by PGx Medical | Oct 31, 2016 | Aging Services
More than one in five U.S. nursing home residents are given antipsychotic medications
What is your medical plan of action to reduce antipsychotics in your LTC community?
The prescribing of antipsychotic medications persists at high levels in U.S. nursing homes despite extensive data demonstrating marginal clinical benefits and serious adverse effects, including death,
The analysis included 1,402,039 individuals overall, as well as a subset of 561,681 with at least 3 months of continuous observation.
A total of 308,449 of the residents had been given at least one prescription for an antipsychotic.
In more than two-thirds of cases, the agents used were from the atypical class of antipsychotics, which are primarily indicated for the treatment of schizophrenia and bipolar disorder.
“The most common antipsychotics prescribed are often used for off-label indications related to dementia, and the extended durations of use raise concerns about the care of frail elders residing in [nursing homes],” the researchers stated.
In addition, among the observed subgroup, only 7.5% had been given just one antipsychotic prescription, and the median number of such prescriptions was 10.
Even though this data dates back a couple of years, the use of antipsychotics is still prevalent in long-term care communities. In fact CMS will be coming out with new mandates for 2018 so communities should start planning now to be ahead of the mandates.
Even though some states met the original reduction guidelines, we are finding they are having trouble meeting new mandates – and have been told more are coming in 2018.
One tool used in homes across the country to help make sure residents are on medications that are actually giving them therapy, is pharmacogenetic testing.
Pharmacogenetics aligns current and future medications with each persons unique genetic profile. This simple, fully reimbursed test, will help guide healthcare professionals when prescribing medication. It takes the “guess work” out of it and provides your clinical team with evidence-based results allowing right drug, right dose, for the right person.
PGx Medical is presently enrolling provider organizations and communities in a pharmacogenetic operational pilot program. If you would like to be part of this program, please contact us at, info@pgxmed.com or 405-509-5112.
source: medpagetoday.com
by PGx Medical | Oct 19, 2016 | Aging Services
Getting through the transitions in life…
Help ease the transition for your loved one by being educated on the tools and resources that can help them live a long, healthy life!
When you are young, you dream of growing up, getting married and having children….but you never dream about taking care of your elderly parents. That isn’t part of the ten year plan. But things happen, life happens, and it is inevitable, we all get older and some of us will require a caregiver to take care of us as we age.
Those who work in eldercare understand and interact with caregivers on a day-to-day basis. Some are part of the “sandwich generation” who are caring for kids, grandkids and parents all at the same time. As you can imagine, this lifestyle can wear you down and take a toll on the caregivers health.
Becoming a caregiver for someone you love sometimes comes sudden due to an illness or accident. When that time comes, will you be prepared? There is no handbook, or step-by-step instructions on what to do, how to do it – or if you are even doing it correctly. You step in and do what you consider the best you can do. But so many choices.
One problem with elderly adults is the amount of medications they are taking. Some go from doctor to doctor, with a different diagnosis each time, and a whole new stack of prescriptions. Some even jump around to different pharmacies making it difficult for any clinical caregiver to keep track. This is dangerous.
Polypharmacy (the use of four or more medications by a patient, generally adults aged over 65 years) can cause falls and a whole host of other problems. Not to mention, do you even know if the medications they are taking are giving them therapy? Are they experiencing one reaction after another because their medications are interacting with each other? How would you know?
At PGx Medical, we have a sayIng, “You don’t know, what you don’t know.” Even a physician or pharmacist can’t predict how your body will respond to certain medications. So how would you know?
According to the AACP, polypharmacy has a high price tag. The economic impact of medication-related problems is estimated at $177.4 billion per year, rivaling that of Alzheimer’s disease, cancer, diabetes and heart disease. Plus adverse effects brought on by the combination of multiple drugs are thought to be responsible for nearly a third of all hospital admissions. Each year 32,000 seniors suffer hip fractures caused by medication-related problems. Its simple: They are overmedicated, feel dizzy when they stand up, and fall. Or worse, get behind the wheel of a car.
Now there is a simple test, pharmacogenetics, that can help guide healthcare professionals when dosing medications. Pharmacogenetics aligns current and future medications with each persons unique genetic profile. In other words, it will tell your physician what medications your body can metabolize, which medications might need a dosage change, and which medications are interacting…all personalized for each individual. Right drug, right dose, for the right person.
So why aren’t more healthcare professionals using pharmacogenetics in their day-to-day patient care? That is a good question. Some say it is because it is too new. Pharmacogenetics has been around for decades. And along the way, the FDA has added pharmacogenetic information (black box warnings) on certain medications suggesting a pharmacogenetic test be done prior to prescribing the medications.
