News
Some Doctors Deprescribe Over Medicated Patients
More and more patients are being screened to help cut out ineffective medicine and avoid harmful drug interactions
More patients are taking five or more prescription medications at once, putting them at risk for side effects and drug interactions. Amid concern about the potential harm of taking too many drugs, more doctors are deprescribing, getting patients off prescriptions that are no longer necessary.~WSJ
According to a recent article in the Wall Street Journal, nearly 40% of patients in their 60s take more than five medications.
“What was good for you once might not be as good for you now,” says Cara Tannenbaum, a geriatrician and the scientific director of the Institute of Gender and Health at the Canadian Institutes of Health Research in Montreal. “On a regular basis, patients should be asking their health-care providers, ‘Is this still the right drug for me, and if not, what other drug or nondrug therapies are safer and equally effective?’ ”
Dr. Tannenbaum and pharmacist Barbara Farrell have developed a website, deprescribing.org, which is maintained by the Canadian Deprescribing Network, a group that includes health professionals, policy makers and patient advocates. The site, used by doctors in both the U.S. and Canada, provides information to help patients determine if they should consider stopping certain medications that may be unnecessary or cause harm, including a common medication for heartburn or reflux called a proton pump inhibitor and certain diabetes drugs that increase the risk for low blood sugar.
Medication use can start to pile up in middle age or earlier, especially in patients being treated for diabetes, heart disease or cancer. People may see different doctors who don’t coordinate care with each other. Soon, they are in a situation known as polypharmacy, defined as five or more drugs.
The body processes many drugs less efficiently as it ages, leading to problems with long-term medications. Statins, prescribed to control cholesterol, may not be needed over age 75, and they can cause muscle weakness and increase the risk of falls.
The American Geriatrics Society last year updated its Beers Criteria, a list of 40 medications or classes of drugs that are potentially inappropriate for older adults. An expert panel is working on an update for 2018.
“The goal is to keep patients as healthy as possible on the least number of medications.”
VIDEO: When Patients Take Too Many Pills, Doctors Deprescribe
Pharmacogenetics is a tool used by doctors across the country to provide evidence-based results on how a person metabolizes medications. This simple swab of the cheek is a guide to help clinicians with current medication regimen, as well as a roadmap for future medications.
“Knowing that a medication doesn’t have the ability to give a patient therapy is a great way to deprescribe. You have evidence that person is not receiving therapy because their body does not metabolize that particular drug the way the drug manufacturer intended you to – making it easier to deprescribe, or discontinue that medication,” said Clay Bullard, President of PGx Medical a pharmacogenetic consulting firm headquartered in Edmond, OK.
“We work within the field of aging services across the country educating them on the benefits and value pharmacogenetics brings to not only the patient, but the caregiver and the community when dealing with a nursing home or assisted living facility, Our job is to be experts in the field of pharmacogenetics and then educate and help implement the test in communities, clinics and pharmacies across the U.S.”
Pharmacogenetics is fully reimbursed by Medicare B and in select states, Medicaid. As stated in the WSJ article, by eliminating multiple drugs, you help reduce the chance of falls, drug interactions, and many other clinical concerns.
For more information about pharmacogenetic testing, contact:
PGx Medical
info@pgxmed.com or 405-509-5112
or go to www.pgxmed.com
Read entire article at WSJ.com
More Patients Are Taking More Prescription Medications At Once
Antipsychotics Aren’t Always The Answer
Managing behaviors in individuals suffering from dementia is challenging
When dementia patients get to a stage where they become very agitated, “people are looking for an easy fix.
Historically, antipsychotics have been used in an attempt to address challenging behaviors, but they are now not only in question, but the dangers associated with these medications are coming to light.
As stated on the Medicare.gov website: “Antipsychotic drugs are an important treatment for patients with certain mental health conditions. However, the FDA has warned that antipsychotic medications are associated with an increased risk of death when used in elderly patients with dementia and the medications have side effects.”
In a recent article in Waugh Consulting, LLC, it states, “Professionals are looking at the dangers and working diligently to stop the use of those medications when dealing with elderly individuals suffering from dementia. Knowing the person and using the social aspects of their lives can be successful while lowering or eliminating antipsychotic medications.”
So how do you decrease antypsychotics in dementia care?
