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A reliable long term care pharmacy services provider should ensure prompt medication delivery that works with your schedule – not the other way around.
At Grane Rx, we take pride in our 99% success rate for on-time deliveries. Your staff shouldn’t have to worry about when (or if) prescriptions will be delivered. A dependable LTC pharmacy services partner should synchronize your deliveries and be willing to schedule them on a timeline that works for your staff and residents.
It’s no secret that adherence to medication is driven by the degree to which a resident or participant understands their treatment regimen. The right LTC pharmacy will simplify med literacy by utilizing simple instructions and tailored packaging that makes taking those meds easier all around.
Grane Rx is a leading provider of pharmacy services that simplify medication management for those in LTC settings – and those who choose to age in place. Our Meds2Home program allows participants to receive their medications, guaranteed – never left on a doorstep. In this program, medication is presorted with all instructions and educational material written at a fifth grade reading level to better support health literacy and prevent errors with dosing.
It’s essential to have a dedicated team of senior care professionals with the knowledge to provide expert support to your teams, 24/7. A good pharmacy partner will make sure you’re never left hanging when it comes to after-hours questions or confusion around a medication regimen.
Medication management is one of the most critical aspects of long-term care, and relying on dated technology can lead to ineffective communication and confusion when it comes to drug administration.
Choosing a pharmacy partner who invests in infrastructure and technology designed to support needs unique to long-term care demonstrates commitment to providing the best possible service.
The patient is at the center of everything you do – and your LTC pharmacy should be ready to provide solutions to the challenges you and your patients face when it comes to medication management.
Whether you’re looking to move away from a one size fits all approach to your prescribing practices or reduce costs and negative outcomes associated with trial-and-error prescribing, incorporating a pharmacogenetic test into your treatment model is a increasingly reliable means of getting better results and healthier patients.
A while back, we collaborated with precision diagnostics leader Access Dx to present a webinar discussing the value of pharmacogenetic (PGx) testing across care settings. While we encourage you to watch the webinar itself, we know you may not have the time – so we’ve hit on some of the important points below in hopes that it might open up a conversation on introducing PGx testing into your practice.
Pharmacogenomics is the study of how a person’s genetic makeup affects their response to medications. PGx testing uses pharmacology and genomics to identify genetic differences, Leveraging this information enables a prescriber to choose the best medications and treatments for patients. It also reduces the chance of harmful side effects. Despite limited clinical trial data and the existence of ever-expanding genetic profiles, we’ve managed to develop medications that work for many patients – but nowhere near all of them.
While the field of PGx was first introduced in the 1950s, it’s only gained traction over the last 10-15 years as clinical trial diversity and efficacy of first-line treatments have been called into question. When commonly utilized therapies prove less-than effective for a sizable portion of the patients for which they are prescribed, it’s time to introduce precision medicine.
Thanks to the rise of direct-to-consumer genetics testing companies like 23 & Me, even individuals with no clinical background are gaining an appreciation for the ability to understand one’s health by examining DNA – and while the applications are a little bit different, the underlying goal of preventing or better treating chronic illness is the same.
While pharmacogenomics certainly sounds like a complicated form of evidence-based medicine, what these evaluations are really looking at is an individual’s ability to metabolize a drug. Depending on a drug’s mechanism of action, specific metabolic enzymes are required to convert the medication to “active” in one’s system. If a patient has a metabolism that digests that medication too slowly (known as a poor metabolizer) or too quickly (known as a ultra-rapid metabolizer) the drug is unable to provide the desired therapeutic effect. That’s just one example of how a medication might not do its job.
For any one indication or diagnosis, there might be 15+ medications approved by the FDA, ranging dramatically in cost. This is why testing is so critical. For example, if a patient is a poor metabolizer of the active ingredient in the top three most affordable medications used to treat their illness, it’s important to know that not only will these meds not work – but that said patient may become even more sick in a way that costs a lot more for an insurer than springing for, say, the 7th medication on the list. The difference, which does add up, is likely a few extra dollars a day – but it’s certainly a lesser expense than ED visit, hospital readmission, or additional diagnostics and follow ups.
While the concept of PGx testing as a regular standard of care may seem cutting-edge, its utilization in precision medicine is growing faster than ever. Even the FDA has provided a set of gene-drug interactions they feel are credible for certain groups of patients.
While not mandated, implementing PGx into the therapeutic process can make the difference when getting a “yes” from insurers. In fact, choosing to do so has the potential to significantly reduce time and money spent on therapies that just won’t work, or worse, could severely injure or worsen a patient – making the case for implementing testing even in cases where reimbursement is not available.
