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Pharmacogenetics and Alzheimers

Jim McWhirter talks about how pharmacogenetics can help address key clinical concerns such as falls, dementia, pain, sleep and more. For more information, contact PGx Medical at 405-509-5112 or info@pgxmed.com

 

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Person-Centered Pharmacogenetic Pilot Program

Currently enrolling provider organizations and communities in a Person Centered Care Pharmacogenetics Pilot Program.

Dr. Linda Shell RN (LindaShell.com), in conjunction with PGx Medical (PGxMed.com) are currently enrolling aging services communities in a Person-Centered Care Pharmacogenetic Pilot Program.

Pharmacogenetics, a simple one-time diagnostic lab, covered by Medicare B, assists providers in aligning medications with a person’s DNA.

Genetic testing has been used extensively in patients with arthritis, anticoagulants, and cancer for many years to assist in personalizing medications, reducing costs and minimizing side effects.

The pilot offers long term care communities – including independent, assisted, skilled, memory care, and home health a streamlined program for implementing pharmacogenetics. The pilot goal is to demonstrate the ability to improve quality, reduce costs and maximize care of older adults through the use of pharmacogenetics.

According to the NIH 50% of nursing home residents take 9 or more medications per day (2016). Dr. Shell states, “as a gerontological nurse, one of my concerns has been the prevalence of polypharmacy. The risk for side effects increases when a patient has more than nine prescriptions.”. The problem is often related to comorbid conditions such as heart disease, diabetes, chronic obstructive lung disease, and hypertension requiring multiple medication management.  In long term care, medication-related problems currently cost $177.4 billion a year (ascp.com). The problem of polypharmacy can lead to interactions between multiple medications resulting in serious harm.  Some medications increase the risk of confusion, falls, and behaviors in the cognitively impaired. With over 43.1 million adults 65 and older, research indicates personalized medications play a role in improving the quality of life.

Along with anti-psychotic medication monitoring, updated CMS regulations coming in 2018 increase the scrutiny of medication review.  A simple, straightforward solution is needed – one that offers providers an effective tool that aligns prescribed medications to the unique needs of each resident.

Collaborating in this pilot program is PGx Medical, a leading supporter and provider of pharmacogenetic testing in older adults. Their team is knowledgeable and uniquely qualified to assist providers in the process of pharmacogenetic testing.  They have spent years educating healthcare professionals on the benefits of pharmacogenetics, how it impacts current medications and is a roadmap for the future.

For more information on this pharmacogenetics pilot program, contact, Bill Shell at bill@legacymarketservices.com or 952-960-0806, or visit www.LindaShell.com/pharmacogenetics.

Testimonials: Pharmacogenetic Testing

Below are testimonials we’ve received from doctors, directors of nursing, pharmacists and government officials regarding our medication management program, via pharmacogenetic testing.

PGx Medical is the trusted and experienced resource for the implementation of pharmacogenetics in the field of aging services.

Pharmacogenetics aligns current and future medication with each persons unique genetic profile.

As we work alongside long-term care communities, clinics and pharmacies, we have the privilege of receiving success stories on how pharmacogenetics has impacted residents, patients, family and staff.

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Pharmacogenetic Testing Addresses Clinical Concerns Such As Falls, Dementia, Sleep, Pain And Overall Staff Efficiencies.

We recently implemented pharmacogenetic testing and feel it is very easy to administer.  The test results are helpful when dosing or treating our residents, and saves our staff time and frustration as providers by making sure our patients are on the correct medications.  On average, approximately 90% of our patients need a dose change, med change or to discontinue a medication after testing.

We had one patient we had tried so many SSRI/SNRIs and after her PGx test, we were able to find the right medication regimen and now she feels great!  We would recommend this program to anyone who has patients on multiple medications.  ~Rachel Moore, PA-C~

I have found the pharmacogenetic test to be very useful for patients in my clinic practice as well as my nursing home patients.  It is quick to use!  In fact, my nurses do all of the work and then they go thru the results and alert me of the medications that are less likely to work for those patients.  It takes no time for me at all! The paperwork is very minimal and nurses can fill it out.  It takes less than a minute to swab the inside of both cheeks.  Then it gets mailed off and the results come back in just a few days.

