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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

Friday FOCUS on Pharmacogenetics: Small difference make big impact

On Friday’s 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 or would like to request education or schedule a webinar regarding pharmacogenetics, please feel free to reach out to us at PGx Medical, info@pgxmed.com or 405-509-5112.  

How is pharmacogenetics affecting the efficacy of medical treatment? 

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Pharmacogenomics can help doctors pick the right treatment option and dose for each patient. photo source: nigms.nih.gov

Your genes determine your hair and eye color, they also play a key role in how medications work in your body.

Currently, providers base the majority of their drug prescriptions on factors, such as a patient’s age, weight, sex, and liver and kidney function.  Researchers have identified genetic variations that influence how people respond. When using a pharmacogenetic test result, providers can use this information to select the best medication and identify people who need an unusually high or low dose.

Pharmacogenetics looks at variations in genes for proteins that influence drug responses. These  proteins include a number of liver enzymes that convert medications into their active or inactive forms.  Even small differences in the genetic sequences of these enzymes can have a big impact on a drug’s safety or effectiveness.

Read entire article at:  nigms.nih.gov

Anticoagulants in older adults

Anticoagulants are one of the most frequently prescribed medications in elderly patients.

Polypharmacy is a growing concern in the elderly population

Some common cardiovascular disorders in older adults have a relationship to thrombosis, including ischemic heart disease, atrial fibrillation, valvular disease, and atherosclerotic vascular disease.

Thrombophilia (sometimes hyper coagulability or a prothrombotic state) is an abnormality of blood coagulation that increases the risk of thrombosis (blood clots in blood vessels).  Such abnormalities can be identified in 50% of people who have an episode of thrombosis (such as deep vein thrombosis in the leg) that was not provoked by other causes.

Older adults represent a patient population at high thromboembolic risk, but also at high hemorrhagic risk. Physicians have a tendency to underuse anticoagulants in the elderly, most likely because of underestimation of thromboembolic risk and overestimation of bleeding risk.

Despite the stroke risk being much higher in the elderly population, the presence of associated comorbidities and accompanying polypharmacy leads to physicians’ being less eager to initiate anticoagulation therapy in the elderly, despite the greater absolute stroke risk reduction by doing so.

Another consideration in deciding on anticoagulation therapy is the elderly patients’ propensity to fall.  According to the U.S. Centers for Disease Control and Prevention, every 11 seconds an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall.

One of the most compelling examples of potential benefits from pharmacogenetic testing is warfarin. Warfarin is a widely prescribed oral anticoagulant; for decades it has been used as standard drug to prevent and treat thrombotic events in patients with deep vein thrombosis, various hypercoagulable states, atrial fibrillation, surgical cardiac valve replacement, etc.

One of the major problems with its use in clinical practice is large inter-individual variation – patients differ in sensitivity to warfarin, hence the dose requirements vary widely (up to 20-fold). The consequences of over- or under-anticoagulation can be serious. In patients less sensitive than typical, the standard doses may be too low to achieve anticoagulation and therapeutic failure may occur, while in highly sensitive individuals the same doses may lead to serious adverse effects, such as hemorrhage.

PGx Medical is the trusted and experienced resource for the implementation of pharmacogenetics into the field of aging services.  We work with LTC communities, clinics and pharmacies across the country educating and implementing pharmacogenetics into their day-to-day patient care.

For more information on education opportunities or implementing pharmacogenetics, contact:

PGx Medical
info@pgxmed.com
405-509-5112

source:  uptodate.com, ncbi.com, intechopen.com

Beers Criteria: Potentially Inappropriate Medications for Older Adults

In 2015, the American Geriatrics Society (AGS) updated the Beers Criteria list of potentially inappropriate medications to be monitored or avoided when treating older adults.

alt = "pharmacogenetics"The goal of the Beers Criteria is to improve the care of older adults by reducing their exposure to potentially inappropriate medications (PIMs). This is accomplished by using the criteria as an educational tool and quality measure.  According to the AGS, two uses that are not always in agreement.

Prescribing decisions are not always clear-cut, and clinicians must consider multiple factors, including discontinuation of medications no longer indicated.

The AGS Beers Criteria for PIM use in older adults is one of the most frequently consulted sources about the safety of prescribing medications for older adults and is used widely in geriatric clinical care, education, and research and in development of quality indicators.

The Beers list is important to help with deprescribing medications that are unnecessary, which helps to reduce the problems of polypharmacy, drug interactions, and adverse drug reactions, improving the risk–benefit ratio of medication regimens in older at-risk adults.

Pharmacogenetics is a tool being used in LTC communities, clinics and pharmacies across the country to help with proper prescribing in older adults.  The PGx Medical test results highlight medications on the Beers report making it easy for providers to quickly determine which medications might be inappropriate for each individual person.

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

 

Pharmacogenomics: A New Era in Healthcare

Doctors are using pharmacogenomics to help determine what drugs will work, and which drugs to avoid.

not new, but more and more doctors are testing their patients to see how they process a variety of drugs from pain relievers to cardio medications.  This will tell them who the medication will work for, who it won’t, and who might have a severe drug reaction and avoid that.

Doctors keep the genetic information on file so they can check to see if a drug will work or cause a problem before prescribing it.  This helps take the guesswork out of prescriptions.

Pharmacogenomics not only helps with medications patients are currently taking, but will guide their future prescriptions and potentially save lives.

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

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

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.