News Brief | August 17, 2021 | A predictive blood test for dementia?

Practice Transformation

PCPs are worried, and vaccine hesitancy isn’t helping
Primary care clinicians are tired and worried, according to a new survey from the from the Larry A. Green Center and the Primary Care Collaborative. Fully 40% of respondents say they worry that primary care will be gone in five years. Vaccine hesitancy plays a role, with 53% noting that hesitancy is high and hard to counter—and it’s contributing to burnout. “While the pressure is now on primary care to convert the most vaccine-hesitant, little has been done to support primary care to date,” Rebecca Etz, co-director of the Larry A. Green Center, said in a statement. (PCC announcement; Healthcare Dive)

Looking at the data: CMM delivered remotely
The August issue of the Journal of the American College of Clinical Pharmacy focuses on the provision of CMM via telehealth. In an introductory editorial, Shawn McFarland, Pharm, and Melissa E. Badowski, PharmD, MPH, offer the following: The primary literature documenting pharmacist improvement of care from providing CMM has increased exponentially. However, the same cannot be said regarding the literature where pharmacists provide care using a telehealth modality.” The reports included in the issue help fill that gap, but continuous evaluation and refinement are essential, they say. (JACCP)

Evidence & Innovation

A predictive blood test for dementia?
Research published in Neurology suggests that blood tests could identify patients facing an increased risk in cognitive decline long before symptoms appear. The large community study shows that midlife plasma amyloid beta levels in cognitively normal people were associated with risk of dementia or mild cognitive impairment 25 years later. “We are likely still a little ways off from these blood tests having any routine use in clinical care,” co-author Kevin Sullivan, PhD, MPH, told MedPage Today. The more immediate use will be for recruiting and screening for Alzheimer’s clinical trials. (MedPage Today; Neurology)

With doc’s ok, older folks willing to deprescribe
Older patients and nursing home residents would be open to deprescribing on the advice of a physician, but most did not have an intrinsic desire to deprescribe, according to a small study out of Denmark published in the Journal of the American Geriatrics Society. “In a large sample of geriatric inpatients, geriatric outpatients, and nursing home residents, we found that most patients would be willing to stop one of their regular medications on their physician’s advice; however, only one third reported an intrinsic desire to do so.” (Medscape; Journal of the American Geriatrics Society)

Google and health care: Many test balloons
A recent Medical Futurist article explored Google’s plan for the future of health care. “With Google revisiting old projects, refocusing its health team’s efforts and announcing new partnerships, it seems like the tech giant’s healthcare plans are all over the place.” The most promising avenues appear to be in AI, remote monitoring software and cloud computing. But just because the company is floating many test balloons doesn’t mean all these projects will launch. “Google is also notorious for pulling the plug on even the most ambitious projects of its projects,” note the authors. (Medical Futurist)

Policy Solutions

“Most favored” drug policy out of favor
A proposed CMS rule would end (before it begins) a Trump-era demonstration that ties Medicare outpatient drug pay to other wealthy countries’ drug prices. It would have been the CMS Innovation Center’s first nationwide, mandatory experiment. The rule was supposed to take effect in January, but it faced an injunction that was repeatedly delayed as the new administration examined the rule. The move represents a big win for pharma and hospitals industry groups, Fierce Healthcare reports (Fierce Healthcare)

US pays the most, gets the least
The United States trails far behind other high-income countries on measures of health care affordability, administrative efficiency, equity and outcomes, according to a report released yesterday by the Commonwealth Fund. The top-performers: Norway, the Netherlands, and Australia. The United States ranks last overall, despite spending far more of its GDP on health care. Four features distinguish top performing countries: They provide for universal coverage and remove cost barriers; invest in primary care systems to ensure that high-value services are equitably available; reduce administrative burdens; and invest in social services, especially for children and working-age adults. (Commonwealth Fund)

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In Case You Missed It!