I had a patient in my clinic that had seen multiple doctors, a psychiatrist and several counselors for her depression.  She had tried many medications to help her depression but she complained that none of them made her feel better.  We did a pharmacogenetic test and found out that the patient had a gene mutation that kept ALL of the antidepressants from working.  No wonder she never felt better with the medications!  From the test results we found some alternative medications that could be used to treat her depression.  She was so relieved that there was a really good reason for the previous anti-depressants not to work.

I had a patient who had shoulder surgery who kept complaining that the Hydrocodone did not help his pain.  The Naproxen actually did better in controlling his pain.  We did a pharmacogenetic test and found out that Hydrocodone does not work well for his pain but Naproxen works best.  This is helpful information if he ever has to use pain medication again.

I had a patient who complained that his pain meds were not working at all and would ask for more and more.  I suspected he was a drug seeker but could not prove it.  We did a pharmacogenetic test on him and discovered ALL of the narcotics work well for him.  We now know he is a drug seeker and treat him appropriately.

The PGx Medical Pharmacogenetic test is helpful if a patient is not responding to a medication as well as we think they should.  This helps us chose appropriate medications that are more likely to work and avoid those that may cause problems for the patient.  It is very helpful with resistant depression, psychosis and ADHD medication failures.  I am even starting to use the testing first before prescribing any medication.  Patients love the testing because we can avoid the medications that are not likely to work or those that could cause adverse reactions; they get on the right medications quicker with less trial and error. Insurances like it because it saves them money by getting quicker results without multiple medication changes.

Nursing Home surveyors encourage nursing homes to use the pharmacogenetic testing on patients to try to keep patients off of multiple medications and to use those that work well.  It also decreases the adverse reactions and helps keep patients off of anti-psychotics or at least on minimal doses of anti-psychotics.  ~ Dr. Jami Benton ~

“The PGx Medical pharmacogenetic test program has yielded great results at our home. It is now a fully implemented tool my clinical staff reviews with all of our residents. The reports are easy to understand with clear actionable recommendations. I am thankful we were allowed to be the first to have such a tool to use here at our home. Each resident deserves our very best.”~Treva, MD~

 “Seems too good to be true, but always produces positive results.  I utilize the testing daily now in my practice.  For Geriatrics provides the tool for easy medication adjustments.  The reports are not complex. Very beneficial for identifying the effectiveness of analgesics in residents who are unable to communicate.  There are residents that we may have labeled as ‘drug seekers’, and when the DNA test report is returned we discover that the analgesic they were prescribed is not being metabolized in their body and they are getting no relief from their pain.  So they have legitimate pain and the analgesic has not been effective in reducing their pain.  This test only has to be performed on each resident one time in their life.  That makes it very cost effective.  And the reimbursement process has been very easy.  The families love it!  It tells them exactly what their loved one metabolizes and what is best for them”.  The DNA Test results give confidence to the residents that they are being prescribed the correct medications.  Yes, would highly recommend this program!  CMS should mandate the test for all residents on Antipsychotics!” ~Dr. Mike M, Long Term Care Physician~

“It is important to me to ensure that each of our veterans in all of our State VA homes are cared for on an individual basis. I was excited to learn of the potential the PGx Medical Pharmacogenetic Program offered and I brought it forward to our administrative and clinical teams, as it seemed to be a ‘no brainer’ for our homes to implement. I’ve heard nothing but positive results and praises of both the Program and PGx Medical.” ~Maj Gen (ret) Secretary of Military and Veterans Affairs~

