News
Medication Management, Via Pharmacogenomics
Clay Bullard travels around the country educating healthcare professional on Medication Management, via pharmacogenomic testing.
Clay Bullard, President
PGx Medical
PGx Medical President, Clay Bullard has made it his goal to reach as many healthcare providers as possible to educate them on a tool that is available to manage medications. Clay’s passion for the test shows when he asks providers, “if this was your loved one, would you want to know if their medication is working properly? You don’t know, what you don’t know. And our simple buccal swab of the cheek will tell you if your loved one is even capable of metabolizing their medications.
“Pharmacogenomics isn’t new, it has been around for a long time,” said Bullard. What is bringing it to the forefront of the healthcare industry is how affordable it has become. PGx Medical works with hundreds of senior communities, clinics and pharmacies across the country and there is no cost for patients with Medicare B. And in select states, Medicaid reimburses for the test as well.
Adverse reactions attributable to prescription drug use cause an estimated 100,000 deaths and more than two million serious reactions in the United States each year, costing the healthcare industry more than $136 billion annually. By 2030, about 72 million people will be 65 or older. Today’s seniors live longer than before, which makes it important to make your extra years as fun-filled and pain-free as possible.
“Our PGx Medical team works with physicians and care providers who are desiring to increase medical efficiencies, reduce cost, increase better outcomes and ultimately do the best they can for each individual patient,” said Bullard.
For more information on pharmacogenomic testing, or to schedule PGx Medical to educate your group or organization, contact:
PGx Medical
info@pgxmed.com
405-509-5112
Proposed Rule Aimed to Improve Quality of Care in Nursing Homes
An estimated 1.5 million beneficiaries are receiving treatment at more than 15,000 long-term care facilities around the country.
The CMS proposed a rule aimed at dramatically improving the quality of care Medicaid and Medicare beneficiaries are receiving in nursing homes.
According to modernhealthcare.com, an estimated 1.5 million beneficiaries are receiving treatment at more than 15,000 long-term care facilities or nursing homes around the country that participate in the Medicare and Medicaid programs.
The 403-page proposed rule released in 2015 contains numerous proposals to reduce unnecessary hospital readmissions and infections, increase quality of care and introduce new safety measures.
President Barack Obama announced the new rules in July 2015 at the White House Conference on Aging.
Some of the changes include making sure that nursing home staff members are properly trained on caring for residents with dementia and in preventing elder abuse. Other changes include improving care planning, including discharge planning for all residents with involvement of the facility’s interdisciplinary team and consideration of the caregiver’s capacity, giving residents information they need for follow-up, and ensuring that instructions are transmitted to any receiving facilities or services. Lastly, the CMS is looking to strengthen the rights of nursing home residents, including placing limits on when and how binding arbitration agreements may be used.
The CMS is the leading payer in the nation for long-term care services. Approximately 64% of nursing home residents have their care paid for by Medicaid, another 14% are covered by Medicare and 22% have another payer, according to the American Health Care Association, a nursing home trade group.
If finalized, the proposals would cost the nursing home industry $729 million in the first year the rule is in effect and $638 million in year two, according to the CMS.
Richard Mollot, executive director at National Consumer Voice for Quality Long-Term Care, said he also wanted more controls to ensure that senior citizens are not unnecessarily prescribed anti-psychotics, which has been a problem at nursing homes.
“When anti-psychotics are used long term, there is an increased risk of death,” Mollot said. Read entire article at modern healthcare.com
Clay Bullard, president of PGx Medical believes by managing a residents medications you can improve quality of care not only for the resident, but also for the staff. “All of a sudden, residents with behavioral issues aren’t a problem any longer when you have them on medications they are able to receive therapy from, and you can reduce cost by eliminating unnecessary medications. It’s a win-win for everyone.”
For information on Metabolic Validation, via pharmacogenomic testing, contact:
PGx Medical
Individualized Care – Personalized Medicine
info@pgxmed.com
405-509-5112
Can Moving to a Nursing Home Cause Depression?
Often a move to a nursing home represents the loss of independence to elderly people.
Today’s nursing homes have improved from years past. Now with beautiful gardens, allowing pets to visit or sometimes stay, and larger rooms. Still, for many elderly people, the move to a nursing home represents the end of the road and a loss of independence. It’s a place you go to die.
For many seniors, these thoughts can lead to depression, ranging from mild to chronic, which affects approximately 40% of nursing home residents, according to the American Geriatrics Society. Despite its prevalence, few elders in nursing homes will openly admit that they are depressed. That means in many cases, the family must look for the warning signs, which can be subtle: Dad isn’t quite as chatty and social as he once was. Mom just picks at her meals.
Often, depression goes undiagnosed and untreated, or treated as a “normal” part of aging. Because the signs of depression can mirror the signs of dementia, especially problems with focusing and concentrating, diagnosing depression in an older adult can be difficult. While medication or therapy or both could be prescribed for any patient with depression, knowing the cause can lead to more effective treatment.
Kenneth M. Sakauye, a geriatric psychiatrist at UT Medical Group in Memphis, Tenn., says getting to the root cause of depression is key. “Depression can have a biological cause or a psychological cause.”