Cureatr, a comprehensive medication management (CMM) solutions company dedicated to repairing the United States’ $528 Billion and 275,000 deaths a year suboptimal medication management problem, has joined the GTMRx Institute as a silver Strategic Partner.
Mary Roth McClurg, Pharm.D., MHS, is professor and executive vice dean-chief academic officer at the UNC Eshelman School of Pharmacy. She has focused her research efforts on advancing comprehensive medication management and the role of the clinical pharmacist as an integral member of the primary care team, with the goal of optimizing medication use and improving care in patients with multiple chronic diseases.
Medicine is how we treat most conditions: Roughly 75%-80% of physician office and hospital outpatient clinic visits involve medication therapy. And more often than we would like, it is how disasters occur. More than 275,000 die each year because of medication misuse, overuse or underuse. The financial cost tops $528 billion annually, and employers are on the hook for a large portion of that.
Employers have the incentive, the leverage and the responsibility to change this. The evidence, best practices and tools are there to solve the systemic issues that lead to suboptimal medication use. Employers can lead the charge, through their contract authority and work with their suppliers, but they first must understand just how irresponsible doing nothing is. Download the issue brief for more.
We are sharing new survey results that assess the medication management habits and needs of over 1,000 people. Nearly one quarter of people cited that their medications are not routinely reviewed and evaluated by their medical team—shocking, given that one-third are taking four or more medications and/or supplements per day. The GTMRx Institute staff, workgroup and taskforce leaders and participants have created a set of tools to help inform and educate the consumers of health care services—and providers who have direct contact with the consumers—about why it’s important to get the medications right. We invite you to read more, share these tools and join us to ensure appropriate use of medications.

GTMRx Payment and Policy Recommendations

Leadership from GTMRx’s PGx Payment and Policy Taskforce and Payment and Policy Solutions Workgroup have created 5 policy recommendations on PGx + CMM that policymakers should consider to ensure that patient medications are managed safely and effectively based on the unique characteristic of an individual patients’ genetic profile, including:
  1. Add the assessment of patient medications and drug-gene interactions to Medicare (Welcome to Medicare visit) and Medicaid benefits,
  2. Require CMS to reimburse preemptive multi-gene panel testing as one single test with one standard compensation code,
  3. Require CMS to reimburse members of the care team trained to evaluate/manage all medications based on patient’s genotype, multi-drug interactions, Rx metabolism, etc.,
  4. Direct the National Quality Forum (NQF) to review and make recommendations on drug-gene interaction efficacy and safety checks prior/post admin of drugs within CMM,
  5. Recommend the U.S. Preventive Services Task Force evaluate evidence of PGx testing and CMM, for drugs with known drug-gene interactions, as a preventive health care practice that addresses patient outcomes/medical expenditures and that should be covered by ACA plans.
In addition to development of Vaccine Confidence Leagues (VCLs) and community-building activities, the task force’s recommendations include:
  • Accelerated approval of vaccines
  • Public education
  • Payment reform
  • Improved vaccine access for primary care practices
  • More effective immunization information systems (IIS)
  • No cost-sharing for certain patients
  • Enhanced diversity, inclusion, and equity
Find the report Frequently Asked Questions here.
Read the report here.
Join us to be part of meaningful change
Irma, like many others, struggles as a result of our current trial-and-error approach to medication. That is why we advocate for a new, comprehensive approach to medication use and prescribing. As a non-profit 501(c)(3) and 501(c)(4) organization, the GTMRx Institute and Foundation relies on funding from our supporting members. We ask that you consider becoming a Supporting Signing Member so we can continue to provide relevant, timely resources to get the medications right!
If you’re interested in supporting the Institute or Foundation at a higher level, please contact us. Your dollars will bring about meaningful change for people like Irma.
AmazonSmile is an easy way for 0.5% of your qualified purchases go to the GTMRx Foundation at no cost to you. And signing up is simple—go to smile.amazon.com and select “Get the Medications Right Foundation” as your charity of choice. If you prefer to directly donate instead, you can do so here.
Adding the foundation on AmazonSmile will help us continue to provide no cost educational webinars, issue briefs, weekly news briefs and promote the need for transformation of our current system of medication use through social media campaigns.
The GTMRx Institute is supported by our Founding Funders, Executive Members and Strategic Partners.
  See past issues of our weekly news brief here. 

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Support the GTMRx Foundation to get the medications right™. A donation from you can help to reduce the 275,000 lives lost and $528 billion wasted each year due to suboptimal medication use. Donations support practice and policy transformations and allows us to provide free resources for our members. We believe everyone deserves access to comprehensive medication management to ensure safe, appropriate and effective medication use. Help us make that happen. Need to be convinced? Watch Brenda's story.