Aging services providers across the country are now implementing pharmacogenetics as part of their “medical plan of action” to address this problem.
Pharmacogenetics aligns current and future medications with each persons unique genetic profile. This medication management program, via pharmacogenentic testing, is a simple swab of the cheek that provides clinical caregivers with an individualized report for each resident. The report provides them with evidence-based information on many medication classes, including antipsychotics. While the goal is to eliminate unnecessary medications, pharmacogenetics is also a good starting point to help guide physicians in adjusting dosages based on metabolization, or changing a medication due to a drug-on-drug interaction.
Nothing takes the place of one-on-one care from those who know them best, to be involved in their care. Making sure the resident or loved one is on the proper medications that can give them therapy, makes the caregivers job a little bit easier and helps the resident live a better quality of life.
These personalized reports are also a great tool to show that you are doing everything in your power to help your residents, decrease unnecessary medications, and manage dosages that may not be appropriate for each individual.
For more information on pharmacogenetics and how you can implement it in your senior community, contact: PGx Medical, info@pgxmed.com or 405-509-5112.
**We are presently enrolling provider organizations and communities in a pilot program. 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.
LeadingAge Minnesota Announces Pharmacogenetic Program
Pharmacogenetic Testing Now Available ~ LeadingAge MN
Dr. Linda Shell RN, in conjunction with PGx Medical announces launch of a pilot program for pharmacogenetics testing in aging services.
Dr. Linda Shell RN, in conjunction with PGx Medical, this week launched a new pilot program for pharmacogenetics testing in aging services. 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 goal is to demonstrate the ability to improve quality, reduce costs and maximize care of older adults through pharmacogenetics.
According to the National Institutes of Health, 50 percent of nursing home residents take nine or more medications per day.
“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,” said Dr. Linda Shell, RN. “The problem is often related to comorbid conditions such as heart disease, diabetes, chronic obstructive lung disease and hypertension requiring multiple medication management.”
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. Along with anti-psychotic medication monitoring, updated regulations from the Centers of Medicare & Medicaid Services in 2018 will increase the scrutiny of medication review.
For more information, visit www.LindaShell.com/pharmacogenetics.
Taking the F-Tags Out of LTC
Avoiding the administration of unnecessary drugs is critical to maintaining a resident’s highest practicable health and well-being, and the basis of F-329.
Sonja Quale, VP and CCO at Pharmerica
In a recent article in McKnights Long Term Care News, Sonya Quale, Vice President and CCO at Pharmerica gets in-depth on F-329 citations.
According to CASPER (Certification And Survey Provider Enhanced Reports), 21.6% of facilities were cited for a F-329 deficiency based on a March 1, 2016, report of data on the last standard health survey of active SNF/NF. That is the sixth highest in the number of citations. In this blog, I’ll share certain facility risk factors for F-329 citation by surveyors, particularly when it comes to use of the highly scrutinized antipsychotic drugs.
F-329 states that each resident must receive only those medications necessary, in the doses and for the duration required, to treat specified conditions after consideration of non-pharmalogical interventions. A resident’s drug regimen must be managed and monitored to promote his or her optimal mental, physical and psychosocial well-being, with particular attention paid to minimized adverse consequences or worsening symptoms.
In addition, F-329 states that antipsychotic drugs should only be given to residents who have adequate indication for its use, and that residents who use antipsychotic drugs must receive gradual dose reductions to determine if the indication for use can be managed at a lower dose or if the medication can be discontinued.