According to agingcare.com, 50% of people develop depression. Dr. Sakauye explained that brain changes caused by Alzheimer’s, such as decreased blood flow, can result in a sort of vascular depression. If the cause is a biological factor like this, medication may be more effective than therapy because it treats the chemical imbalance.
On the other hand, if depression is mild and caused by psychological factors, such as lack of socialization and stimulation, therapy could be more helpful. “Elderly patients often say the best times of their lives are over,” Dr. Sakauye explains. “They were forced to move from home. They feel as if they don’t have anything left to live for.”
These people can benefit from talking to a professional therapist as well as lifestyle changes such as socialization, stimulation, exercise and bright lights.
There are many ways to treat depression the key is recognizing the symptoms and knowing how to treat it. Medication can play a key role in managing depression. But how do you know what medications will work best?
“There is a simple test available that cost the facility nothing and the resident nothing when they are covered by Medicare B. This simple buccal swab of the cheek will let the healthcare providers know if the depression medications they are taking has the ability to work, or if it isn’t being metabolized by that individual. Or, it might be that the other medications they are on aren’t working therefore adding to the depression,” said Clay Bullard, President of PGx Medical.
Making sure your elderly parent, friend or patient is on the right medication is key to helping them live longer…better!
For more information on medication management via Metabolic Validation, contact:
PGx Medical
info@pgxmed.com
405-509-5112
www.pgxmed.com
source: agingcare.com
Studies Confirm Metabolic Validation Testing Does Have A Positive Financial Impact
As the education of Pharmacogenomic Testing becomes more prevalent within the LTC arena, many questions have been raised as to the potential for “true savings” or “financial benefits” to testing.
Clay Bullard, President
PGx Medical
Several studies have been published that speak to both the clinical and financial benefits of utilizing testing. The goal of this article is to highlight several of these reference studies and their findings, all in an effort for CEO’s, DON’s and Physicians to potentially rethink some of their processes in Medication Management for LTC residents.
In 2014, the amount of money spent on prescriptions in the US was approximated to be $300 billion, with an estimated 6.3% annual increase according to Medicare and Medicaid data1. It is estimated that an additional $.50 is spent on Adverse Drug Reactions (ADR’s) for every $1 spent on the initial prescription. Polypharmacy dynamics increase significantly within the Elderly, specifically LTC residents, compounds additional costs associated with falls, hospitalizations, increased level of care, pain management and so on2-6.
Other studies have shown that implementing the PGx testing program can change referral rates and decrease mortality rates within LTC facilities. This can lead to higher census rates, better marketing efforts and staff efficiency7-8. A healthier patient population on fewer medications, and lower mortality rates, should provide a positive value proposition for any LTC facility Owner, CEO, Physician, or care provider to consider.
Additionally, one study has shown the value of testing to decrease patient treatment cost by over 60% in a clinic setting9. In the hospital setting, studies show the true impact to care providers, as hospital length of stay was three times longer with twice the amount of hospital charges/cost for patients who had an ADR and intermediate metabolization of their 2D6 gene10. Implementing Metabolic Validation testing early in the care process is key to provide clinical and financial benefit11.
In summary, the argument that there is not data to support the value proposition for a program that costs an LTC facility $0 to implement, has now been eliminated. We are very excited to have an overwhelming amount of clinical and statistical data that supports the “real world” feedback we receive daily from clinicians in facilities all over the United Sates. These data points validate the clinical and financial impact the program has had and can have in an LTC facility.
We hope every facility will ask the simple question, “Is our facility doing everything we can do to offer the best opportunities for quality of life for your residents?”
For more information, contact:
PGx Medical
info@pgxmed.com
405-509-5112
References:
- (Centers for Medicare and Medicaid Services. Available from: https:// www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends- and Reports/NationalHealthExpendData/Downloads/proj2014.pdf. CMS; 2013. Accessed November 27, 2015.)
- SgangaF,LandiF,RuggieroC,etal.Polypharmacyandhealthoutcomes among older adults discharged from hospital: Results from the CRIME study. Geratr Gerontol Int. 2015;15(2):141–146.
- 10. Runganga M, Peel NM, Hubbard RE, et al. Multiple medication use in older patients in post-acute transitional care: a prospective cohort study. Clin Interv Aging. 2014;9:1453–1462.
- 11. Garfinkel D, Mangin D. Feasibility study of systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170(18):1648–1654.
- 12. Garfinkel D, Zur-Gil S, Ben-Israel J. The war against polypharmacy: a new cost- effective geriatric-palliative approach for improving drug therapy in disabled elderly people. Isr Med Assoc J. 2007;9(6): 430–434.
- Winner J, Allen JD, Altar CA, Spahic-Mihajlovic A. Psychiatric phar- macogenomics predicts health resource utilization of outpatients with anxiety and depression. Transl Psychiatry. 2013;3:e242.
- Garfinkel D, Mangin D. Feasibility study of systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170(18):1648–1654.
