Latest / Pharmacy Podcast Network / Precision Psychiatry in Practice – A Pharmacist–Physician Collaboration| Precision Medicine Pharmacist Podcast

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Precision Psychiatry in Practice – A Pharmacist–Physician Collaboration| Precision Medicine Pharmacist Podcast · Pharmacy Podcast Network

0:05
Speaker 1: You are listening to the global network of podcasters dedicated
0:09
Speaker 1: to the pharmacy profession.
0:10
Speaker 2: Welcome to the Pharmacy podcast Network.
0:29
Speaker 1: Welcome to the Pharmacist podcast network. The Precision Medicine Pharmacist,
0:33
Speaker 1: which is a podcast where science, innovation, and collaboration are
0:37
Speaker 1: redefining patient care. And for those of you who don't
0:40
Speaker 1: know my series yet, my name is doctor Melissa Smith.
0:43
Speaker 1: I'm your Precision Medicine Pharmacist and we are kicking off
0:46
Speaker 1: a special two part series titled Precision Psychiatry and Practice
0:51
Speaker 1: a Pharmacist physician collaboration. And in the series, we're going
0:55
Speaker 1: to explore how precision medicine is reshaping mental health and
0:59
Speaker 1: its treatment options and what becomes possible when a pharmacist
1:03
Speaker 1: and a psychiatrist work together, which shared clinical goals. Today's
1:07
Speaker 1: episode the new frontier how pharmacists and psychiatrists are teaming
1:11
Speaker 1: up for precision mental health, and this focus is on
1:15
Speaker 1: how this collaboration began, the challenges that inspired it, the
1:19
Speaker 1: early conversations that shaped it, and the practical steps taken
1:23
Speaker 1: to bring pharmacogenomics into psychiatric care.
1:26
Speaker 2: Joining us is Saba our Shad.
1:28
Speaker 1: A clinical pharmacist, the founder of MEDDNA Health and a
1:31
Speaker 1: strong advocate for integrating pharmacogenomic testing insight into the mental
1:35
Speaker 1: health treatment space. We will also hear from doctor Kahn,
1:38
Speaker 1: a psychiatrist and clinical partner in part two of the series,
1:42
Speaker 1: as we explore how their professional pass aligned to create
1:46
Speaker 1: something new. In this first episode, we will lay the
1:48
Speaker 1: foundation examining the why behind precision psychiatry and the systems
1:52
Speaker 1: that had to evolve to support it. Let's begin by
1:56
Speaker 1: meeting Saba our shod Hi.
1:58
Speaker 3: Everyone, Hi Melissa, thank you for having me and I'm
2:02
Speaker 3: grateful for the opportunity.
2:03
Speaker 1: I am so excited to have you here on this
2:05
Speaker 1: podcast series because as we know, pharmacogenomics is such a
2:11
Speaker 1: crucial tool in my opinion, to be utilized in the
2:15
Speaker 1: psychiatric space because it really has a lot of high
2:18
Speaker 1: level evidence that can really align with lessening treatment resistance
2:22
Speaker 1: with patients, having them go into remission more quickly because
2:27
Speaker 1: they're getting appropriate care the first time around as opposed
2:30
Speaker 1: to having trial and error being implemented. So I'm very
2:34
Speaker 1: excited to have you just explain your journey and how
2:39
Speaker 1: you were able to get into collaboration with doctor con
2:44
Speaker 1: as well. So if you don't mind give me a
2:47
Speaker 1: brief introduction. I want you to lay the foundations. Let
2:49
Speaker 1: me know, give our listeners and our audience a peek
2:53
Speaker 1: into how you became a psychiatric pharmacist utilizing pharmacogenomic testing.
3:00
Speaker 3: Sure, I'll try to keep it brief. My name is Sabarashad.
3:05
Speaker 3: I am an Irish Pakistani citizen. I am a clinical pharmacist,
3:10
Speaker 3: founder of MEDDNA Health and we focus more on pharmacogenomic testing.
3:15
Speaker 4: I am also I work part.
3:17
Speaker 3: Time at a hormone compounding pharmacy and I can't tell
3:20
Speaker 3: you how much that has shaped a lot a lot
3:24
Speaker 3: of things, a lot of things that.
3:26
Speaker 4: I didn't take into account earlier.
3:28
Speaker 3: I'm also a board member for a local nonprofit and
3:32
Speaker 3: we provide primary care services to people who are uninsured.
