FOCUSED CARE PROGRAM OVERVIEW
The Focused Care Consulting (FCC) Program is an initiative designed to integrate pharmacogenomic testing with comprehensive medication management. This initiative is aimed at enhancing the quality of healthcare through precision in medication management, ensuring that patients receive optimal benefits from their treatment plans.
Our pharmacogenomic testing is a key component of the medication regimen review process at FCC. It is not merely an add-on but a core aspect of our service, providing valuable insights into the effectiveness and safety of medications prescribed to residents. FCC takes charge of every aspect of the service, which includes determining the eligibility and necessity for resident testing, coordinating sample collection, and conducting a thorough analysis of the results.
We have established Collaborative Practice Agreements (CPA) with the facility’s Medical Director or with in-house Nurse Practitioners (NP)/Physician Assistants (PA) to administer tests to residents. This ensures that testing is conducted responsibly and in accordance with the highest medical standards.
FCC’s pharmacogenomic services are provided by certified consultant pharmacists who specialize in the interpretation of pharmacogenomic results. These professionals make evidence-based recommendations that are specific to each patient, aiming to optimize their therapeutic regimen.
It is important to note that the FCC Program is focused on residents who are likely to benefit most from pharmacogenomic testing. Therefore, residents who are on a short-term stay, defined as less than 100 days, are not included in the initial phase of testing.
Goals of Testing
The FCC Program is guided by several key goals:
Optimize Drug Therapy and Mitigate Polypharmacy: Tailoring medication regimens to the individual needs of our residents helps optimize drug therapy and reduce the risks associated with polypharmacy.
Improve Medication Responses and Reduce Adverse Effects: By carefully managing and reviewing medication regimens, we aim to improve the efficacy of medications and minimize the potential for adverse effects.
Prevent Hospitalizations: Through proactive medication management, the program seeks to reduce the incidence of hospitalizations related to medication issues.
Provide Long-Term Cost Savings: By improving medication management and reducing adverse events, the program also aims to provide long-term cost savings for both residents and healthcare facilities.
With these goals in mind, the FCC Program is committed to delivering a higher standard of care through improved medication management and pharmacogenomic testing.
.
Process
Eligibility Determination, Obtaining Consents, and Sample Collection.
A cornerstone of the FCC Program is the meticulous process of determining which residents will benefit most from pharmacogenomic testing. To this end, FCC conducts a thorough evaluation of all residents to assess eligibility and necessity for testing. This assessment is grounded in adherence to appropriate guidelines, ensuring that each decision for testing is made with the utmost consideration for the resident’s health and wellbeing.
Consent
Prior to sample collection, obtaining informed consent is paramount. FCC requires signed consent forms from residents or, where necessary, verbal consent from their Power of Attorney (POA) or guardians. This step is crucial and is carried out with full transparency to ensure that residents or their representatives are well-informed about the testing procedure, its benefits, and any potential risks.
Sample Collection
The sample collection process is designed to be as comfortable and non-invasive as possible. Utilizing an oral swab method allows for a simple and painless collection of samples, thereby minimizing discomfort for the resident and facilitating ease of collection for healthcare providers.
Analysis and Recommendations
Once collected, the samples are sent to the laboratory for analysis. The results are then forwarded to FCC, where our team of specialized pharmacists interprets the data. Evidence-based, patient-specific recommendations are formulated based on the lab findings. These recommendations are made with the intention of optimizing the resident’s medication regimen, with adjustments made as appropriate to enhance efficacy and safety.
The FCC Program is committed to a process that is not only medically sound but also respectful and minimally invasive to residents. Our practices are rooted in the principles of precision medicine, with every step taken to ensure that the unique needs of each resident are met with the highest standard of care.
Level 1 A/B Recommendations
Within the scope of the FCC Program, the Level 1 A/B Recommendations represent the pinnacle of our pharmacogenomic testing initiative. These recommendations are derived from the highest tier of evidence and clinical utility, ensuring that the medications prescribed to our residents are not only effective but also safe.
