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 | Jan 11, 2017 | 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.
by PGx Medical | Jan 9, 2017 | News
Nursing homes hospitalize residents when physicians and nursing staff determine that residents require acute-level care
Nursing homes hospitalize residents when physicians and nursing staff determine that residents require acute-level care.
According to DHHS Office of Inspector General (OIG), in fiscal year 2011, nursing homes transferred one quarter of their Medicare residents to hospitals for inpatient admissions, and Medicare spent $14.3 billion on these hospitalizations. Nursing home residents went to hospitals for a wide range of conditions, with septicemia the most common. Annual rates of Medicare resident hospitalizations varied widely across nursing homes.
Nursing homes with the following characteristics had the highest annual rates of resident hospitalizations: homes located in Arkansas, Louisiana, Mississippi, or Oklahoma and homes with one, two, or three stars in the Centers for Medicare & Medicaid Services’ (CMS) Five-Star Quality Rating System.
The OIG recommended to: (1) develop a quality measure that describes nursing home resident hospitalization rates and (2) instruct State survey agencies to review the proposed quality measure as part of the survey and certification process. CMS agreed with both recommendations.
Penalties:
In a recent article in MedPage Today, A new study suggests that financial penalties provide an effective incentive to reduce avoidable readmissions, particularly at low-performing hospitals. Based on 30-day readmission rates after initial hospitalization for acute myocardial infarction, congestive heart failure or pneumonia, researchers found that hospitals with the highest incidences of readmissions also saw the highest reductions in readmissions when the financial penalties started kicking in.
How Pharmacogenetics Can Help:
Pharmacogenetics aligns current and future medications with each persons unique genetic profile. This simple test addresses key clinical concerns such as falls, dementia, sleep, pain and many other areas that effect residents in a nursing home setting on a daily basis. Having evidence-based reports for each individual resident, helps manage medications and in turn, reduces falls, helps residents sleep better, and allows the healthcare team to manage pain based on prescribing medications you know have the ability to give that person therapy.
Person-Centered Care:
CMS is now using person-centered care and care plan in their language when addressing LTC facilities. Pharmacogenetics is “person-centered” care and provides the healthcare team with documentation for each individual when preparing a medical plan of action. These pharmacogenetic reports will help identify problem areas or drug reactions that could be avoided preventing falls and/or readmissions.
PGx Medical in conjunction with Dr. Linda Shell, MA, RN are now accepting community organizations and providers in a Person-Centered Care Pharmacogenetics Pilot Program To see if your community qualifies, go to: Pilot Program, or email info@pgxmed.com, or call 405-509-5112.
Source: MedPageToday.com, oig.hhs.gov
by PGx Medical | Jan 5, 2017 | Aging Services
Person-Centered Care is defined 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
In a Person-Centered Care Model a Patients Values Guide All Clinical Decisions
Person-centered care involves transforming the relationship between providers and patients from the traditional model, in which a care provider prescribes the same treatment for most patients with similar diagnoses or conditions, into a patient-provider partnership that considers treatment options based on a patient’s unique concerns, preferences, and values.
Long Term Care:
Normal life is the goal in a LTC person-centered care environment. To achieve this goal, nursing homes adjust care and routines to the resident, instead of the other way around. For example, when a person moves into a nursing home, they typically receive a schedule of the waking time, bathing times, and seating in the dining room. When a community is person-centered, the person who has just moved in is asked about their life-long patterns and the nursing home adapts its schedule of services to support their continuation. This is important even for someone who is only planning a short-stay in a nursing home.
Person-Centered Care Pharmacogenetic Pilot Program:
Making sure an individual is on the right medications that have the ability to give them therapy is extremely important in a person-centered care environment. Having that discussion with the resident and family when they enter a Long Term Care community helps make their transition a smooth one.
Pharmacogenetics is person-centered care and provides valuable information to the physician, nurse, resident and family for each individual person.