“This DNA Testing has been a Win-Win for both the residents and families!  By utilizing the DNA test results we know exactly which medication is effective for the residents.  It is a tremendous cost saver on medications.  Not all people that we think are ‘pain seekers’ really are.  We had one resident that kept begging for more and more pain meds.  We did the DNA Swab Test on her and the test revealed that she was metabolizing zero percent of the pain medication.  So she was truly in pain.  We are such Believers in this program!  It is a wonderful Marketing Tool!  We can advertise that we provide the best care possible for residents on these medications!”~Brenda W.  Clinical Manager~

“I was privileged to introduce the PGx Medical Pharmacogenetic Testing Program to the Oklahoma Department of Veterans Affairs. As a State Representative, I felt this program was in the best interest of each of our Veterans living in the seven ODVA homes, and to those who are in the homes caring for and assisting them everyday. This program has been exceptional and has produced wonderful results while helping the homes practice a level of personalized care that was previously unattainable.  The program has also been clinically and economically beneficial to veterans living in homes.”~State Representative~

“I perform about 20 of the DNA Tests a week.  The results are a tremendous help in my practice.  The DNA Report provides an objective list to choose from to help my patients.  Not knowing the metabolic profile of the patients increases the risk of side effects.  It is hit and miss without the test.  There is no trial and error period when you use the DNA swab testing.  It allows me to select from a list of medications that will help my patients.  I recommend this program to many other Doctors and patients.  It gives you an individualized report with objective information to correctly order the right medication.”~Dr. Timothy B, Pain Management Specialist~

“We initiated this DNA Testing program in response to the CMS Directive to reduce our Antipsychotic usage.  Through the metabolic reports, we have identified that residents were receiving antipsychotics that were actually adverse for them.  These residents have shown a marked improvement in abilities and a reduction in side effects.  The residents are doing so much better now that they are off these medications.  The Family members are very excited about the results.  All the medication changes have been positive.  When the swab reports come back we have been amazed.  We then understand why the residents have been exhibiting behaviors and mood swings.  This program is very individualized.  It has positive results for everyone, but first and foremost the residents.  Our Administrator Markets this DNA Testing as a great program for our residents and the facilities.  We have multiple Physicians that see our residents.  Some of the Physicians were skeptical at first, but now they are really happy with the results.  When we had our Survey, we had signed up with AssureRx but had not put the program into place.  The Surveyors asked that we write a letter for them to take back to their Office about out Pending DNA Antipsychotic Program.  They were so interested that the Surveyor called back and asked if we would fax them copies of the results.  The Surveyor stated their Supervisors were very impressed with the individualized data provided.”~Jennifer H., Director of Nursing~

 “The PGx Pharmacogenetic Test was easy for us to see the clinical value it offers, even before implemented. The implementation process that PGx offered was very simple, with very little interruption to our staff.  As a pharmacist, the information is extremely valuable on my monthly med reviews and for all new residents upon admission. It helps address the issues of polypharmacy, unnecessary medications and more importantly is another tool to help assure that  our residents are getting the best therapy for them.  It is a great tool for any pharmacist to have.”~Valarie, DHP~

For more information on how you can implement pharmacogenetics into your community, clinic or pharmacy, contact us at:

PGx Medical
Empowerment at the Source of Treatment
Individualized Care – Personalized Medicine
405-509-5112
info@pgxmed.com

Patient Centered Care: Education is Key

The Institute of Medicine defines patientcentered care as: “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.”

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Education is key to Patient-Centered Care

In 2016, there were approximately 4.45 billion prescriptions issued all over the United States. And according to the Patient-Centered Primary Care Collaborative, four out of five patients who visit a physician leave with at least one prescription.

Medications are involved in 80 percent of all treatments and impact every aspect of a patient’s life. The two most commonly identified drug therapy problems in patients receiving comprehensive medication management services are: (1) The patient requires additional drug therapy for prevention, synergistic, or palliative care; and (2) The drug dosages need to be titrated to achieve therapeutic levels that reach the intended therapy goals.

