Dr. Scott Dellinger, MPC Geriatrics
Metabolic Validation has become an integral part of my house call practice for everyday patient care. My practice is in nearly 30 Assisted Living facilities with approximately 1,100 patients and growing. Pharmacogenomic testing allows for tailoring better preventative efforts and finding the best pharmaceutical therapy for each individual patient.
Accurate information about drug response is crucial for individualized treatment. It explains why the old method of “trial and error” would often take so long and why it sometimes never worked. By using this clinical tool, health care providers will be better equipped to move beyond the “one size fits all” treatment strategy, to more personalized care that helps avoid drug on drug interactions, select correct dosages, and provide treatment more quickly and precisely. Upon utilizing this tool, I was able to identity that 50-75% of my patients were on a medication that needed a dosage change, had a drug on drug interaction or had little to no opportunity to receive therapy based on their metabolization of that drug.
In my practice, the test results explain why every patient doesn’t do well with the same blood pressure regimen, psychotropic medication, or a whole host of other mediations to treat various types of pain, behavior issues, cardio vascular or risk of clotting factors. I receive my results back in about 48 hours and review them to validate that the patients’ current medications are appropriate and without interferences, or that another medication change would be appropriate for better care. This also helps me select the appropriate medications with precise guidance that can be metabolized.
Once a patient has been tested, I am now able to reassure the patient and their family from this point on that we have him/her on the right medication at the right dosage. I now only start medications or change medications their loved one metabolizes appropriately at the lowest possible dosage, is most effective and that doesn’t interact with the other medications they are taking.
Utilizing pharmacogenomics also help me and the facilities be in compliance with black box warnings or other warnings referencing the need for pharmacogenomic testing for certain medications. When it comes to black box warnings, it clearly depends on the medication. In other words, we weigh the risks vs. benefits of continuing the medications. In the case of Plavix a large percentage of cardiologists and neurologists continue Plavix, in spite of the warning and without testing. In the case of most medications, there are better alternative choices, but not always. Like the drug Reglan for instance, minimal alternatives exist.
As a physician using the metabolic validation program, I am seeing a response at lower doses in the majority of my patients which will also make the reduction process shorter and more efficient, while reducing side effects due to over sedation and increase the risk of falls, loss of appetite, etc. This helps our facilities with CMS’s push to reduce psychotropic medications and unnecessary medications, as I am now able to scientifically discontinue inappropriate and ineffective medications, find the best medication and effective lower dosage for that individual patient.
Additional education to LTC owners and care providers is needed to make this clinical tool more widely utilized in their population of patients that are at the highest need and risk. This tool has made my practice more effective and efficient, benefiting the patient, the facility and my staff.