by PGx Medical | Jun 15, 2017 | News, Uncategorized
At PGx Medical, we made the decision to focus on the field of aging services. Doing one thing, and one thing only helps us direct all our attention on the unique needs in senior communities across the country.
The American Geriatrics Society reports there are 7,300 certified geriatricians in the United States, which is one geriatrician for every 2,700 Americans who are 75 or older. Due to the projected increase in the number of older adults and the plateauing of the number of geriatricians over the last 10 years, it is expected to drop to one geriatrician for every 4,500 older Americans by 2030. In an article in Medicalnews.com, several medical experts state with a growing elderly population that is living longer with fewer physicians available to treat them, the future of geriatric medicine is on the verge of transitioning from disease treatment to disease prevention.
According to Paul Hill, MD, a geriatric psychiatrist and associate professor of psychiatry at the University of Tennessee Health Science Center (UTHSC), a common challenge for physicians is determining whether geriatric patients are taking their medicine consistently. Hill says advances in pharmacology will make the process easier.
Another issue physicians and pharmacists deal with on a frequent basis is the prescribing cascade. This is when the side effects of drugs are misdiagnosed as symptoms of another problem, resulting in further prescriptions and more side effects and ultimately drug reactions.
Older adults on multiple medications can lead to polypharmacy, which is common in geriatric patients. Polypharmacy refers to the effects of taking multiple medications concurrently to manage coexisting health problems. According to Dr. Linda Shell, MA, RN, “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.”
The CDC reports 76 percent of Americans over 60 use two or more prescription drugs and 37 percent use five or more. It is important to not only know what medications someone is taking, but track each patient’s medications and any side effects that may result from drug-to-drug interactions.
PGx Medical partners with pharmacists and physicians to educate and implement a tool to help determine the right drug, at the right dose, for each individual patient. It’s called pharmacogenetics.
Pharmacogenetics aligns current and future medications with each persons unique genetic profile. When the pharmacist and the physician work as a team to look at metabolization, side effects or any drug-drug interactions, it helps eliminate the guessing game – or prescribing by trial and error. By being proactive, healthcare professionals can help prevent the cascading event that happens when medications are added on top of one another. In the field of aging services, you may not have the luxury of waiting 3-6 weeks to see if a medication is working.
For more information on pharmacogenetics, contact:
PGx Medical
info@pgxmed.com
405-509-5112
source: medicalnews.com
by PGx Medical | Jan 17, 2017 | News
Doctors look for clues when trying to determine if a patient might become addicted to opioid painkillers. Clinical risk factors such as medical history, family history, and other environmental or social clues can help.
Addiction is estimated to be about 40% to 60% heritable, meaning genetics likely account for about half of a person’s risk.
Overdose deaths continue to climb with 19,000 deaths related to prescription opioid painkillers
While pharmacogenetics is not the end all be all, it is a tool used by many healthcare professionals across the country to help guide them in proper prescribing. It can help physicians and pharmacist determine if a patient has the ability to metabolize a pain medication, therefore alerting them if a patient says they are not receiving therapy and need more.
“There might actually be something to that,” said Clay Bullard, president of PGx Medical. “We’ve had physicians tell us they had patients who would complain their pain medication wasn’t working and they needed more. After performing a pharmacogenetic test, they realized the patient wasn’t able to metabolize the medication – or they were a ultra-rapid metabolizer of their pain medication so they needed to adjust their dosage accordingly. On the other hand, we’ve had physicians tell us their concern was validated after performing a pharmacogenetic test. The patient did have the ability to metabolize the medication.” Bullard went on to say with opioids, one concern is with a poor metabolizer. The body doesn’t metabolize the medication the way the manufacturer intended so the drug sits in their body and can build up toxins which can be deadly.
Cytochrome P450 2D6 (CYP2D6) is a gene product responsible for the metabolism of many major drug groups, including opioids. “A pharmacogenetic (PGx) test, approved by the FDA, is available, which looks for specific changes in the gene and interprets whether you have a ‘good copy’ or a ‘bad copy. A good copy would be a functional allele, while a bad copy is a non-functional allele. These changes and their combinations help predict how well a person will metabolize a drug.
An individual’s genotype can help predict the CYP450 activity, which classifies them into one of the four metabolizer types. The incidence of poor and ultrarapid metabolizers varies greatly among various populations. For example, approximately 10% of Caucasians are PMs for CYP2D6.
The CYP450 testing is a once-in-a-lifetime test. The result will be part of your medical record and denotes your genetic capability of handling these drugs. This not only applies to pain medications but also to other medications such as anti-convulsive medications, cardiac medications and psychotropic drugs that are used for depression and anxiety control.
Hydrocodone, the most frequently prescribed drug in the U.S., is metabolized differently depending on an individual’s phenotype. An ultra-rapid metabolizer may get some pain control, but their hydromorphone levels are going to increase and they may complain of side effects. Physicians have to be aware of that and they may need to make dosing adjustments accordingly. Poor metabolizers may not get sufficient pain control. If a patient is complaining about a drug not being effective, or about side effects, and the physician is considering a dosing adjustment, genetic testing can guide them.
The potential risks relating to how pain medications are metabolized are exacerbated by drug diversion. Drugs are now one of the leading causes of death in this country. It’s important for physicians to be aware of the impact of genetic variation on metabolizing drugs and try to identify those patients who may be at risk. If someone says they always take a half dose of a drug because of its effect or somebody else says the drug doesn’t really work for them, it’s a warning sign.
Getting the nation’s opioid addiction epidemic under control is a top priority for U.S. public health officials as overdose deaths continue to climb — with nearly 19,000 deaths related to prescription opioid painkillers.
PGx Medical is the trusted and experience resource for the education and implementation of pharmacogenetics.
For more information on pharmacogenetic testing contact:
PGx Medical
info@pgxmed.com
405-509-5112.
source: medpagetoday.com, Dr Leland McClure
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 | 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
by PGx Medical | Dec 23, 2016 | News
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
by PGx Medical | Dec 21, 2016 | News
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,