Drug therapy problems occur every day and add substantial costs to the health care system. Drug-related morbidity and mortality was estimated to cost $76.6 billion in the ambulatory setting in the United States. The largest component of this total cost was associated with drug-related hospitalizations.

So what can we do as a society to help focus on Patient-Centered Care and decrease the cost related to drug therapy?  Educate.

By educating healthcare professionals on the tools and resources available will help not only individualize care, but will also save money and time by providing scientific based results for proper prescribing and help eliminate the “trial & error” prescribing that has been done for decades.

When a patient is on medications he/she can metabolize properly, you reduce the risk of falls, re-hospitalization and what they call the “Prescribing Cascade” where the side effects of drugs are misdiagnosed as symptoms of another problem resulting in further prescriptions and further side effects and unanticipated drug interactions.

So how do we combat this problem?  Pharmacogenetic testing.

Pharmacogenetics is one of those tools.  Pharmacogenetics aligns current and future medications with each persons unique genetic profile.  It is a simple cheek swab that can help “personalize” medicine based on each individual person – Right Drug, Right Dose, for the Right Person.

Patient-centered care is intended to empower patients in making decisions regarding their own healthcare.  The hope is by engaging patients and getting input on their own health, they will have better outcomes.  Education is a big component of patient-centered care.  By educating the patient and providing information to help them understand their diagnosis and treatment, they can begin to work alongside their provider and have input into their treatment.

Patients bring a unique perspective on their own care.  No one knows your body better then you.  Far too often patients and their families are not educated or informed on their healthcare decisions.  Looking forward into the future, creating a system that is “patient-centered” and focuses on educating patients and healthcare providers will help in so many areas of our healthcare system.

PGx Medical is single-focused.  Meaning, we do one thing and we do it with passion.  We focus on pharmacogenetics in  the field of aging services.  As consultants, PGx Medical educates healthcare providers, senior communities, patients and families across the country on the benefits and value of this medication management tool.

For more information, or to schedule an educational webinar or request educational material, contact:
PGx Medical
405-509-5112
info@pgxmed.com

source:  pcpcc.com, ncbi.com

 

 

Implementing Pharmacogenetics In Long Term Care

Pharmacogenetics can play an important role in effective use of medications by optimizing drug dose, identifying responders and non-responders to medications, and avoiding adverse events by aligning medications with personal DNA.

Learn how to effectively implement a pharmacogenetics program into your community to help improve quality of life, quality of care, reduce medication costs, and optimize medication usage.

 

To request more information, or to schedule a webinar or phone call, contact PGx Medical at info@pgxmed.com or 405-509-5112.

 

 

 

 

Focus on Seniors: Improving the life and quality of care of older adults

At PGx Medical, we made the decision to focus on the field of aging services. Doing one thing, and one thing only helps us direct all our attention on the unique needs in senior communities across the country.

alt = "pharmacogentics"The American Geriatrics Society reports there are 7,300 certified geriatricians in the United States, which is one geriatrician for every 2,700 Americans who are 75 or older. Due to the projected increase in the number of older adults and the plateauing of the number of geriatricians over the last 10 years, it is expected to drop to one geriatrician for every 4,500 older Americans by 2030.  In an article in Medicalnews.com, several medical experts state with a growing elderly population that is living longer with fewer physicians available to treat them, the future of geriatric medicine is on the verge of transitioning from disease treatment to disease prevention. 

According to Paul Hill, MD, a geriatric psychiatrist and associate professor of psychiatry at the University of Tennessee Health Science Center (UTHSC), a common challenge for physicians is determining whether geriatric patients are taking their medicine consistently. Hill says advances in pharmacology will make the process easier.

Another issue physicians and pharmacists deal with on a frequent basis is the prescribing cascade. This is when the side effects of drugs are misdiagnosed as symptoms of another problem, resulting in further prescriptions and more side effects and ultimately drug reactions.