We also hear from clinical caregivers that these tests are draining medicare dollars. Yes, this once in a lifetime test is fully reimbursed by Medicare, but this is based on cost savings. In fact, performing a pharmacogenetic test on elderly patients who are on multiple medications can save medicare dollars. Think about it…if you reduce a patients medications to “only” the ones that the pharmacogenetic report says they can metabolize and should give them therapy, you are saving money on unnecessary medications, and you are helping prevent future falls or re-hospitalization due to drug-on-drug interactions.
According to the CDC, in 2015, costs for falls to Medicare alone totaled over $31 billion. Medications play a big role in falls in elderly patients.
The more educated healthcare professionals are on pharmacogenetics, the more they understand the value and impact it can have on improving the quality of care in elderly adults. Our most fragile patients who are dependent on us to make sure we provide them the best care possible. All of this starts with the caregiver. Whether you are a family member, friend, or POA for an elderly adult, check into pharmacogenetics and other available tools and resources that can help provide a longer, healthier life – and make your job as caregiver a lot easier.
For more information on pharmacogenetics, contact PGx Medical, info@pgxmed.com or 405-509-5112
source: cdc.gov, AACP.com
by PGx Medical | Oct 17, 2016 | Aging Services
Prescribing for older patients presents unique challenges.
Atypical antipsychotic medications, used for the management of the behavioral and psychological symptoms of dementia, are among the drugs most frequently associated with adverse events in long-term care facilities.
Optimizing drug therapy is an essential part of caring for an older person. The process of prescribing a medication is complex and includes: deciding that a drug is indicated, choosing the best drug, determining a dose and schedule appropriate for the patient’s physiologic status, monitoring for effectiveness and toxicity, educating the patient about expected side effects, and indications for seeking consultation.
But how do you know what a person can metabolize, or receive therapy from, and what they can’t? It’s all kind of a guessing game and you hope that you get it right the first time. Pre-marketing drug trials often exclude geriatric patients and approved doses may not be appropriate for older adults. Many medications need to be used with special caution because of age-related changes in pharmacokinetics (ie, absorption, distribution, metabolism, and excretion) and pharmacodynamics (the physiologic effects of the drug).
Adverse drug events (ADEs) are the serious consequences of inappropriate drug prescribing. The possibility of an ADE should always be top of mind when evaluating an older adult individual; any new symptom should be considered drug-related until proven otherwise.
Atypical antipsychotics:
Atypical antipsychotic medications, used for the management of the behavioral and psychological symptoms of dementia, are among the drugs most frequently associated with adverse events in long-term care facilities. In particular, psychotropic medications are associated with an increased risk for falls. In one meta-analysis of patients age 60 or older, the odds ratio for any psychotropic use among patients who had one or more falls was 1.73 (95% CI 1.52-1.97).
Use of antipsychotic medications in long-term care facilities is widespread. A study of 19,780 older adults with no history of major psychosis prior to long-term care admission found that antipsychotic therapy was prescribed for 17 percent within 100 days of their long-term care admission and for 24 percent within one year.
Pharmacogenetics is one tool that can help determine the right drug, at the right dose, for the right person. This one time test is simple to administer and will give clinical caregivers valuable information for each individual resident in a long-term care community. There is no-cost to the resident and no-cost to the community since it is reimbursed by Medicare B and in select states, Medicaid.
If you would like more information on Pharmacogenetics, or you would like to sign up for an educational webinar, contact: info@pgxmed.com or call 405-509-5112.
Source: uptodate.com
by PGx Medical | Oct 12, 2016 | Aging Services, News
Medication management can reduce interactions and side effects that may lead to falls. Although many medication classes have been linked to falls, the evidence is strongest for a few drug categories.
Avoid prescribing medications for an older person where the risk from side effects outweighs the benefit
According to the CDC, they feel it is MOST important to:
- reduce or eliminate psychoactive drugs, especially any benzodiazepines.
- Eliminate medications if there is no active indication to use them.
- Reduce doses of necessary medications (e.g.,antihypertensives) to the lowest effective dose.
- Avoid prescribing medications for an older person where the risk from side effects outweighs the benefit (e.g., skeletal muscle relaxants).
With even more changes and reductions in psychotropic medications coming in 2018, now is a good time to be proactive and implement programs that can help you achieve these mandates.
Medication Management, via pharmacogenetic testing is a great way to avoid trial and error prescribing and have scientific-based results at your fingertips when treating your residents.
