by PGx Medical | Jan 16, 2017 | Pilot Program
Aligning Rx with DNA
The Pharmacogenetics Program is specifically designed for providers serving older adults in any setting. The program is a simple three-step process that facilitates DNA testing and aligns medications with the resident’s personal DNA. Polypharmacy is an ever-increasing problem in long term care and pharmacogenetics testing is a tool that can be utilized as part of a quality assurance and process improvement (QAPI) program. Additional benefits of pharmacogenetic testing are reduction of medications, reduced trial and error, less med pass time for nurse, and overall medication cost reduction.
by PGx Medical | Jan 11, 2017 | Pilot Program
Here in the West, we live in a culture that loves its medicine—just turn on the TV and you’ll see a drug ad at nearly every commercial break. We’ve become so impatient for a cure to every symptom imaginable, and hope our doctor will just prescribe whatever’s been working for everyone else. But the reality is, even with the great strides we’ve made in pharmaceutics, there isn’t a pill for everything – including old age.
Dr. Linda Shell MA, RN
Polypharmacy, the prescribing of 5+ medications. Polypharmacy is a problem in America and stems from the drastically different reactions each of us can have when taking the same drug. It’s not a new issue—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.
It’s called
pharmacogenetics: the study of genetic differences in humans that affect how each person responds to drugs. Pharmacogenetics has been studied for over 30 years, but it’s practical applications become most widespread in the medical community in recent years. Identifying precisely which chemicals interact with which genes, medical professionals can map specific drugs to the DNA profiles of individual patients to find the prescription that will work best for them.
This mapping process is critical for patients being prescribed the most consequential and care-intensive classes of drugs, such as cardiovascular, chemotherapy, and neurological drugs. Without pharmacogenetics, doctors may be blindly trying several different drugs in these classes until one seems to work the best, greatly increasing the risk of an adverse drug effect. Not to mention, the circumstances of these drug uses are relatively urgent. Gene-to-drug mapping ensures that a patient is prescribed one that metabolizes at the right speed and delivers the intended effect, avoiding those risks and saving precious time in treatment.
In the long term, we hope to see pharmacogenetics take more of a priority in prescriptions of all drug types as we recognize the financial benefits of pharmacogenetics. Prescribing drugs that more effectively treat a patient’s conditions and the symptoms manifested by them cuts down on ordering multiple prescriptions. Additionally, a drug that achieves its purpose more quickly saves the time and money a less fitting drug would cost in continuing care.
If you were trying on a rock climbing harness in preparation for an ascent up a dangerous cliff, wouldn’t it be common sense to pick a harness that fits you specifically? That’s what pharmacogenetics is finally doing for the drug industry; it’s high time we minimize the risk we’ve been taking with prescription drugs and become intuitive in our medicating.
by PGx Medical | Dec 2, 2016 | Uncategorized
Gene mutations that affect drug metabolism may explain higher hospitalization rates in some older adults taking multiple medications, according to researchers from Columbia University.
Nearly 40 percent of Americans 65 or older take at least five or more medications.
Polypharmacy (the use of multiple medications), is on the rise among U.S. seniors, according to an article in Sciencedaily.com. The article states, approximately 40 percent of Americans 65 or older take at least five or more medications. Previous studies have shown that older adults with polypharmacy are more prone to adverse events and hospitalizations than those taking fewer medications. However, few studies have investigated individual, genetic risk factors for adverse drug events in this population.
For this small pilot study, the researchers hypothesized that older adults with polypharmacy and increased hospitalization rates would have more genes associated with altered drug metabolism or lack of sensitivity to certain drugs than those with fewer hospitalizations.
The researchers performed pharmacogenetic testing to identify five such genes — CYP2C19, CYP2C9, VKORC1, CYP2D6, CYP3A4/5 — in older adults with polypharmacy. The study included six seniors who had been admitted to the hospital at least three times over the past two years and six age-matched controls who had fewer hospitalizations. Both groups had an average age of 77 years, and were taking an average of 14 medications.
In the higher hospitalization group, each of the participants had at least one of the mutations, and half had more than one. None of the controls had any of the mutations.
“Although this was a very small pilot study, the findings suggest that routine testing for these gene variants could improve health outcomes for older adults taking multiple medications,” according to Joseph Finkelstein, MD, PhD, director of the Center for Bioinformatics and Data Analytics in Oral Health at the Columbia University College of Dental Medicine, associate professor of health informatics in dentistry at Columbia University Medical Center, and lead author of the paper. “In dentistry, for example, pharmacogenetic testing could be part of a personalized approach in which clinicians select pain medications that are most effective and least risky for each patient.”
Pharmacogenetics aligns current and future medications with each persons unique genetic profile.
For more information on pharmacogenetics in the field of aging services, contact: PGx Medical, info@pgxmed.com or 405-509-5112
source: Sciencedaily.com
by PGx Medical | Nov 15, 2016 | Uncategorized
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
by PGx Medical | Nov 7, 2016 | Pilot 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.
