by PGx Medical | May 31, 2017 | Uncategorized
Polypharmacy is defined simply as the use of multiple medications by a patient. The precise minimum number of medications used to define “polypharmacy” is variable, but generally ranges from 5 to 10.
Polypharmacy is a growing concern in the elderly population
The issue of polypharmacy is of particular concern in older people who, compared with younger individuals, tend to have more disease conditions for which therapies are prescribed. It has been estimated that 20 percent of Medicare beneficiaries have five or more chronic conditions and 50 percent receive five or more medications.
The use of greater numbers of drug therapies has been independently associated with an increased risk for an adverse drug event (ADE), irrespective of age, and increased risk of hospital admission.
There are multiple reasons why older adults are especially impacted by polypharmacy:
●Older individuals are at greater risk for ADEs due to metabolic changes and decreased drug clearance associated with aging; this risk is compounded by increasing numbers of drugs used.
●Polypharmacy increases the potential for drug-drug interactions and for prescription of potentially inappropriate medications.
●Polypharmacy was an independent risk factor for hip fractures in older adults in one case-control study, although the number of drugs may have been an indicator of higher likelihood of exposure to specific types of drugs associated with falls (eg, central nervous system [CNS]-active drugs).
●Polypharmacy increases the possibility of “prescribing cascades”. A prescribing cascade develops when an ADE is misinterpreted as a new medical condition and additional drug therapy is then prescribed to treat this medical condition.
●Use of multiple medications can lead to problems with medication adherence, compounded by visual or cognitive compromise in many older adults.
A balance is required between over- and under-prescribing. Multiple medications are often required to manage clinically complex older adults. Clinicians are often challenged with the need to match the complex needs of their older patients with those of disease-specific clinical practice guidelines.
Pharmacogenetics is a tool used in long term care communities across the country to help manage polypharmacy. Pharmacogenetics is a simple swab of the cheek that allows providers to look at how medications align with each persons unique DNA. The results help guide providers in proper prescribing eliminating unnecessary medications and guiding them when dosing changes are recommended based on metabolization.
For more information on pharmacogenetics, contact: PGx Medical at 405-509-5112 or info@pgxmed.com.
source: uptodate.com
by PGx Medical | May 25, 2017 | Uncategorized
With the growing patient population, more health systems are utilizing PAs and NPs.
PAs and NPs play a bigger role with the emphasis on team-based care
Patients today have multiple health issues. According to an article in CompHealth, hospitals and health systems nationwide are moving toward using more PAs and NPs and there is a greater emphasis on team-based care across all settings. With the growing number of patients seeking care, it is critical and necessary.
Physician Assistants (PAs) and Nurse Practitioners (NPs) are skilled medical professionals who play an integral part in healthcare. Redesigning teams to include increased numbers of primary care providers, to include PAs and NPs, is a significant part of the solution to alleviate the well-known shortage in primary care.
Long Term Care:
NPs have been authorized to provide Medicare services to post-acute and long-term care facilities for nearly 30 years. Increasingly, medical directors and attending physicians rely on nurse practitioners as part of their team in the long term care setting.
PAs treat geriatric patients in long-term care facilities and their role is consistent: to provide medical care to seniors under the supervision of a physician. PAs as geriatric medical providers can offer comprehensive geriatric assessment with a focus on the functional status, cognitive status, and special needs of the patient.
Because adults over the age of 65 remain the fastest growing population in the United States, and because people continue to live longer, requiring care for both chronic and acute illnesses, the need for physician assistants in geriatrics remains strong.
Prescribing:
Nurse practitioners can prescribe medication, including controlled substances, in all 50 states and Washington DC. PAs are authorized to prescribe medications in all jurisdictions they are licensed.
PGx Medical works with NPs and PAs across the country educating and implementing pharmacogenetics within the field of aging services. With the shortage of staff in the long term care setting, it is more important then ever before to utilize these healthcare providers.
For more information on , or to schedule a speaker or educational webinar, contact us at info@pgxmed.com or 405-509-5112
source: CompHealth, Okmedicalboard,
by PGx Medical | May 23, 2017 | Uncategorized
Antipsychotic medications are meant to treat psychosis, but what about dementia?
In an article on changingaging.com, in a two part series Dr. Al Powers discusses Guidelines for Antipsychotic drugs in Dementia. Dr. Powers, ChangingAging Contributor, says “there are guidelines here in the U.S., both from the Federal government and from various professional organizations. But I believe these guidelines have holes a doctor can drive a med cart through. I believe we need to raise the bar in order to influence a change of habit in many professionals.”
“Putting aside the obvious point that there is no risk-free environment, let’s look at where the bulk of liability truly rests. These drugs have never been approved for use in dementia; in fact, the FDA has given them a black box warning, due to the risk of excess mortality and morbidity in this population. A doctor prescribing a drug for an unapproved use—with such a severe warning attached to the labeling—runs a much greater liability risk from an untoward side effect of the drug than from not using it,” said Powers.
Black Box Warning:
The Food and Drug Administration (FDA) is charged with the responsibility of regulating most medicines used by the public in order to ensure that pharmaceutical products are safe. One of its most straightforward ways of doing this is by issuing black-box warnings. The black-box warning appears on prescription drug labels and is designed to call attention to serious or life-threatening risks.
More dementia care professionals are speaking out about the use of antipsychotics with dementia patients.
An estimated 25% of nursing home and 13% of assisted living residents in the United States receive at least one antipsychotic medication in a given year. These medications are often used off-label and put the resident at risk for serious side effects. CMS has focused surveys on the reduction of antipsychotics in the nursing home over the past few years and rates have slowly declined.
