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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 and 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

Friday FOCUS on Pharmacogenetics

Each Friday we will post new and relevant information regarding Pharmacogenetics. We hope you will find this useful and pass along to colleagues. If you should have any questions regarding pharmacogenetics, please feel free to reach out to us at PGx Medical, info@pgxmed.com or 405-509-5112.  

Antipsychotic / Dementia:
An estimated 25% of nursing home and 13% of assisted living residents in the U.S. 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. It is essential that if used, antipsychotics should be carefully monitored to ensure efficacy and safety of the drug. One of the methods for ensuring that an older adult is on the right drug is pharmacogenetics. Pharmacogenetics offers the following benefits:

  • Aligns medications with personal DNA.
  • Optimizes medication use.
  • Identifies responders and non-responders.
  • Avoids adverse drug events such as serious side effects.
  • Reduces trial and error.
  • Reduces costs.
  • Enhances confidence regarding medication use.
  • Provides for person centered medication regimen.

To learn more about getting started with pharmacogenetics, call us at 405-509-5112 or email info@pgxmed.com

Can Precision Medicine Revolutionize Health Care?

Implementing precision medicine could shift the relationship between health care providers and their patients.

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Pharmacogenetics can help revolutionize healthcare

Implementing precision medicine, via pharmacogenetic testing, could change the way healthcare providers and their patients interact.  By having information at your fingertips, a pharmacogenetic test result can guide healthcare professionals on what medications can and cannot work based on a patients unique genetic make-up.  It  changes the relationship to a scientific approach rather then the previous trial and error treatment approach.

When medications work the way the drug manufacturer intended for them to work, you don’t have the guessing game prescribing and re-hospitalizations due to adverse drug events.  Patients start to receive therapy, feel better and potentially save money by reducing unnecessary medications.

Precision medicine has been around for decades but it is just now becoming affordable.  The Centers for Medicare and Medicaid (CMS) understands that precision medicine can be a cost savings when monitored and used for long term med management.

The healthcare professionals who understand precision medicine and implement it with their patients understand the importance of proper prescribing and the risks involved if a patient is on a medication their body doesn’t metabolize properly.

Pharmacists can work alongside physicians to manage test results and offer ongoing medication therapy management (MTM) services afterwards. The consultant pharmacist can also decipher pharmacogenetic test results to determine whether patients have the proper enzymes to metabolize their medications.  When healthcare professionals work together, precision medicine can bring a proactive approach and give healthcare professionals a more “preventative care” approach to patient care.

As healthcare changes, precision medicine can revolutionize how physicians treat patients.  Being proactive can save money and give patients a better quality of life.

For more information on precision medicine via pharmacogenetic testing, contact PGx Medical at info@pgxmed.com or 405-509-5112.

 

 

 

Pharmacogenetics: It’s What We Do

At PGx Medical, Pharmacogenetics isn’t “one” thing we do, it’s ALL we do.

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Pharmacogenetics is not “one” thing we do, it’s ALL we do.

As we travel the country educating healthcare professionals on pharmacogenetics, we hear time and time again, “We’ve tried that with another company and once we tested, we haven’t heard from them and we don’t know how to implement results.”

After digging a little deeper, we find that the company they worked with did many other lab services and pharmacogenetics was just one of them.  That isn’t who we are.

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

We aren’t a lab, we are educators, consultants and advocates for a medication management tool that can help take the guesswork out of prescribing medications.  We work alongside clinical staff to educate them on pharmacogenetics, and then step them through the process of implementing it into a senior community, pharmacy or clinic to provide the best care possible for their patients.

The PGx Medical process impacts quality, adds value and enhances the patient experience by addressing clinical concerns such as falls, dementia, pain, sleep, med management and overall staff efficiencies.

The PGx test analysis 19 different enzymes in the body that are responsible for medication processing.  When clinicians see how those enzymes work in your body, the test results let them know what medications are a better fit for their body and will provide the most therapy.  It also lets them know what medications they should stay away from avoiding the cascading effect of “trial and error” prescribing.  By providing healthcare professionals with an evidence-based tool, this allows them to prescribe only the medications they know a patient can metabolize, or adjust dosage based on test results.

“The beauty of pharmacogenetics in seniors is it is covered by Medicare B,” said Clay Bullard, President of PGx Medical.  “As people age, their body metabolizes medications differently.  Now there is a tool to help manage those changes.  Whether you are a poor metabolizer, ultra-rapid metabolizer, or you don’t metabolize a medication at all, now the clinician can prescribe medications based on their patients unique genetic profile.”