3:36
Speaker 4: We're not only.
3:38
Speaker 3: UH like st of Texas, we also serve other states
3:42
Speaker 3: as well. And the last one would be I am
3:45
Speaker 3: a volunteer and ambassador of for NAMI Central Texas Chapter.
3:48
Speaker 3: So that probably relates to my mental health advocacy part.
3:53
Speaker 4: And from my journey I'll start. I'm thinking were should
3:57
Speaker 4: I start?
3:59
Speaker 3: So I'll start back from when I was in pharmacy
4:02
Speaker 3: school a lot of people ask me, why did you
4:04
Speaker 3: go into psychiatry or why would do you start with
4:07
Speaker 3: you persist in psychiatry.
4:09
Speaker 4: So my wife started when I was in pharmacy.
4:13
Speaker 3: School, Melissa, one of my loved one in the family.
4:16
Speaker 4: They were suffering during the teenage years.
4:20
Speaker 3: Because I'm a practicing Muslims and back home, especially in
4:23
Speaker 3: our Southeast Asian community, we.
4:24
Speaker 4: Do not talk about mental We do not talk.
4:27
Speaker 3: About what are the red flags that do happen with
4:29
Speaker 3: a lot of kids.
4:32
Speaker 4: At that time, I just started pharmacy.
4:34
Speaker 3: School in two thousand and eight, so I was I
4:37
Speaker 3: didn't know a lot of things, but at the end
4:39
Speaker 3: I did feel guilty although there were little.
4:42
Speaker 4: Things that I just didn't know and I couldn't handle.
4:45
Speaker 3: And unfortunately, at that time, my loved one was diagnosed
4:49
Speaker 3: with borderline personality major depression disorder. They were not just
4:54
Speaker 3: they were on a suicide watch. They were on I
4:57
Speaker 3: had no idea what self format I did. I have
5:00
Speaker 3: had no idea what kind of those marks meant and
5:02
Speaker 3: what it actually felt. But there were a lot of
5:04
Speaker 3: things and the hardest part, Melissa was going them, you know,
5:08
Speaker 3: seeing them go through those treatment protocols because they were
5:12
Speaker 3: put on everything. They were on antiq persians, anti psychotics,
5:16
Speaker 3: mood stabilizers, and it wasn't like a trial of you
5:19
Speaker 3: would start.
5:20
Speaker 4: With one or two medications. They were like bombarded.
5:22
Speaker 3: We're like eight to ten medications and then unfortunately to
5:27
Speaker 3: come to those side effects, there were more medications at it,
5:30
Speaker 3: and that just came off.
5:32
Speaker 4: It was, you know a lot of emotional instability. Everything.
5:38
Speaker 3: I think the quality of life is just tremendously declining.
5:42
Speaker 3: Their school and everything else was impacted tremendously. But that
5:48
Speaker 3: took a lot of time and eventually when we got
5:51
Speaker 3: them tested that was probably by to six years back,
5:55
Speaker 3: and that has helped and a lot of the credit
5:59
Speaker 3: he had does go to the clinical psychologist on the
6:01
Speaker 3: team and the psychiatrist that they were willing to work
6:04
Speaker 3: with whatever data we had and we were able to
6:07
Speaker 3: figure out what medications would work best and a lot
6:10
Speaker 3: of the side effects that Malaberman was having, it made
6:14
Speaker 3: a lot of sense why it did not work, and
6:16
Speaker 3: they were having a lot of brain fog and other
6:20
Speaker 3: emotional issues that do come with that, especially wadgain and zombia.
6:25
Speaker 3: That was the biggest one that did come up. So
6:28
Speaker 3: a lot of these things. Then eventually we were able
6:30
Speaker 3: to figure that part out, and now I'm so happy
6:34
Speaker 3: to say that they are thriving and they are medication free.
6:37
Speaker 4: So it took it was a long journey. It was
6:39
Speaker 4: about sixteen years.
6:41
Speaker 3: It wasn't an easy journey, and they did work on
6:44
Speaker 3: That's what I tell a lot more patients. You can
6:46
Speaker 3: start with the medication, but unless you try to figure
6:49
Speaker 3: out what is happening inside your traumas, your other things
6:53
Speaker 3: that keep you up at night. Unless we start working
6:56
Speaker 3: on this the medication, you're just going to support you,
7:00
Speaker 3: not just going to eliminate whatever happened unfortunately in your past.