Even better, this kind of testing normally doesn’t need to be repeated as it is done by evaluating an individual’s DNA against a continuously growing body of peer-reviewed and consensus data. For most patients, a buccal swab only needs to be collected once, and that information is used in perpetuity for evaluating therapies for which they might be considered in the future. This ability to cross reference the patient’s results with a continuously growing body of data is also a good reason to make the initial panel highly comprehensive – so as many genes as possible are being assessed. Having all of the information available up front maximizes the cost efficacy of PGx long term – and typically the only patients who may need an updated buccal swab are those who undergo procedures that affect the DNA of specific systems, like in the case of a liver transplant.
Though we most commonly see PGx utilized in the treatment of conditions falling under cardiology, GI diseases, oncology, behavioral health challenges and pain management, it’s easy to see how these systems are areas of focus touching on nearly every care delivery setting. Whether you’re providing care in a hospital, skilled nursing, long-term care facility, or even as an outpatient clinician, it’s important to be armed with the facts when making the case to insurers and payers alike. PGx testing takes the burden out of making your case – the data says it all.
In our recent webinar presented by Center for Healthcare Solutions, Jen Devinney, Chief Clinical Officer at Grane Rx is joined by Rick Shigaki, VP Pharmaceutical Solutions at Access Dx, where they provide an even deeper dive on PGx testing, including case studies applicable to nearly every care setting. Watch it here.
While we cover this in-depth throughout our webinar hosted by Center for Healthcare Solutions, we’ve bulleted out the quick hits – so you can start thinking about if PGx is a strategy you’d like to add to your prescribing toolkit.
Pharmacogenetic testing helps you understand how different individuals metabolize drugs differently, providing insight into which medications will be most effective – allowing you to create more personalized treatment plans and get better outcomes for patients.
Accurate pharmacogenetic testing makes it easier to avoid costly trial-and-error drug treatments, reducing medical costs for both patients and insurers.
With greater knowledge of how a patient’s body reacts to certain medications, providers can deliver tailored care faster, leading to improved quality of life for the patient.
With pharmacogenetic testing, you can identify which drugs may be too strong or ineffective for a patient – helping to avoid delays in the drug’s response, adverse reactions and other potentially dangerous side effects.
By testing for an individual’s genetic makeup, pharmacogenetic results help providers make highly personalized and data-driven treatment decisions based on a patient’s ability to metabolize a drug.
Overall, implementing pharmacogenomics into your care delivery is essential for providing the most effective treatments possible while reducing overall costs and improving safety – leading to better outcomes for everyone involved.
For a closer look at the how, when, and why of genetic testing for precision prescribing, watch our recent webinar with Access Dx, Pharmacogenomics Across Care Settings, hosted by our friends at the Center for Healthcare Solutions.
In our recent webinar presented by Center for Healthcare Solutions, Jen Devinney, Chief Clinical Officer at Grane Rx is joined by Rick Shigaki, VP Pharmaceutical Solutions at Access Dx, where they provide a detailed overview of the applications for Pharmacogenomics (PGx) testing across a variety of care settings, examples of exactly how it can be applied, and case studies that contextualize its value in a variety of situations where patient care can be dramatically improved.
To learn more about PGx testing and its applications across care settings, you can check out our blogs on the topic by clicking here and here.
Analyzing Medication Administration Times Moving Forward: Gain Workflow Efficiencies and Resident Safety
While evaluating and optimizing medication administration practices are especially important in the short term to prevent transmission of COVID-19, in the long term, these strategies help make workflow more efficient, medication regimens safer for residents, and prevent the spread of other microbes overall.
Consolidating Medication Administration: To help determine the most efficient strategy in administering medications, analyze the way in which a resident’s medications are currently administered. Look for ways to reduce the number of visits to the resident which require direct or very close contact (such as medication administration), thereby allowing time for other care related tasks or socialization opportunities as well as reducing pill burden for residents.
Flex Time Administration: For medications that do not need to be administered at very specific times, consider switching to a flexible medication administration schedule or the universal medication schedule to minimize the number of medication passes per day. These schedules allow for more flexibility in administration of medications throughout the day for the nursing staff and are generally more resident-friendly.
For example, under the universal medication schedule, the directions “take one tablet twice daily” may become “take one tablet in the morning and one tablet at bedtime”. Medications with directions written according to the universal medication system at a certain time of day can then be given together in one administration time rather than at separate, specific times.
For example, a medication that was originally scheduled to be administered at 10:00 AM and another scheduled to be administered at 9:00 AM can be given at the same time “in the morning”, as long as there are no interactions or restrictions. This reduces the number of medication passes from two to one.
Assess for Unnecessary Medication: As mentioned previously, it is important to actively and continuously work with other healthcare professionals on your team to make sure the resident’s medication regimen does not have any unnecessary medications. Reducing the amount of medications in a resident’s regimen in turn reduces the frequency of administration times.
Eliminating unnecessary medications not only minimizes transmission of microbes, but also minimizes the opportunity for medication interactions and adverse effects. Unnecessary medications may complicate medication regimens and increase pill burden. The more medications in a resident’s regimen, the more chance of a resident experiencing adverse effects and potential medication interactions.