- 12. Garfinkel D, Zur-Gil S, Ben-Israel J. The war against polypharmacy: a new cost- effective geriatric-palliative approach for improving drug therapy in disabled elderly people. Isr Med Assoc J. 2007;9(6): 430–434.
- Herbild L, et al. Does Pharmacogenetic Testing for CYP450 2D6 and 2C19 Among Patients with Diagnoses within the Schizophrenic Spectrum Reduce Treatment Costs? Basic & Clin Pharmacol&Toxicol 2013; doi10.1111/bcpt.12093.
- Chou WH, et al. Extension of a Pilot Study: Impact From the Cytochrome P450 2D6 Polymorphism on Outcome and Costs Associated With Severe Mental Illness. J Clin Pyschopharmacol 2000;20(2):246-251.
11. Saldivar JS, Taylor D, Sugarman EA, Cullors A, Garces JA, Oades K, Centeno J; Initial assessment of the benefits of implementing pharmacogenetics into the medical management of patients in a long-term care facility; Dove Medical Press, 19 January 2016 Vol2016:9 Pages 1-6
Pharmacogenomic Testing and MTM
MTM and Pharmacogenomic Testing…a perfect fit
Blair Green Thielemier, PharmD
Pharmacy Times
Genetic testing has come a long way since completion of the project. Now pharmacists and physicians can use pharmacogenomic test results to help choose safer and more effective medications for their patients. An article posted on Crain’s Chicago Business website featured a physician clinic in Illinois that is doing preemptive genotyping: NorthShore University’s HealthSystems clinic is building a program that will screen patients and use DNA test results to guide therapies.
Another recent study, this one published in the Journal of Medical Economics and conducted at the University of Utah, used cytochrome P450 pharmacogenetic profiling in clinical decision making for elderly patients. The study results found that the hospitalization rate of the genotype-tested group was 6.3 percentage points lower than the untested cohort: 9.8% versus 16.1%, respectively. The estimated potential cost savings was $218 (mean) in the genotype-tested group.2 The study also found that among the health care providers of the genotype-tested group, 95% of providers found the test “helpful” and 46% followed the clinical decision support tool recommendations for therapy changes. The Mayo Clinic is conducting similar studies on the effectiveness of preemptive genotyping, developing clinical decision-making support tools of its own and planning integration of test results into its electronic medical record (EMR).
No one understands medication management better than a pharmacist. So why not help guide them by determining upfront which medications a patient can actually metabolize? A simple swab of the cheek can help lower healthcare costs and improve the quality of life for our seniors.
Read entire article at: pharmacytimes.com
For more information on pharmacogenomic testing, or how you can implement pharmacogenomics, contact:
PGx Medical
Individualized Care – Personalized Medicine
info@pgxmed.com
405-509-5112
Pharmacogenetics: Testimonial
PGx Medical is proud to partner with Brookdale Senior Living!
Rose Willingham, Wellness Director
Brookdale Senior Living Norman
On October 14, 2014 I heard PGx Medical President, Clay Bullard speak in Tulsa at the State Provider Training meeting. Pharmacogenetics was the only thing I took away from the seminar. I wrote Clay’s name down and went back and spoke to our doctors about doing the test.
I had several residents at the time on 3-4 blood pressure medications that I knew would benefit from something like this. I remember thinking, if this test can get them off of some of their meds and help prevent falls, that’s what I need to do. When something is wrong, you always look at the medications. And when someone is on three pages of meds and they are tiny, you start to wonder what is going on.
I was so impressed with Clay’s talk that I came back and told Dr. Dellinger about the program. He has always been so receptive to anything I talk to him about, so I asked Dr. Dellinger if he had ever heard about the test. He said a little, but not a lot. I told him I really want to try it and see if we can get some of our residents off medications they don’t need to be on and get them on the right medications. He said, “It sounds great! Check into it for me.”
I called PGx Medical and one of their consultants came out right away and explained the program to us. Dr. Dellinger started writing orders for me and I began testing. I also have a couple of physicians outside the facility that the residents still go out to see and they have started testing their residents as well.
We’ve been using the Metabolic Validation Program (pharmacogenetic testing) for about two years and now we test all of Dr. Dellinger’s patients with medical necessity. Dr. Dellinger comes in every two weeks and knows everything about the residents, he’s great!
I have one resident who wasn’t metabolizing any of her medications. That is one of those residents who was on three pages of medications. She was on all the wrong ones. We made some tweaks and it’s amazing, her hallucinating went away. She doesn’t hallucinate anymore and she sleeps better too. She is doing well now!
We have another lady who liked to take things away from other people. Then she quit eating. We did the test, got her on the right medications, and she did so well after we made changes to her meds that we were able to discharge her back out into the community. She was just doing that well. She is now living at home with no problems. It was the medication changes and finding the one that she metabolized and worked for her.
The majority of Dr. Dellinger’s residents that we’ve tested, we’ve made changes and tweaked and they are doing so much better. There are none that we have tested that it hasn’t worked on.
It’s great, we love it, and I will tell anyone they need to do it!
For more information on Metabolic Validation, via Pharmacogenetic Testing, contact:
PGx Medical
info@pgx.med.com
405-509-5112
www.pgxmed.com