7:05
Speaker 3: So those were few things that I believe have strongly
7:09
Speaker 3: shaped my perspective. And that's what And then I did
7:14
Speaker 3: work at chain pharmacies and during COVID times, we were
7:19
Speaker 3: also vaccinating, right, so, and we were vaccinating, especially in Texas,
7:23
Speaker 3: were vaccinating kids who were older, who were twelve years
7:25
Speaker 3: and above. And Melissa, even till day, I cannot forget
7:31
Speaker 3: the faces of those sweet children because I would whenever
7:34
Speaker 3: we used to like vaccinate them, I could see the
7:37
Speaker 3: same self harm marks those kids.
7:41
Speaker 4: And those were all major girls and boys.
7:43
Speaker 3: And this was This was the time when people actually
7:46
Speaker 3: started kind of realizing how mental health was impacted. It
7:52
Speaker 3: wasn't something that just came out of COVID. There were
7:55
Speaker 3: a lot of people who were suffering really bad. COVID
7:58
Speaker 3: was just a reason that kind of pushed people to
8:02
Speaker 3: actually kind of realized that this was happening in their community,
8:07
Speaker 3: with their kids, in their families. And the last thing
8:10
Speaker 3: that I think that kind of also shaped me or
8:16
Speaker 3: helped me to become what I am today is as
8:19
Speaker 3: a born graduate pharmacist. They are like a couple of
8:22
Speaker 3: different liscensing steps you have.
8:23
Speaker 4: To take, and there's certain number of hours you have
8:26
Speaker 4: to do.
8:26
Speaker 3: And I was fortunate enough to work at a specialty
8:30
Speaker 3: pharmacy back in Boston before I moved to Texas.
8:33
Speaker 4: And now I think back and I think I.
8:37
Speaker 3: Was just intentionally pushed into these spaces by God, because
8:41
Speaker 3: I believe everything does happen for a reason.
8:44
Speaker 4: And I only worked with people who.
8:46
Speaker 3: Were an eaige demanded medication, or people who had HIV, hypriatis,
8:52
Speaker 3: alcohol and abuse disorder. So those were a lot of
8:55
Speaker 3: things and everything does gravitate to mental health at the
8:58
Speaker 3: end of the day, so that I think all of
9:00
Speaker 3: those experiences counseling patients and other pharmacies looking at the
9:04
Speaker 3: other side effects, so everything cheaped.
9:09
Speaker 4: I have what I have become toy.
9:12
Speaker 1: That is a tremendous story and it really resonates with
9:15
Speaker 1: me as I can tell that so many points, critical
9:20
Speaker 1: points within your career, psychiatry really was something that was
9:25
Speaker 1: always present, that you observed and that you just at
9:30
Speaker 1: a very visceral level felt for these patients, and it
9:34
Speaker 1: really has called to you.
9:36
Speaker 2: I totally agree with that, and.
9:38
Speaker 1: It's just so interesting to me that when we think
9:41
Speaker 1: about the different areas as we practice as pharmacists, the
9:46
Speaker 1: especially for like the in patient setting in your early
9:49
Speaker 1: I would imagine one of your clinical rotations for happier
9:52
Speaker 1: it be rotations. You had the experience of an impatient
9:55
Speaker 1: psychiatry rotation. I also did, and I agree with you
10:00
Speaker 1: that the amount of medications that these patients go on
10:03
Speaker 1: within the hospital setting, where you can say that it's
10:06
Speaker 1: a little bit safer environment because they're already in hospital,
10:10
Speaker 1: but the.
10:11
Speaker 2: Mouse that they go on is just insane.
10:15
Speaker 1: And to think about the prescribing being done just off
10:18
Speaker 1: a clinical protocol and without the proactive testing utilizing pharmacogenomic
10:23
Speaker 1: testing where it could be such a useful tool if
10:26
Speaker 1: it was already done for the patient.
10:28
Speaker 2: We're not having to wait for results.
10:30
Speaker 1: Especially in those those patient settings where multiple medications in
10:34
Speaker 1: those categories anywhere from antidepressants, mood stabilizers, antipsychotics being added.
10:39
Speaker 2: So for us as.
10:40
Speaker 1: Pharmacists, it's so important for us to have an awareness
10:44
Speaker 1: awareness around that information and also being able to apply it.
10:48
Speaker 2: But you're also thinking outside the box when we think.
