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What is Person-Centered Care?
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.
What is Pharmacogenetics?
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
PGx Medical: A Year At A Glance 2016
2016 was a big year for PGx Medical with growth, new partnerships and a new website
Clay Bullard, President, PGx Medical
We want to start by saying “thank you” to our partners, clients and employees. We are truly blessed to have such a wonderful team!
We kicked off January 2016 by adding bipolar and seizure to our list of medication classes giving healthcare professionals more information then ever before. With this addition, our program now offers the most comprehensive PGx test report on the market.
We have been in our new building for two years and have expanded our team. With the addition of a full time Client Service Coordinator and a Clinical Sales and Support Coordinator, PGx Medical continues to grow and expand as the market demands.
Throughout the year, I was privileged to speak to many senior communities, conferences and healthcare organizations about our program and how pharmacogenetic testing addresses key clinical concerns such as falls, dementia, pain, sleep and staff efficiencies.
In August, PGx Medical expanded our focus into the field of aging services. With the launch of a new website, a pilot program and partnership with Dr. Linda Shell, we were able to reach more healthcare professionals than ever before.
We also had the privilege to partner with physicians and pharmacists who understand the value of the program and use pharmacogenetics in their day-to-day patient care. These partners have been instrumental in educating others through online video, articles, local media outlets and case studies on outcomes based on changes from test results. We are appreciative and humbled by their willingness to share these stories.
During 2016, we partnered with one of the largest Oklahoma state agencies to manage their PGx Feasibility Pilot Program. Results and benefits analysis for the pilot will be available in Q1 of 2017. This is one of the largest pilot programs of its kind and we were honored to be able to partner with the State of Oklahoma.
Pharmacogenetic testing has received a lot of attention over the years under the umbrella of Precision Medicine, and we are excited to see that continue. Future outlook is good and precision medicine will continue to grow and expand as new CMS regulatory requirements rollout 2017-2018 for unnecessary drugs.
We look forward to long-lasting relationships with current clients and new partnerships in the coming year.
Enjoy the holidays! As always, you can contact us anytime with questions, comments or to schedule an appointment or speaking engagement.
PGx Medical
Individualized Care – Personalized Medicine
www.pgxmed.com
405-509-5112
info@pgxmed.com
Looking Forward: The future of Precision Medicine
Looking forward – what the future holds for precision medicine
Outlook for precision medicine.
According to a recent article in Medical Device & Diagnostic Industry, medical technology took big leaps forward in 2016. So whats in store for 2017?
Personalized Medicine
We are seeing a trend in personalization in every sector. One area that has seen a lot of progress is in the mapping of the human genome and the understanding of how individuals react to specific drug treatments. Increased technical power and understanding of the human genome is now allowing targeted therapy to become a reality.
With over more than 60% of patients failing to achieve remission with the first anti-depressant they are prescribed, personalized medicine is a big piece of the puzzle. Physicians and pharmacists can now review results from a simple no-cost buccal swab whether or not an individual can metabolize a medication, or may have drug interactions. Technology and the scope of personalized medicine will continue to grow and expand.
Government reimbursements for personalized medicine is one factor that is expected to propel the demand from 2016-2022.
There are three beneficiaries from the advancements of personalized medicine — patients, the pharmaceutical industry, and society. As developments are made in the field of personalized medicine, patients will receive safer and more effective treatment; the pharmaceutical industry will gain increased efficiency, productivity, and better product lines; and society will gain from decreased health care expenditures as a consequence of the more precise allocation of limited health care resources.
Pharmacogenetics is an emerging field that’s helping physicians make better prescription decisions. PGx Medical is the trusted and experienced resource for the implementation of pharmacogenetics in the field of aging services.
For more information on pharmacogenetics, contact: PGx Medical, info@pgxmed.com or 405-509-5112
References: MD&DI.com, managedcaremag.com,
Opioids and Pharmacogenetic Testing
Between 2000 and 2014, opiate-related overdose deaths in the U.S. increased 200%
Opioid-related hospitalizations and ED visits spike in US. photo courtesy of healthcare dive
The rate of opioid-related hospitalizations and ED visits varied significantly by state, with the highest hospitalization rate occurring in Maryland and the highest rate of ED visits in Massachusetts.
According to an article in Healthcare Dive, Opioid-related hospitalizations and ED visits spike in US.
Between 2005 and 2014, the rate of opioid-related hospital stays increased 64.1% while opioid-related ED visits increased 99.4%.
But not all states were the same. Opioid-related hospitalizations and ED visits varied by state with the highest ED visits being in Massachusetts and the highest hospitalization being in Maryland.
An opioid epidemic was declared in the U.S. by the HHS (U.S. Department of Health & Human Services) this past October due to a marked increase in the misuse of opioids over the past decade. The new statistical brief provides detailed, state-by-state data on overdose deaths, the rate of opioid-related hospitalizations and the rate of opioid-related ED visits. The brief did not differentiate between illegal opioid use, misuse of prescription opioids and compliant use of opioids.
HHS has urged providers to alter their prescribing practices, essentially making opioid medications a last resort. Meanwhile, hospitals and healthcare systems have started their own initiatives to address this national challenge, such as focusing on pain management alternatives or requiring across-the-board reductions in the number of opioid prescriptions.
Pharmacogenetics and Opioids:
Patients with CYP450 pharmacogenetic variations may respond differently to opioids, ranging from drug unresponsiveness to toxicity with elevated serum levels. The administration of opioids may be associated with adverse drug reactions including sedation, dizziness, nausea, vomiting, constipation, physical dependence, tolerance, and respiratory depression. By performing pharmacogenetic testing, patients can be dosed appropriately to avoid experiencing dose-dependent side effect or lack of drug efficacy.
