sample of 30 patients in a large public healthcare system who had been prescribed the pharmacogenetically actionable opioids codeine or tramadol. Data related to medication exposure were drawn from large data repositories. Using a person-oriented qualitative approach, eight subgroups of patients who shared common patterns of medication exposure were identified. The subgroups had one of five opioid prescription patterns (i.e., singular, episodic, switching, sustained, multiplex), and one of three types of primary foci of medical care (i.e., pain, comorbidities, both). The findings reveal medication exposure patterns that are dynamic, multidimensional, and complex, and the typology offers an innovative approach to assessing medication exposure.


Medication Exposure, Pharmacogenomics, Opioid, Pain Management, Person-Oriented Approach

Author Bio(s)

Mitchell Knisely, PhD, RN-BC, ACNS-BC is an Assistant Professor at Duke University School of Nursing, Durham, NC. His program of research is in the areas of precision health and pain management. Correspondence regarding this article can be addressed directly to: mitchell.knisely@duke.edu.

Janet S. Carpenter, PhD, RN, FAAN is a Distinguished Professor and Associate Dean for Research at Indiana University School of Nursing, Indianapolis, IN. Her program of research is in the areas of menopausal symptom management.

Marion E. Broome, PhD, RN, FAAN is the Dean and Ruby Wilson Professor of Nursing at Duke University School of Nursing, Durham, NC. Her research expertise is in the areas of research ethics and pediatric pain management.

Ann M. Holmes, PhD is an Associate Professor at Indiana University Fairbanks School of Public Health, Indianapolis, IN. Her research centers on the financing and delivery of health care, particularly to chronically ill populations, and the measurement of health status for economic and health policy evaluation.

Diane Von Ah, PhD, RN, FAAN, is an Associate Professor at Indiana University School of Nursing, Indianapolis, IN. Her research focuses on advancing the state of the science in the areas of cancer survivorship including symptom management and quality of life.

Todd Skaar, PhD, is a Professor of Medicine in the Division of Clinical Pharmacology at the Indiana University School of Medicine, Indianapolis, IN. His research is focused on the discovery and implementation of genomic predictors of drug response.

Claire Burke Draucker, PhD, RN, FAAN, is the Angela Barron McBride Endowed Professor in Psychiatric Mental Health Nursing at the Indiana University School of Nursing, Indianapolis, IN. Her program of research program of research is in the areas of interpersonal violence throughout the lifespan. She also has expertise in the use of qualitative methods for theory development.


The authors would like to thank Dr. Joseph Ipe, the Regenstrief Institute, the Indiana Biobank, contributors who collected samples used in this study, and subjects whose participation made this work possible. Funding Acknowledgements. This work was supported by the Indiana University School of Nursing 100th Anniversary Scholars Fellowship; William & Doris Rodie Dissertation Award; National Institute of Nursing Research [Award Numbers T32NR007066 & T32NR009759]; National Human Genome Research Institute [Award Number 5U01HG007762]; and the Indiana Clinical and Translational Sciences Institute which is funded in part from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award [Award Number UL1TR001108] and the National Center for Research Resources, Construction Grant [Award Number RR020128] and the Lilly Endowment. The content is solely the responsibility of the authors and does not necessarily represent the official views of the mentioned funding agencies.

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