10:51
Speaker 1: You mentioned hormone replacement, and just like hormonal imbalances, especially
10:56
Speaker 1: for women, that is key to balancing out loud of
11:00
Speaker 1: the mental health mood changes that can happen in perimenopause
11:03
Speaker 1: and menopause.
11:04
Speaker 2: So you are really just focusing on, in my opinion,
11:09
Speaker 2: the main.
11:11
Speaker 1: Precursors to how essentially people, especially women, can be developing these.
11:17
Speaker 2: Certain mood disorders as well.
11:19
Speaker 1: So it's not just about the genetic findings, it's about
11:22
Speaker 1: the whole picture. So I love that. And there is
11:25
Speaker 1: an interesting statistic that I was looking at before we
11:28
Speaker 1: hopped on today, and that it's concerning to see that
11:32
Speaker 1: there's such high rates of inadequate response and treatment resistance
11:36
Speaker 1: for depression medications and it was saying that less than
11:39
Speaker 1: fifty percent of patients achieve adequate response in their first
11:42
Speaker 1: interdepressant trial. I mean, when you think about that, that's insane.
11:46
Speaker 1: That's such a high percentage to even think about. And
11:50
Speaker 1: then around thirty percent of patients meet criteria for treatment
11:53
Speaker 1: resistant depression after multiple treatment attempts. That's crazy to me.
11:58
Speaker 1: That right there is enough to show me that clinically,
12:04
Speaker 1: we need a tool to help us eliminate that from
12:08
Speaker 1: occurring with our patient populations, because the more we delay
12:12
Speaker 1: treatment for them and not finding the most adequate and
12:16
Speaker 1: appropriate treatment the first time really delays it in that space,
12:21
Speaker 1: because it's what sixty I like to say, six to
12:23
Speaker 1: eight weeks before we see true treatment response with the
12:25
Speaker 1: antidepressant categories. Many others take a long time to regulate
12:29
Speaker 1: out in the patient populations as well. I mean, don't
12:32
Speaker 1: you agree, I mean, I'm sure you see this a
12:34
Speaker 1: lot even where you're practicing currently.
12:37
Speaker 4: Yes, I totally agree with that.
12:40
Speaker 3: The same thing. You know, patients are not just on
12:44
Speaker 3: just two or four or five of them.
12:45
Speaker 4: They are taking a lot of them.
12:47
Speaker 3: And even when I started working on my own on
12:50
Speaker 3: the consultant practice and now with doctor Kahn, I just
12:53
Speaker 3: don't look at the psychiatry medications. It's whatever other medications
12:57
Speaker 3: they're taking. They could be understanding, they could the pressure medications,
13:01
Speaker 3: they could be on maybe something for God, they could
13:04
Speaker 3: be anything else. So that helps me to see them
13:08
Speaker 3: from a whole person perspective, not just looking at the genetics.
13:12
Speaker 3: So with the even with this office was I want
13:15
Speaker 3: to use pharmacogenomics as another clinical decision support tool. It's
13:19
Speaker 3: not we're replacing the clinical judgment. We're still the evidence
13:23
Speaker 3: based guidelines we have and then using the SEP guidelines,
13:26
Speaker 3: and then just not just the guideline part, but considering
13:30
Speaker 3: the patient test, what are the symptoms, what is the
13:33
Speaker 3: patient willing to do as well? Because sometimes if we're
13:36
Speaker 3: just forcing the patient, they would still.
13:40
Speaker 4: Not stop doing it. That's that's the problem right now,
13:43
Speaker 4: and how.
13:44
Speaker 3: I can explain it currently where you're working with a
13:46
Speaker 3: patient and unfortunately she is on the very high tours
13:49
Speaker 3: of venzodiac I fem actual's taking four milligrams three times
13:52
Speaker 3: a day, yes, and she I think the maximum is
13:56
Speaker 3: six milligrams. It is so hard, Melissa, It's been like
14:00
Speaker 3: a couple of sessions. It is so hard to taper
14:03
Speaker 3: her off because whilst she's in the menopaustage. The problem
14:08
Speaker 3: is it's so hard to make her understand because when
14:11
Speaker 3: she thinks that she's not going to sleep, she's not
14:13
Speaker 3: good no matter what you do. And sanich is not
14:17
Speaker 3: the only thing she did. She takes hydroxidin, then she
14:19
Speaker 3: takes in benddryl. Then she she has she's been metaziitin.