Results of pharmacogenetic tests allow patients to be dosed appropriately. Pharmacists can play a role in providing information to patients on selecting opioids where genetic testing may be useful. ~medscape.com
For more information on Pharmacogenetic Testing, contact: PGx Medical, info@pgxmed.com or 405-509-5112.
Read entire article at: healthcaredive.com
Precision Medicine: Filling Needs In LTC
In a recent article by Bill Kubat, LNHA – Move over patient-centered care, make way for precision medicine, Manju Beier explains how pharmacogenetics fills a need in LTC.
Several terms, including “precision medicine,” “stratified medicine,” “targeted medicine,” “pharmacogenetics” and “pharmacogenomics” are sometimes used interchangeably with “personalized medicine.” The American Medical Association describes personalized medicine as “health care that is informed by each person’s clinical, genetic and environmental information.”
Pharmacogenetics Fills a Need
To better understand its implications in long-term care, I visited with Manju T. Beier, PharmD, CGP. Dr. Beier is president and founder of Geriatric Consultant Resources, LLC, a firm that provides clinical expertise in pharmacotherapy and clinical pharmacology to geriatrics professional organizations, managed care organizations, and health care plans. Dr. Beier has been a frequent presenter at AMDA – the Society for Post-Acute and Long-Term Care Medicine conferences.
Dr. Beier explained that the recognition of PGx as a science with clear implications for patient-centered care has been facilitated by the convergence of several factors across all health care, including implications for long-term care:
•The need for improved therapeutics. Studies and numbers frequently cited by the FDA and other regulators include a 2001 study that showed that the response rates of patients to medications from different therapeutic classes ranged from about 80% for analgesics to about 25% for oncology, 52% for osteoporosis, 75% for cancer chemotherapy, 70% for Alzheimer’s disease, 38% for depression, 43% for diabetes, 50% for arthritis, 48% for migraine (prophylaxis), 40% for asthma, and 40% for cardiac arrhythmias. Varying response rates to medications may be explained by a variety of factors; perhaps underlying variability in pharmacogenetics is one of them.
• Increased focus on adverse drug reactions. An estimated 2.2 million adverse drug reactions occur each year in the United States, including more than 100,000 deaths. Older adults with polypharmacy are especially at risk.
• Increased emphasis on medication management. PGx is potentially useful for predicting dosing, toxic side effects, and therapeutic effects, and for eliciting drug-gene interactions.
• Effects on measurable outcomes. Clinical studies evaluating the impact of pharmacogenetic-guided dosing and monitoring on ED visits, hospitalizations, quality of life, and health care costs are few and far between but slowly making their way into the literature.
To move it from the hypothetical to the concrete, consider the following case as described by Dr. Beier in The Consultant Pharmacist (Beier MT. Pharmacogenetics: has the time come for pharmacists to embrace and implement the science? Consult Pharm 2013;11:696–711):
~ Mr. J is an 83-year-old patient who resides independently in a senior living community. His past medical history includes depression comorbid with dementia, hypertension, and type 2 diabetes. He has no known allergies to medications. He has taken several anti-depressants in the recent past, including amitriptyline, paroxetine, and citalopram for his major depressive disorder. However, he either failed to achieve an adequate response or exhibited intolerable side effects to these medications. His current daily medications include simvastatin 20 mg, glipizide 5 mg, sertraline 50 mg, donepezil 5 mg, aspirin 81 mg, lisinopril-hydrochlorothiazide 20 to 25 mg, and metformin 500 mg twice daily. At the request of the consultant pharmacist, and in light of his past history with medication intolerance for depression, the physician orders cytochrome P450 genetic testing.
The resident’s pharmacogenetic results indicate that he is an ultra-rapid metabolizer of the CYP2C19 pathway and could potentially need higher doses of sertraline, which is metabolized via CYP2C19. CYP2D6 is a minor pathway in the metabolism of sertraline, and the resident’s poor metabolizer status suggests the need for extra vigilance. Based on the consultant pharmacist’s recommendation, the physician increases the sertraline dose gradually while monitoring for response over the next several weeks.
Eventually, the patient achieves a significant reduction in symptoms at a dose of 150 mg/day. The ultra-rapid CYP2C19 status may explain why the patient previously did not respond to citalopram, also a CYP2C19 substrate. The citalopram dose was not increased beyond 20 mg daily, complying with FDA-recommended maximum dose limits set for citalopram in the elderly. Amitriptyline is converted to nortriptyline via CYP2C19, and both amitriptyline and nortriptyline are further metabolized via the CYP2D6 pathway. As an ultra-rapid metabolizer of CYP2C19 and a poor metabolizer of CYP2D6, the resident may have had increased levels of nortriptyline, potentially causing his intolerance to the medication.
Similarly, his intolerance to paroxetine may have been as a result of his poor CYP2D6 status. It is well recognized that older patients, especially with dementia, are more susceptible to the anticholinergic side effects from nortriptyline and amitriptyline. This, combined with a poor metabolizer status, could potentially increase the risk for adverse events from paroxetine as well, which exhibits some antimuscarinic activity and has recently been added to the Beers list as a generally inappropriate medication to use in the elderly. Changes were not made to donepezil, as he was clinically stable at the prescribed dose.
This case illustrates how pharmacogenetic testing and appropriate resultant interventions can enable a patient to be maintained in the environment they wish to call home. It also illustrates the need for collaboration across the inter- disciplinary team with patient assessment (note the involvement of the consultant pharmacist) to identify the appropriateness of testing and determining interventions based on those test results.
PGx Medical is the trusted and experienced resource for the implementation of pharmacogenetics in the field of aging services. For more information on pharmacogenetics or to schedule a speaker/educator, contact: PGx Medical, info@pgxmed.com, 405-509-5112.
Read entire article at: caringfortheages.com