For more information on this Medication Management Program, via pharmacogenetic testing, contact:
PGx Medical, info@pgxmed.com or 405-509-5112. .
source: cdc.gov
by PGx Medical | Sep 13, 2016 | Aging Services
For some, being a clinical caregiver at a long term care facility is just a job. For others, it is personal.
Personalized medicine helps residents live longer…better!
As most of you know, PGx Medical has expanded our focus within the field of aging services. Why? Because of the thousands of nursing homes, assisted living and home health residents who get lost in the system. Those who walk into a facility on 8+ medications from multiple physicians. And for the clinical caregivers that signed up for this job because they are passionate about caring for seniors and want to do everything in their power to help them live a long, healthy life.
As we were launching our new website, we decided to reach out to a few nurses, administrators, and physicians across the country to hear what they had to say about personalized medicine, also known as pharmacogenetics. One common theme we heard was “better patient outcomes” and “improves quality measures.”
Personalized medicine is just that, aligning current and future medications with each persons unique genetic profile – it is personal. No medicine works the same for everyone, so why should everyone take the same medication? With pharmacogenetics (personalized medicine) you can now know which medications your body can metabolize and which ones it can’t. Not only does this provide you relief when it comes to pain, or therapy for other disease states, but it also saves you money.
For many seniors who are on a fixed income, they have been taking the same medication for years and they don’t appear to be having any problems. So why test them? What if this simple no-cost test was able to tell you that the medication(s) you are taking are providing you no therapy so you are just throwing your money away? Just because you aren’t having an adverse event from medication, doesn’t mean the medication is working for you. It could be, and we’ve seen it many times before, that a medication doesn’t even have the ability to work due to your genetic makeup so it is like swallowing candy each day…no therapy, expensive medications, and who knows, at some point it may interact with other medications you are taking. So why keep taking it?
Now, your doctor can order a simple swab of the cheek and within 48 hours a report is available that is “personal” to each person. Personalized medicine helps address clinical concerns such as falls, dementia, sleep, pain and overall staff efficiencies as it relates to medication management. The best part is…it is covered by Medicare B so there is no cost to the facility and no cost to resident.
To get more information on personalized medicine and how to implement it into your aging services community, contact:
PGx Medical
Individualized Care – Personalized Medicine
405-509-5112
info@pgxmed.com
by PGx Medical | Aug 26, 2016 | Aging Services
As a nurse in long term care one of my concerns has been the prevalence of polypharmacy, the excessive use of medications. According to the NIH 50% of nursing home residents take 9 or more medications per day (2016). The problem is often related to the comorbid conditions of nursing homes elders such as heart disease, diabetes, chronic obstructive lung disease, and hypertension requiring multiple medication management. Many of the medications prescribed have not been tested in clinical trials with frail elders as research studies exclude nursing home residents related to their aging bodies and comorbid complexities. The problem of polypharmacy can also lead to serious interactions between multiple medications resulting in serious harm. Some medications increase the risk of confusion, falls, and behaviors in the cognitively impaired. Other risks of polypharmacy are excessive amounts of pills that must be passed by a nurse taking them away from resident care, therefore increasing the risk for a medication error and adverse drug event.
Interactions between medications prescribed, ineffective medications (too little and not enough), trial and error with multiple medications (trying to find the right fit), risk for side effects, cost of medications, time associated with med pass that takes nurse away from bedside, plus the impact on quality of life for residents, demands a new approach in assessing medication efficacy. Additionally, CMS regulations coming in 2018 regarding medication management and requiring diligent review, heightens the need for additional tools and resources for addressing the problem of polypharmacy.
A simple, straightforward solution is needed– one that offers providers a more effective tool that can align prescribed medications to the unique needs of each resident. I believe that pharmacogenetics testing provides such a solution.
Pharmacogenetic testing provides a very simple test that aligns a residents’ personal genetic profile with the medications they need. This alignment can enhance clinical impact and improve quality of life.
Testing starts with a doctor’s order and simple buccal swab. Within 72 hours a resident’s genetic profile is generated for assisting the physician in aligning present medications being taken, along with a roadmap for future medication prescribing. Reports are simple to understand and provide clarity for clinical teams plus peace of mind for residents and their families. It’s fully reimbursed for qualifying Medicare B participants.
When I’m asked “why pharmacogenetics testing makes sense?” my response is “based on the information available, and potential impact, why doesn’t it make sense?” Pharmacogenetics is an innovative tool that has the potential to transform the process of medication management in long term care, reduce polypharmacy, and ensure the efficacy of medications.
Dr. Linda M. Shell MA, RN
Legacy Market Services / LindaShell.com