Level A Recommendations
Level A medications have the strongest evidence supporting the need for pharmacogenomic testing. This category includes medications for which genetic information is crucial to prescribing decisions. Our certified pharmacists rely on these guidelines to recommend precise dosages and to identify suitable medication alternatives that align with the resident’s genetic markers, thus optimizing therapeutic outcomes.
The following medications are included in the Level A category:
Abacavir
Amitriptyline
Azathioprine
Carbamazepine
Citalopram
Codeine
Clopidogrel
Dabigatran
Fluorouracil
Irinotecan
Mercaptopurine
Nortriptyline
Tamoxifen
Thiopurines (azathioprine, 6-mercaptopurine, and thioguanine)
Warfarin
For each of these medications, pharmacogenomic testing can significantly influence the choice of medication, dosage, and treatment duration. By adhering to these recommendations, the FCC Program ensures that each resident receives the best possible care tailored to their individual needs.
Level B Recommendations
Level B recommendations, while still based on significant evidence, suggest a moderate correlation between genetic makeup and drug response. For these medications, pharmacogenomic testing can inform, but may not be critical to, the initial selection of medications. Nevertheless, when prescribing these drugs, our pharmacists consider the genetic factors that may affect treatment efficacy and safety.
The medications listed under Level B include:
Allopurinol
Aripiprazole
Atorvastatin
Clobazam
Escitalopram
Flecainide
Hydrocodone
Imatinib
Leucovorin
Omeprazole
Oxcarbazepine
Paroxetine
Phenytoin
Risperidone
Sertraline
Simvastatin
Tacrolimus
Tramadol
Venlafaxine
By incorporating these Level 1 A/B Recommendations into our practice, the FCC Program upholds a standard of care that is at the forefront of personalized medicine. Our approach ensures that all residents receive medications that are selected and dosed based on the highest levels of evidence, thereby maximizing the effectiveness of treatment while minimizing potential risks.
Outcomes and Follow Up
The FCC Program is committed to delivering a comprehensive and continuous care cycle that doesn’t end with the provision of recommendations. The evaluation of outcomes and the follow-up process are integral to ensuring the effectiveness and relevance of our pharmacogenomic interventions.
Evidence-Based, Patient-Specific Recommendations
Our pharmacists are dedicated to formulating evidence-based, patient-specific recommendations. This personalized approach guarantees that each resident’s care plan is based on robust scientific evidence and tailored to their individual medication response profile. The recommendations are not generalized but are meticulously crafted to suit the unique needs and conditions of each resident.
Appropriate Follow Up of Responses to Recommendations
After the implementation of the recommendations, the FCC Program places a strong emphasis on monitoring and evaluating the resident’s response to the changes in their medication regimen. This involves regular follow-ups to assess the efficacy and tolerability of the medications, ensuring that the intended outcomes are being met and that any adverse reactions are promptly addressed.
Evaluate Future Changes to Medication Therapy
Medication therapy is not static; it evolves with the resident’s changing health status and needs. The FCC Program, therefore, includes a protocol for re-evaluating and modifying medication regimens over time. This dynamic process ensures that the medication therapy remains optimal throughout the resident’s care journey.
Tracking of all Outcomes and Changes to Therapy
To maintain the highest standards of care, the FCC Program systematically tracks outcomes and any subsequent changes made to the therapy. This not only includes the clinical outcomes but also encompasses the resident’s quality of life and satisfaction with their treatment. This data is invaluable for ongoing quality improvement, helping to refine our processes and enhance the overall effectiveness of the program.
The commitment to follow-up and outcome evaluation underscores the FCC Program’s dedication to excellence in pharmacogenomic healthcare. By continually monitoring and adapting our approach, we ensure that our residents receive the highest level of personalized care, with medication regimens that are safe, effective, and conducive to their overall well-being.