Hospitals, Pharma

Hospice program uses drug testing to get the right pain management plan for patients

A lot of the discussion around personalized medicine focuses on surviving cancer or other scary […]

A lot of the discussion around personalized medicine focuses on surviving cancer or other scary illnesses.

In my experience, people need as much help with dying as they do with surviving. Any change – more hospice programs, better pain management, more informed patients, more honest doctors – that can make it easier for elderly or terminally people to die peacefully is worth making. More people could die how and where they want to if this process were easier.

One hospice provider in Ohio
is making a change in this direction. ViaQuest Inc. became the first hospice provider in Ohio to provide a pharmacogenetics pain management program for its patients earlier this year. Now, the company is expanding this testing to other healthcare programs it provides and is adding a behavioral health medication component.

Kathy Richard, ViaQuest’s chief clinical officer, said that 15 months ago the company started talking with patients about this testing. If a patient consents to the process, ViaQuest tests the person to determine how well standard pain medications will work for him or her.

“The current prescription method is guess work and often we are with patients who can’t communicate pain level,” Richard said. “The genetic piece narrows it down for us to get the best dose.”

In the first 3 months, ViaQuest conducted 29 tests and 17 people needed changes to their medication plans.

The results of the pharmacogenetic test show how a person’s body metabolizes a drug. A person’s reaction to a particular drug can fall into one of four categories:

  • Effective metabolization
  • Intermediate metabolization
  • Poor metabolization
  • Ultra rapid metabolization

“If you are poor or ultra rapid, the med is no go for you,” Richard said.

Based on the results, the nurse or doctor would do one of three things:

  1. Make no change
  2. Find an alternative drug with the same benefit
  3. Adjust the dose of the drug if it can be effective at a lower level

ViaQuest offers home health and hospice care, community mental health, adult day programs, and employment services in Ohio, western Pennsylvania and Indiana. Outside of its hospice program, ViaQuest uses certain criteria to determine suitability for pharmacogenetic testing, including uncontrolled symptoms, high-risk complex patients and repeated readmissions. Richard said that patients with multiple or complex conditions can be on as many as 30 to 40 drugs at one time.

“Dealing with adverse drug reactions in itself costs more than chronic condition,” Richard said.

ViaQuest is working with PGXL Labs in Louisville, Kentucky, to do the testing. This information about Cytochrome P450 2D6 (CYP2D6) Genotyping explains how the test works and has more information on metabolization.

ViaQuest tracks home health care patients for three years and will be monitoring how pharmacogenetic testing changes patient care.

“We are tracking information like how may changes we’re making in the dosage of meds, what’s the cost, what’s the hospitalization rate before the changes and after, are there any cost savings from fewer lab tests or doctor follow-up visits,” Richard said.

“In three years we’ll have signification data to say to a managed care org or state medicaid, ‘These are the patients we’ve tracked and here are the clinical outcomes.'”

Richard gave two examples of how this kind of testing could be expanded beyond pain management. Plavix is a prodrug, meaning it has no affect unless a person’s body can metabolize it. If a person cannot metabolize the drug, she just secretes it.

“If you go to the FDA web site and look up Plavix, it specifically will tell you that if you are an intermediate or poor metabolizer, this drug will have no effect,” Richard said, “but few people are tested before taking it.”

Richard also said that for patients taking the blood thinner warfarin, pharmacogenetic testing would be more accurate than a PT/INR test which measures the levels of the drug in a person’s blood.

“People who are poor or intermediate for that specific med won’t get to a therapeutic dose until 21 days on the drug,” she said. “That could lead to a dangerous level of the drug in a person’s body.”

Richard said that the testing program includes lots of professional education about pharmacogenetic testing, both before and after a care team gets results for a specific patient. She said they are always doing continuing education with social workers and discharge planners.

Richard said ViaQuest is not looking to sell the program, just to get the testing services covered for patients.

“Right now some insurance will cover it but it is prior authorization or medical necessity,” she said. “We are pretty confident that our data will show better clinical outcomes.”

“We hope that in the next 4 – 5 years, we are not the only hospice group doing this,” she said. “The technology is available and a benefit to patients and families.”

Veronica Combs

Veronica is an independent journalist and communications strategist. For more than 10 years, she has covered health and healthcare with a focus on innovation and patient engagement. Most recently she managed strategic partnerships and communications for AIR Louisville, a digital health project focused on asthma. The team recruited 7 employer partners, enrolled 1,100 participants and collected more than 250,000 data points about rescue inhaler use. Veronica has worked for startups for almost 20 years doing everything from launching blogs, newsletters and patient communities to recruiting speakers, moderating panel conversations and developing new products. You can reach her on Twitter @vmcombs.

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