Older adults on multiple medications can lead to polypharmacy, which is common in geriatric patients.  Polypharmacy refers to the effects of taking multiple medications concurrently to manage coexisting health problems.  According to Dr. Linda Shell, MA, RN, “polypharmacy has been a silent killer for years, draining funds from Medicare and dismantling the treatment plans of millions as it becomes a habit ingrained in our culture, especially in eldercare. We’ve become resigned to the falsehood that more drugs mean better treatment, but there’s something putting an end to that.”

The CDC reports 76 percent of Americans over 60 use two or more prescription drugs and 37 percent use five or more.  It is important to not only know what medications someone is taking, but track each patient’s medications and any side effects that may result from drug-to-drug interactions.  

PGx Medical partners with pharmacists and physicians to educate and implement a tool to help determine the right drug, at the right dose, for each individual patient.  It’s called pharmacogenetics.  

Pharmacogenetics aligns current and future medications with each persons unique genetic profile.  When the pharmacist and the physician work as a team to look at metabolization, side effects or any drug-drug interactions, it helps eliminate the guessing game – or prescribing by trial and error.  By being proactive, healthcare professionals can help prevent the cascading event that happens when medications are added on top of one another.  In the field of aging services, you may not have the luxury of waiting 3-6 weeks to see if a medication is working.

For more information on pharmacogenetics, contact:
PGx Medical
info@pgxmed.com
405-509-5112

 

source:  medicalnews.com

 

 

Polypharmacy: A growing concern in older adults

Polypharmacy is defined simply as the use of multiple medications by a patient. The precise minimum number of medications used to define “polypharmacy” is variable, but generally ranges from 5 to 10. 

Polypharmacy is a growing concern in the elderly population

The issue of polypharmacy is of particular concern in older people who, compared with younger individuals, tend to have more disease conditions for which therapies are prescribed. It has been estimated that 20 percent of Medicare beneficiaries have five or more chronic conditions and 50 percent receive five or more medications.

The use of greater numbers of drug therapies has been independently associated with an increased risk for an adverse drug event (ADE), irrespective of age, and increased risk of hospital admission.

There are multiple reasons why older adults are especially impacted by polypharmacy:

Older individuals are at greater risk for ADEs due to metabolic changes and decreased drug clearance associated with aging; this risk is compounded by increasing numbers of drugs used.

Polypharmacy increases the potential for drug-drug interactions and for prescription of potentially inappropriate medications.

Polypharmacy was an independent risk factor for hip fractures in older adults in one case-control study, although the number of drugs may have been an indicator of higher likelihood of exposure to specific types of drugs associated with falls (eg, central nervous system [CNS]-active drugs).

Polypharmacy increases the possibility of “prescribing cascades”. A prescribing cascade develops when an ADE is misinterpreted as a new medical condition and additional drug therapy is then prescribed to treat this medical condition.

Use of multiple medications can lead to problems with medication adherence, compounded by visual or cognitive compromise in many older adults.

A balance is required between over- and under-prescribing. Multiple medications are often required to manage clinically complex older adults. Clinicians are often challenged with the need to match the complex needs of their older patients with those of disease-specific clinical practice guidelines.

Pharmacogenetics is a tool used in long term care communities across the country to help manage polypharmacy.  Pharmacogenetics is a simple swab of the cheek that allows providers to look at how medications align with each persons unique DNA.  The results help guide providers in proper prescribing eliminating unnecessary medications and guiding them when dosing changes are recommended based on metabolization.

For more information on pharmacogenetics, contact:  PGx Medical at 405-509-5112 or info@pgxmed.com.

source:  uptodate.com

PAs and NPs: A New Focus on Team Based Care

With the growing patient population, more health systems are utilizing PAs and NPs.