To ensure compliance with F329, a surveyor will seek to determine:
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Whether a resident is taking only those medications that are clinically indicated in the dose and for the duration to meet his or her assessed needs,; if non-pharmacological approaches were attempted when clinically indicated; and if gradual dose reductions were made for antipsychotics
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If comprehensive care plans reflect appropriate parameters for monitoring medications or mediation combinations that pose a risk of adverse consequences
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If a facility’s medication management system monitors the effectiveness of medications and evaluates worsening signs or symptoms or change in condition that could be related to the medication
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Whether the pharmacist performs monthly medication regimen reviews
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How a center identifies and reports irregularities
Revisions to guidance in the State Operations Manual issued in 2016 highlight the importance of reducing the risk of psychosocial harm associated with noncompliance with specific regulations. Recommendations include:
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Using non-pharmacological approaches for distressed behaviors
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Focusing on identifying underlying causes of delirium, a common adverse consequence from medications, as well as other factors such as electrolyte imbalance and infection
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Monitoring of psychosocial functioning that can result from a medication side effect
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Watching for signs, symptoms or conditions that may be associated with medications, such as apathy, lethargy, and mental status changes
Moreover, significant additions to the guidance noted in the deficiency categorization section of F329 include:
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Failure to recognize that symptoms of increased confusion and that newly developed inability to do activities of daily living resulting in hospitalization are the result of excessive doses of antipsychotic given without adequate clinical indication
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Failure to recognize the continuation of an antipsychotic, originally prescribed for delirium, has caused significant changes in the resident’s behavior from baseline
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Failure to re-evaluate continuation of an antipsychotic originally prescribed for acute delirium which resulted in significant side effects
Source: McKnights Long Term Care News
One medical plan of action is to implement a medication management tool, via pharmacogenetic testing into your community for residents with medical necessity. This fully reimbursed diagnostic is a simple swab of the cheek that provides clinical caregivers an individualized report aligning current and future medications with each persons unique genetic profile. Right drug, right dose, right person. This allows individualized treatment and evidence-based reports to guide you in therapy for your residents.
For more information on how you can implement pharmacogenetics into your community, contact: PGx Medical, info@pgxmed.com or 405-509-5112.
Are Medications an Easy Fix for Dementia Patients?
Medicare and Medicaid say antipsychotics are still used too often in nursing home dementia units
When dementia patients get to a stage where they become very agitated, people start looking for an easy fix.
In an article in MedPageToday, Leonard Gelman, MD, CMD, president of the board of directors of the American Medical Directors Association was interviewed on dementia patients and the use of antipsychotics.
When dementia patients get to a stage where they become very agitated, “people are looking for an easy fix. So these medications are used,” even though in many cases they don’t help,” Gelman continued. On the other hand, “the things we know work the best are most difficult logistically, and that is, essentially, having someone be with the patient … all the time.”
“Many people think that most of the medications nursing home patients take have been prescribed by the nursing homes, but that’s not the case, said Gelman. “They get prescribed in the hospital [or by the patient’s primary care physician]. In essence, the nursing home doctors rarely prescribe these things, but we continue them for many different reasons, unfortunately. It’s a merry-go-round that keeps going ’round and ’round but it’s difficult to push the horse off the merry-go-round, because everyone has told the family and the patients they need [the medications].”
Reducing antipsychotics is part of a larger approach on nonpharmacologic treatment for these patients, according to Gelman. “In general, this is one of things we’ve been internally talking about, and also talking with CMS and others,” he said. “There are many instances where medications can be reduced, not just antipsychotics — certainly benzodiazepines, also blood pressure medications and cholesterol medications.”
The agency also released a fact sheet with state-by-state data on antipsychotic reductions. States varied in how much they reduced use of these medications over a 21-month period ending with the first quarter of 2014 — Hawaii reduced use in that state by 31.4%, while Nevada reduced antipsychotic use by 1.6%.
Even though this data is several years old, it gives you an idea of what states are dealing with and which ones met their reduction goal. 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.
Most nursing homes are being proactive – setting programs in place to be ahead of any future mandates or regulations. That’s where PGx Medical comes in. Our fully reimbursed diagnostic test can help guide healthcare professionals when dosing residents. Right drug, right dose, for the right person. Pharmacogenetics aligns current and future medications with each persons unique genetic profile – individualized treatment that can give them the therapy they need.
If you don’t have a medical plan of action to help reduce antipsychotics along with other medications, contact us and we’ll help you get started.
PGx Medical
Individualized Care – Personalized Medicine
info@pgxmed.com
405-509-5112
source: medpagetoday
Dr. Linda Shell in Conjunction with PGx Medical Announces Pharmacogenetics Pilot Program for Long Term Care
Aligning Rx with DNA – Serving One Resident at a Time
Dr. Linda Shell RN, in conjunction with PGx Medical announces launch of a pilot program for pharmacogenetics testing in aging services.
MINNEAPOLIS, Nov. 1, 2016 /PRNewswire/ — Effective immediately: Dr. Linda Shell RN (LindaShell.com), in conjunction with PGx Medical (PGxMed.com) announces launch of a pilot program for pharmacogenetics testing in aging services. 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.