14:23
Speaker 1: But you actual be awake, she's yeah, ye are not
14:29
Speaker 1: sleeping rather, I mean I would be knocked out for
14:32
Speaker 1: days on a combination like that. So you can see,
14:35
Speaker 1: like the the fact that she's built such a tolerance
14:39
Speaker 1: to the combinations of therapies through the years, I can
14:42
Speaker 1: imagine that it's treacherous to navigate the titration down off
14:47
Speaker 1: of those therapies.
14:48
Speaker 3: So that's true interesting thing to train the mix is,
14:52
Speaker 3: you know, like about twenty five percent of antidepressant and
14:56
Speaker 3: the psychotics they are metabolized by twenty six and she's
14:59
Speaker 3: a pumata, can you imagine?
15:02
Speaker 4: Yes?
15:02
Speaker 2: Oh, no, I know.
15:03
Speaker 1: And then when we think about the potentials for that
15:06
Speaker 1: enzyme to pheno convert with other addition of medications to
15:10
Speaker 1: be onboarded as well. I mean, siftyenty six is the
15:14
Speaker 1: enzyme activity that we as pharmacists have to be so
15:18
Speaker 1: careful with because it just has so many things that
15:20
Speaker 1: can really interfere not only at the genetic standpoint, but
15:25
Speaker 1: also from the drudge of drug interaction standpoint that we
15:28
Speaker 1: need to be very highly vigilant around. So yeah, knowing
15:33
Speaker 1: that ahead of time, I mean that spreads into other
15:35
Speaker 1: areas of her treatment as well as you know, fifty
15:38
Speaker 1: six has its hands in many medications in.
15:42
Speaker 2: The pharmacogenomic space.
15:43
Speaker 4: So that's that's true. It's just crazy.
15:47
Speaker 1: Yeah, I want to ask you a question, So I
15:50
Speaker 1: want to know a little bit about how you got
15:53
Speaker 1: started at doctor CON's practice kind of just your your conversations,
15:57
Speaker 1: your connections, and just how.
15:58
Speaker 2: You're operating right now her in that space.
16:02
Speaker 3: So it started probably six seven months back, so I
16:08
Speaker 3: was it's been almost three years. I've been doing the
16:11
Speaker 3: consulting part I do from Connuma Consultation for a lab
16:17
Speaker 3: in Houston. So I started doing that last year, yes,
16:20
Speaker 3: around sometime last year, so with.
16:22
Speaker 4: Her office specifically.
16:24
Speaker 3: The good thing was they were doing gene side before,
16:27
Speaker 3: so that kind of helped. But the problem was because
16:31
Speaker 3: in our traditional insurance world. Providers are busy, you know,
16:36
Speaker 3: looking at patients and they're just giving a very small window.
16:39
Speaker 3: Sometime I just tend to fifteen minutes. And unfortunately they're
16:43
Speaker 3: not reimbursed for anything else that to do because then
16:46
Speaker 3: they cannot put a CPD code or other codes for
16:50
Speaker 3: that stuff. So she always and the best thing was
16:53
Speaker 3: because she was not only a psychiatrist, she also did
16:57
Speaker 3: her training in indicative.
16:59
Speaker 2: Psychiatry, so that love.
17:01
Speaker 4: Yeah, So that was another.
17:04
Speaker 3: Area that that she was open to different things, and
17:08
Speaker 3: that was that really helped because they were doing jeans
17:11
Speaker 3: that so she had an idea, but there were a
17:13
Speaker 3: lot of questions because she was confused by, you know
17:16
Speaker 3: how the lab. Most of the labs there were just
17:19
Speaker 3: color code that this is yeah, this is green, you
17:22
Speaker 3: can start using it, this is yellow, and.
17:25
Speaker 1: This is real, which infers too much in my opinion,
17:27
Speaker 1: and that it's a safe option as opposed to this
17:31
Speaker 1: is one that a lot of times when I'm having
17:34
Speaker 1: interactions with providers and explaining the results to them, I
17:36
Speaker 1: have to reiterate to them that this is part of
17:39
Speaker 1: the puzzle.
17:39
Speaker 2: It's not the end all, say all. You have to
17:41
Speaker 2: look at other factors.
17:42
Speaker 1: Which I know, you know, but this can be a
17:46
Speaker 1: very good starting point for a guided direction in one
17:49
Speaker 1: way or another too.
17:50
Speaker 4: That's true.