Prevention is an Outcome: in the older adult population, medication management can go a long way in preventing falls, potential visits to the emergency room, and reducing costs.
The above medication management and administration strategies can help reduce transmission of microbes and allow for efficient and safe medication administration overall. Grane Rx consultant pharmacists can help implement these strategies as they have the ability to analyze your facility medication pass distribution and resident pill burden to help balance and optimize the efficiency of medication administration.
Reduce Transmission of COVID-19. During this emergency, it is important to take all precautions to reduce transmission of COVID-19. While we are actively working to increase infection control practices and maximize physical distancing, as health care professionals, we must continue to provide care for our residents as well as ensure that they are receiving the medications they need.
Reducing the frequency of medication administration is one additional way to help reduce direct physical contact and potentially reduce transmission of COVID-19.
Here are some tips for evaluating potential areas of opportunity to impact frequency of medication administration:
In PACE pharmacy, medications are typically dispensed to participants in monthly increments that are either picked up at the PACE center or delivered to the home. But what happens when a participant’s medication regimen needs to change in the middle of a cycle? Because PACE participants usually take multiple medications for a variety of medical conditions, it isn’t uncommon for physicians to switch out a medication or change its dosing. It also isn’t a problem. We’ve created a seamless process designed to handle medication regimen changes when they occur—without compromising participant safety or health. Read on to learn more. Let’s first take a look at the “why” behind our packaging. Medication nonadherence is a significant problem among the senior population and is especially critical for PACE participants. With this in mind, Grane Rx uses innovative packaging called SimplePacks when dispensing PACE pharmacy medications. This packaging is just one part of the overall Grane Rx PACE Pharmacy Solution, which is designed specifically with seniors in mind—featuring clear, understandable information about medications to encourage adherence. Each month, participant’s medications are packaged together inside two color-coded boxes: one for everyday medications and one for medications that are taken as necessary. Within those boxes, medications are packaged in SimplePacks, which are easily opened perforated packs of medications taken at the same time of day, whether morning, noon, evening or at night. This unique PACE pharmacy solution offers a much better medication management system than the bingo cards typically used by long term care pharmacy and other PACE pharmacy providers. The very thing that makes our packaging unique and innovative—our SimplePacks perforated pill packs—can seem like it would be tricky when medication changes are needed. But actually, that isn’t the case. [Tweet “A simple #PACEpharmacy process can make medication changes seamless”]
The ultimate goal of PACE is to keep participants healthy and aging in place at home. For PACE pharmacy providers, one significant part of that mission is ensuring participants understand and adhere to their medication regimens. Each year, an estimated 700,000 people visit emergency rooms due to adverse drug events, including medication nonadherence. In many cases, health illiteracy plays a significant role, as patients don’t understand why they’re taking medications or how to take them correctly. That problem is magnified among seniors, with more than two-thirds having basic or less than basic health literacy. Adding to the problem, prescription labels have long been highly variable and inconsistent, with vague and unhelpful directions. Grane Rx offers a number of solutions that work hand-in-hand with UMS, helping PACE participants understand their medications and take them properly. Let’s take a look at three of those PACE pharmacy solutions.
The medication packaging used in long term care pharmacy has evolved over the past few decades, with rapid changes occurring just a few years ago. Most LTC pharmacy services providers today utilize medication punch cards to dispense medications to SNF residents or PACE participants. Medication punch cards were first used in the 1970s, when pharmacies began packaging together 30-day or larger supplies of medications. Current usage of punch cards can be traced back to 2009 when the Congressional Budget Office determined that medication waste in long term care would cost Medicare more than $5.5 billion by 2019. As a result of those findings, rules were issued in the next few years mandating that prescription medications in long term care pharmacies be dispensed in no greater than two-week increments. This drive to reduce medication waste led to the advent of punch cards for 7- or 14-day periods, rather than 30-day periods as they were previously. But when it comes to medication management, there’s a better kind of packaging than medication punch cards. Let’s take a look.
By Jennifer Devinney, RPh, PharmD Agitation and aggression in elderly residents with cognitive disorders can be a common occurrence in long term care settings. Recently, there has been research published evaluating the role of untreated or undertreated pain in residents with dementia and the potential impact of proper treatment. Residents with Alzheimer’s disease are reported to have an incidence of agitation approaching 80 percent. Furthermore, agitation and aggression are leading causes of institutionalization in older people with dementia. The source of the agitation or aggression in the residents may not be entirely known; however, what is known is that dementia causes a biological change in an individual, which affects and impairs their ability to process new information and stimuli. As a result, their ability to communicate effectively about what is bothering them is inhibited. When a resident is experiencing agitation or aggression, there are a number of factors that should be evaluated from the environment to daily routines or perhaps most importantly comfort and pain.