PGx Medical is currently enrolling provider communities in a Person-Centered Care Pharmacogenetics Pilot Program. This pilot program is specifically designed to serve residents in the field of aging services and will address new requirements by CMS such as – Patient-Centered Care Plans, Comprehensive Assessments, Monthly Drug Regimen Reviews and Psychotropic Drug Reduction.
To see if your senior community qualifies for the Patient-Centered Care Pharmacogenetic Pilot Program, email PGx Medical at info@pgxmed.com or call 405-509-5112.
by PGx Medical | Dec 27, 2016 | News
Pharmacogenetics uses a patient’s genetic information to aid prescribers in selecting the right drug at the right dose for that patient.
Pharmacogenetics uses a patient’s genetic information to aid prescribers in selecting the right drug and the right dose for the patient.
WHAT is Pharmacogenetics?
Researchers have identified some 200 drug–gene pairs in which a particular gene mutation has implications for how a patient will respond to a given drug. The National Institutes of Health (NIH)–funded Clinical Pharmacogenetics Implementation Consortium (CPIC) has compiled these pairs into a list along with clinical guidelines. FDA offers a list of drugs for which pharmacogenomic markers are included in the labeling.
In addition to cancer drugs, medications for HIV, heart disease, depression, and chronic pain, among many other conditions, are associated with genes that can modulate the drugs’ effects or the adverse effects they bring.
Take codeine, for example. The cytochrome P450 (CYP) 2D6 gene produces a protein that converts codeine into morphine in the body. The morphine then has its pain-relieving effect. Some people have a mutation in CYP2D6, however, that causes the body to convert codeine too slowly or not at all, rendering the drug ineffective. Another possible mutation in the gene can cause dangerously high levels of morphine to accumulate in the body after a standard dose of codeine.
“There’s been cases where children have died from having too much morphine because the conversion by that gene is ramped up,” said James Hoffman, PharmD.
WHY Pharmacogenetics:
Just as a patient’s age, lifestyle, existing comorbidities, and other medications figure into a prescriber’s selection of a drug, genetic predisposition to do well or poorly on that drug is a crucial clinical factor that health care providers can now consider.
“If you’re a patient newly diagnosed with depression, we have 10 or 15 drugs that we know will work in the population, but we need to know which one to pick for you,” said Mark Dunnenberger, PharmD, director of the pharmacogenomics program at NorthShore University HealthSystem in Evanston, IL. “Up until today we might ask the patient, ‘Has somebody in your family had this problem before? What medications worked for them?’ That really is a genetic question.”
Physicians sometimes do the “trial and error” process of trying numerous drugs before finding one that works. Each drug can bring new potential risks, and the time it takes to find the right drug is time that the condition goes untreated. Genotyping can increase the odds that prescribers try the right drug first.
“We believe it will lead to safer, more effective medication therapy by reducing the probability that patients accumulate side effects and by increasing the probability that the patient receives the benefit we expect from the medication,” said Dunnenberger.
Pharmacists and other health care providers should not see pharmacogenomics as an esoteric bench science, Hoffman added, but as a tool for optimizing medication safety.
Rather than removing codeine from formularies, for example, in response to mortalities associated with the drug, “it allows us to still use codeine safely in our patient population,” Hoffman said. “[Codeine] is a good application for pharmacogenomics because it leaves this therapeutic option that can be used safely. More therapeutic options are usually better.”
~American Pharmacists Association
Pharmacogenetics has many applications in todays medicine. PGx Medical is the trusted and experienced resource for the implementation of pharmacogenetics in the field of aging services.
Our team of educators/consultants travel around the country working with healthcare professionals to help implement this program into senior communities, pharmacies and provider organizations. Pharmacogenetics addresses key clinical concerns such as falls, dementia, sleep, pain, med management and overall staff efficiencies.
For more information on pharmacogenetics, contact: PGx Medical, info@pgxmed.com or 405-509-5112.
Resource: pharmacists.com