17:50
Speaker 3: That's true, yeah, and that I think eventually helped because
17:53
Speaker 3: I think her openness and willingness to listen, So I
17:57
Speaker 3: think that that was a different mindset that she had
17:59
Speaker 3: from other different people that I've usually worked with, and
18:02
Speaker 3: that's started because they were doing inside.
18:05
Speaker 4: I usually.
18:08
Speaker 3: Like using Tempest because I've been using it for a
18:11
Speaker 3: violent they have been honestly very consistent in the reports
18:14
Speaker 3: and everything that as computer other labs.
18:16
Speaker 4: I have used, So that's just my opinion.
18:19
Speaker 1: I do like temp especially in the psych psychiatric space,
18:22
Speaker 1: and when I first started doing the consulting myself, they
18:25
Speaker 1: were one of the first labs I ever used. Utilized
18:27
Speaker 1: them for one of my own family members. And yes,
18:30
Speaker 1: their comprehensiveness of the genes that are necessary in my
18:34
Speaker 1: opinion to be tested for for psychiatry are very comprehensive, accurate,
18:38
Speaker 1: up to date, and they also are implementing some new
18:42
Speaker 1: AI type of integration because did you know that they
18:46
Speaker 1: actually took in one OME, so they actually acquired one OME,
18:50
Speaker 1: which is another pharmacogenomic lab that I used for years,
18:54
Speaker 1: so I was really pleased to hear that they're still
18:57
Speaker 1: utilizing that as a comprehensive test under the umbrella of tempest.
19:02
Speaker 4: So in case you did know that, yeah, that's true,
19:06
Speaker 4: and that would be exciting.
19:07
Speaker 3: I would really love to see if there add different
19:09
Speaker 3: genes that we could, you know, help because when we
19:11
Speaker 3: see a patient, they have like everything, not just the
19:14
Speaker 3: psychiatary ones. They have other blood pressure medications and other ones.
19:18
Speaker 3: And because even on tempest, we don't have we just
19:21
Speaker 3: have to SIP to C nine, but we don't have
19:24
Speaker 3: anything related to the wark in response.
19:26
Speaker 4: We don't have the four F two, we don't have
19:28
Speaker 4: the k r C one. So then that I would
19:31
Speaker 4: really like.
19:34
Speaker 3: That there were because when I first started, Melissa, I started,
19:37
Speaker 3: I had opportunity to get my testing done through one own,
19:40
Speaker 3: but a lot of things I learned about my cell
19:43
Speaker 3: that I wasn't expecting. There is usually when it comes
19:48
Speaker 3: to work, And let me give you an example, like
19:49
Speaker 3: I am a SIP to C nine normal metabolizer. I
19:53
Speaker 3: am okay with SIP four F two v k o
19:57
Speaker 3: r C one, but I have a rare variant and
20:01
Speaker 3: there's usually a snip which is called mattin RS one
20:06
Speaker 3: two two seven three that is usually found in people
20:09
Speaker 3: of Best African descent, and interesting, anyone in our family
20:15
Speaker 3: who did belong to Best Africa. So I have absolutely
20:17
Speaker 3: no idea, but yeah I do. I'm normal for everything,
20:20
Speaker 3: but I do have that cluster. So where do I
20:22
Speaker 3: fall into this guideline and those algorithms?
20:25
Speaker 4: So yeah, they are there.
20:28
Speaker 1: So much of our guideline does have a lot of
20:30
Speaker 1: different ancestries that need to be accounted for, especially for
20:33
Speaker 1: African American ancestries, Asian ancestries, and there's a lot of
20:37
Speaker 1: different guidance around that. So yes, that's it's important to
20:40
Speaker 1: bring up as well. And my other thing I was
20:45
Speaker 1: looking at before we kind of started our talk today
20:49
Speaker 1: is you were talking about the like just actionable variance
20:53
Speaker 1: to really look at.
20:54
Speaker 2: So I was looking at real world.
20:55
Speaker 1: Prevalence of actionable SIP twoty six and SIP toot nineteen phenotypes,
21:00
Speaker 1: and I was looking at a large clinical trial. This
21:03
Speaker 1: is actually coming from one of Tempest's clinical trials testing
21:08
Speaker 1: for cohorts to show around sixty five percent of patients
21:11
Speaker 1: had actionable two D six and or two.
21:13
Speaker 2: C nineteen phenotypes.
21:15
Speaker 1: So if that tells you anything as far as actionability
21:18
Speaker 1: and applicability for PGX testing and its utilization, it speaks volumes.