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PAs and NPs play a bigger role with the emphasis on team-based care

Patients today have multiple health issues.  According to an article in CompHealth, hospitals and health systems nationwide are moving toward using more PAs and NPs and there is a greater emphasis on team-based care across all settings. With the growing number of patients seeking care, it is critical and necessary.

Physician Assistants (PAs) and Nurse Practitioners (NPs) are skilled medical professionals who play an integral part in healthcare.  Redesigning teams to include increased numbers of primary care providers, to include PAs and NPs, is a significant part of the solution to alleviate the well-known shortage in primary care.

Long Term Care:
NPs have been authorized to provide Medicare services to post-acute and long-term care facilities for nearly 30 years.  Increasingly, medical directors and attending physicians rely on nurse practitioners as part of their team in the long term care setting.

PAs treat geriatric patients in long-term care facilities and their role is consistent: to provide medical care to seniors under the supervision of a physician.  PAs as geriatric medical providers can offer comprehensive geriatric assessment with a focus on the functional status, cognitive status, and special needs of the patient.

Because adults over the age of 65 remain the fastest growing population in the United States, and because people continue to live longer, requiring care for both chronic and acute illnesses, the need for physician assistants in geriatrics remains strong.

Prescribing:
Nurse practitioners can prescribe medication, including controlled substances, in all 50 states and Washington DC.  PAs are authorized to prescribe medications in all jurisdictions they are licensed.

PGx Medical works with NPs and PAs across the country educating and implementing pharmacogenetics within the field of aging services. With the shortage of staff in the long term care setting, it is more important then ever before to utilize these healthcare providers.

For more information on , or to schedule a speaker or educational webinar, contact us at info@pgxmed.com or 405-509-5112

source:  CompHealth, Okmedicalboard,

Should antipsychotics be prescribed to people with dementia?

Antipsychotic medications are meant to treat psychosis, but what about dementia?

alt = "antipsychotics"In an article on changingaging.com, in a two part series Dr. Al Powers discusses Guidelines for Antipsychotic drugs in Dementia.  Dr. Powers, ChangingAging Contributor, says “there are guidelines here in the U.S., both from the Federal government and from various professional organizations. But I believe these guidelines have holes a doctor can drive a med cart through. I believe we need to raise the bar in order to influence a change of habit in many professionals.”

“Putting aside the obvious point that there is no risk-free environment, let’s look at where the bulk of liability truly rests. These drugs have never been approved for use in dementia; in fact, the FDA has given them a black box warning, due to the risk of excess mortality and morbidity in this population. A doctor prescribing a drug for an unapproved use—with such a severe warning attached to the labeling—runs a much greater liability risk from an untoward side effect of the drug than from not using it,” said Powers.

Black Box Warning:
The Food and Drug Administration (FDA) is charged with the responsibility of regulating most medicines used by the public in order to ensure that pharmaceutical products are safe. One of its most straightforward ways of doing this is by issuing black-box warnings.  The black-box warning appears on prescription drug labels and is designed to call attention to serious or life-threatening risks.

More dementia care professionals are speaking out about the use of antipsychotics with dementia patients.

An estimated 25% of nursing home and 13% of assisted living residents in the United States receive at least one antipsychotic medication in a given year. These medications are often used off-label and put the resident at risk for serious side effects. CMS has focused surveys on the reduction of antipsychotics in the nursing home over the past few years and rates have slowly declined.

Antipsychotic rates in nursing homes are required to be monitored as part of an overall quality program. The antipsychotic prescribing rate in both assisted living and nursing homes and the relationship between the use of antipsychotics and mortality remain an area of concern for providers, patients and families.  One of the methods for ensuring that an older adult is on the right drug is pharmacogenetics.  Pharmacogenetics is a simple swab of the cheek and helps guide healthcare professionals in proper prescribing.  Eliminating unnecessary medications and making sure residents are on the right drug, at the right dose, based on each individuals genetic profile. For more information, contact PGx Medical at info@pgxmed.com or 405-509-5112.

Read more on the two-part series at changingaging.com