Bullard went on to say,  “Once you decide to implement the program, make sure you are working with a reputable company.  Check references and see how long they have been doing pharmacogenetics.  Unfortunately, some companies got into pharmacogenetics for the wrong reason and because of that, they aren’t providing their partners with adequate information to implement the results once they are ready.  You can have the results and not know what to do with them and it does you no good.  That is a waste of everyone’s time and medicare dollars.  But if used correctly, pharmacogenetics saves money on unnecessary medications, re-hospitalizations and overall when your staff is more efficient and not dealing with behavioral problems because someone’s medications aren’t giving them therapy.”

To learn more about pharmacogenetics, contact:  PGx Medical, info@pgxmed.com or 405-509-5112.  Or got to www.pgxmed.com

 

 

Outcomes for Psychiatry Patients Improve with Pharmacogenetics

Pharmacogenetic testing has been shown to improve outcomes in psychiatric patients in clinical trials

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Outcomes for Psychiatry Patients

Studies  from The Neuropsychiatric Clinic, Carolina Partners, Raleigh, NC show that depression and psychosis have low success rates with the initial selected medication. In fact, the initial medication typically achieves meaningful response in 40% or less of patients.

Now, precision medicine offers a tool to help enhance the success rate. Many psychiatric medications have specific verbiage on their label highlighting information regarding genetic variants that alter activity.  With pharmacogenetics, physicians will now know scientifically which medications can give a patient appropriate therapy, and which ones won’t.

Studies found that psychiatric symptoms improved significantly more for patients with pharmaogenetic testing compared to those that were not tested.  The study provided the treating physician with information regarding how the biology and genetics of individual patients was likely to influence the pharmacokinetics and pharmacodynamics of commonly used psychotropic medications and classes of medication. The treating physician then incorporated this information into his personalized treatment plan for each individual patient.

Virtually all tested patients had at least one genetic variant with actionable information indicating that routine testing would be beneficial to most patients being treated with psychotropic medications.

Tested patients experienced significantly greater improvement over time in a number of symptom dimensions. Aggression, anxiety, depression, fatigue, impulsivity, mood instability, panic, and suicide symptoms improved more in tested patients compared to untested patients.

In routine clinical practice, pharmacogenetic testing can enable significant improvement in clinical outcomes for psychiatric patients with a variety of diagnoses.

For more information on Pharmacogenetic Testing, contact PGx Medical, info@pgxmed.com or (405) 509-5112.

Source:  Journal of psychiatry

Pharmacogenetics: Who Should Be Tested

Pharmacogenetics is intended to be a long term care medication management tool

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Pharmacogenetics uses a patient’s genetic information to aid prescribers in selecting the right drug and the right dose for the patient.

 

Pharmacogenetics enables personalized therapeutic decisions for people suffering from some of the most prevalent clinical conditions in the United States, including cardiovascular disease, neuropsychiatric disorders and pain.

Why Pharmacogenetic Testing:

  • Polypharmacy
  • Reduction of trial and error
  • Risk of adverse drug events (falls, re-hospitalization, delirium)
  • Medication errors, adherence
  • Regulatory guidelines
  • Med pass time (increased pill burden), costs
  • One size fits all

 

 

Indicators for Testing:

  • Depression diagnosis
  • Frequent fallers
  • Increased Behaviors
  • Cognitive Impairment
  • Polypharmacy
  • Antipsychotics / Antidepressants
  • Pain management comprehensive care plan
  • Re-hospitalization

One common question we hear over and over, “should everyone be tested?”  No, only residents with proper medical necessity should be tested.

For more information on how to implement pharmacogenetics into your long term care community, contact:  PGx Medical at info@pgxmed.com or 405-509-5112.

Side Effects and Psychiatric Medications

With so many side effects from psychiatric medications, why aren’t more physicians using pharmacogenetics?

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In the U.S. we spend billions of dollars managing the side effects of psychiatric medications.

World wide over 100 million people take psychiatric medications. In 2004, the FDA finally ordered a “black box” label on all antidepressants to warn of psychiatric drugs’ increasing suicide risk in children and adolescents. Being an adult, however, doesn’t guarantee safety. In 2006, the FDA increased the age to include young adults up to age of 25.  So why aren’t we doing more about it to prevent this from happening?

Pharmacogenetics aligns current and future medications with each persons unique genetic profile.  So if a test can scientifically tell you what medications can give you therapy, which ones can’t, and which drugs can have potential drug on drug interactions based on your genetic make-up.

In the U.S. it is estimated we spend billions of dollars annually managing the side effects from psychiatric medications.  Now there is a tool available that can improve patient outcomes and help physicians monitor the side effects in the field of psychiatry and it is simple to use.

Pharmacogenetics is now being used across the country to help guide healthcare professionals with proper prescribing.  When used correctly, it can save money and the patient can be spared a lot of undue stress.

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

source: globalhealingcenter.om