Antipsychotic rates in nursing homes are required to be monitored as part of an overall quality program. The antipsychotic prescribing rate in both assisted living and nursing homes and the relationship between the use of antipsychotics and mortality remain an area of concern for providers, patients and families. One of the methods for ensuring that an older adult is on the right drug is pharmacogenetics. Pharmacogenetics is a simple swab of the cheek and helps guide healthcare professionals in proper prescribing. Eliminating unnecessary medications and making sure residents are on the right drug, at the right dose, based on each individuals genetic profile. For more information, contact PGx Medical at info@pgxmed.com or 405-509-5112.
Read more on the two-part series at changingaging.com
by PGx Medical | May 19, 2017 | Uncategorized
Social and public policy changes must begin soon to meet the long-term care needs of Baby Boomers.
There are many challenges facing Baby Boomers.
According to a study by Health Services Research, the real challenges of caring for the elderly in 2030 will involve: (1) making sure society develops payment and insurance systems for long-term care that work better than existing ones, (2) taking advantage of advances in medicine and behavioral health to keep the elderly as healthy and active as possible, (3) changing the way society organizes community services so that care is more accessible, and (4) altering the cultural view of aging to make sure all ages are integrated into the fabric of community life.
A major public policy concern in the long-term care field is the potential burden an aging society will place on the care-giving system and public finances. The “2030 problem” involves the challenge of assuring that sufficient resources and an effective service system are available when the elderly population is twice what it is today. Much of this growth will be prompted by the aging of the Baby Boomers, who in 2030 will be aged 66 to 84—the “young old”—and will number 61 million people. In addition to the Baby Boomers, those born prior to 1946—the “oldest old”—will number 9million people in 2030.
Various aspects of economic burden are associated with an aging population: social security payments will increase, medical care insurance costs will grow, the burden associated with uncovered medical expenses such as pharmaceuticals will become quite serious, and long-term care costs will grow.
Every elder has to prepare for four key “aging shocks”: uncovered costs of prescription drugs, the costs of medical care that are not paid by Medicare or private insurance, the actual costs of private insurance that partially fills in the gaps left by Medicare, and the uncovered costs of long-term care.
One area that continues to increase is the cost of prescription medications. Studies show, as a person ages, the more medications they take. According to a report in mdmag.com, the statistics on medication usage among elderly patients in the U.S. are eye-opening: more than one-third of prescription drugs used in the U.S. are taken by elderly patients; the ambulatory elderly fill between 9-13 prescriptions a year including new prescriptions and refills); the average elderly patient is taking more than five prescription medications; the average nursing home patient is taking seven medications. The increased risk for adverse drug-drug interactions that accompanies high levels of polypharmacy among this patient population, should lead physicians to exercise caution when prescribing to their elderly patients.
Resources Available:
Pharmacogenetics is a tool that is now being used across the country to help reduce unnecessary medications and it addresses key clinical concerns that a large number of baby boomers will face as they grow older, such as falls, dementia, sleep, pain, and overall medication management, This simple swab of the cheek enables personalized therapeutic decisions for people suffering form some of the most prevalent clinical conditions in the United States, including cardiovascular disease, neuropsychiatric disorders and pain. It was designed to help clinicians determine the right drug, at the right dose, for the right person.
PGx Medical is the trusted and experienced resource for the implementation of pharmacogenetics in the field of aging services. For more information on pharmacogenetic testing, contact, PGx Medical at info@pgxmed.com or 405-509-5112.
Read entire article at: The 2030 Problem
source: Health Services Research, mdmag.com
by PGx Medical | May 17, 2017 | Uncategorized
PGx Medical is proud to partner with senior communities across the country to help educate and implement pharmacogenetics.
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.
PGx Medical is proud to partner with senior communities across the country to help educate and implement pharmacogenetics.
Below is an interview with our partner community in Virginia Beach:
Resident 1:
We had one resident who came to us from a skilled facility. When she arrived, she was on an antipsychotic medication which we immediately look at as a red flag. We don’t want our residents on antipsychotics if we can avoid it. She was having some tearful episodes so we decided to do a pharmacogenetic test to see what the test results said because her family was reluctant to stop the medication. She was also on the medication for a diagnosis which was not really appropriate for the medication – the diagnosis was depression. We swabbed her and the test results came back that the medication Seroquel was in the black box for Use with Caution. Then we were able to go back to the family and talk to them about the test results and how that medication was probably not the best for her. So we started her on Effexor which was in the green category on the test report. The tearful episodes have decreased and she has made a really nice adjustment in the community.
The family was well educated and very involved in their loved ones life. They were nervous at first, but once we explained the test they were open to the test and didn’t want her on a medication that wasn’t effective for her. The family has been to a care plan meeting with our staff since the change and they seem happy with her progress.
Resident 2:
We had another resident who came to us from a skilled facility. She had a significant stroke that affected her ability to verbally communicate. She was having numerous crying episodes along with significant frustrations with her inability to effectively communicate with us. This was very sad to watch and was extremely frustrating to her because she thought she was saying things that we could understand. She was having these episodes frequently so we decided to test her. After reviewing her test results, we discontinued Lexapro and we started Effexor which was in the green category on the pharmacogenetic test report. There has been a significant change in her behaviors. She is having episodes a lot less then she used to. They now happen every once in a while where they were happening a couple of times a week before we made the change. She just seems more content.
~Virginia Beach Senior Community
Clinical Caregiver
PGx Medical is the trusted and experienced resource for implementation of pharmacogenetics into the field of aging services. For more information on pharmacogenetics, or contact us at info@pgxmed.com or 405-509-5112.