21:22
Speaker 1: So for us, it's really important to make sure, like
21:27
Speaker 1: you said, a lot of times with providers, it's their
21:29
Speaker 1: time constraint. They're seeing the patients actively working with them,
21:34
Speaker 1: and they really need an advocate like a pharmacist like
21:37
Speaker 1: you and I who are able to come in, interpret
21:40
Speaker 1: the results, provide them with clinical action plans that they
21:43
Speaker 1: can actually implement in real time.
21:45
Speaker 2: And that really should be, in my opinion, where the
21:51
Speaker 2: practice should be going, and it really is.
21:53
Speaker 1: There's more roles available to pharmacists now in that kind
21:56
Speaker 1: of a I wouldn't cause genetic specialists, but pharmacogenomics specialists
22:01
Speaker 1: where it's applicable for us to be in those conversations
22:04
Speaker 1: and advocating for them for safe utilization of it, because
22:08
Speaker 1: I feel like that's always the apprehension, right, is that
22:11
Speaker 1: they feel clinically liable if they don't interpret and understand
22:14
Speaker 1: the results. And that's why I want anybody, any of
22:17
Speaker 1: our clinic, any of our physicians, nurse practitioners who are
22:20
Speaker 1: wondering about pharmacogenomics and how the work is. That's what
22:24
Speaker 1: we are for you as your advocate to be able
22:27
Speaker 1: to utilize it correctly, safely, and to take a burden
22:30
Speaker 1: off your plate. And I feel like when you've talked
22:33
Speaker 1: to me about your interactions with doctor con that's really
22:35
Speaker 1: what I feel like you're doing is the medication management.
22:38
Speaker 4: Right, Yeah, that's true. And another thing, the biggest thing
22:41
Speaker 4: for the clinic was they do not want another burden
22:45
Speaker 4: on themselves.
22:46
Speaker 2: That was a great thing.
22:47
Speaker 3: So that took a while to figure out how would
22:50
Speaker 3: we scheduled appointments or how would be you know, without
22:56
Speaker 3: putting a lot of pressure on the office manager and
22:58
Speaker 3: the people who are scheduling more appointments. How should how
23:01
Speaker 3: should I take those kinds of things out because they
23:03
Speaker 3: were unfortunately no answers for most of them.
23:07
Speaker 4: So what we did was what I did was I
23:10
Speaker 4: did a brochure.
23:11
Speaker 3: So what I do is because I do a website,
23:13
Speaker 3: so I did design a brochure that was specific to
23:16
Speaker 3: that clinic. So whoever wants to learn more about it,
23:20
Speaker 3: there were just scan that code that takes them to
23:22
Speaker 3: my website and they can email me. They can just
23:25
Speaker 3: they can book a free console and just talk to me.
23:28
Speaker 3: So that just helped me to take away a lot
23:31
Speaker 3: of things from their plate. So every so everything that's
23:35
Speaker 3: from scheduling from uh up.
23:39
Speaker 2: That is that at MEDDNA health dot com. Is that correct?
23:42
Speaker 4: Yes, yeah, that's correct.
23:43
Speaker 2: Yes, I love this as this is nicely executed.
23:47
Speaker 1: I like this a lot, but it helps the patients
23:49
Speaker 1: to know there's kind of some different resources how it
23:53
Speaker 1: works to schedule a discovery call.
23:56
Speaker 2: DNA sampling.
23:56
Speaker 1: So you're managing all this at doctor CON's office, you're
23:59
Speaker 1: basically just the built in structured, you know, operating business
24:03
Speaker 1: within a within a practice.
24:05
Speaker 4: That's true. Yes, So I've tried to keep everything up
24:08
Speaker 4: their plate.
24:09
Speaker 3: The only sometimes the only thing is that the office
24:13
Speaker 3: has to do is send them send me any kind
24:15
Speaker 3: of flab work or any kind of previous history even
24:18
Speaker 3: for that.
24:18
Speaker 4: What I've done because I use practice Better for all
24:20
Speaker 4: of my patients. So what I did was I didn't
24:23
Speaker 4: need too.
24:23
Speaker 2: I really love that for us.
24:26
Speaker 4: Yes, So what I did was I just made a
24:28
Speaker 4: folder for that office.
24:30
Speaker 3: So anytime I want something and the patient cannot provide
24:33
Speaker 3: to me, I would just email or text the office.
24:36
Speaker 4: Manager and she would upload it to Practice Better.
24:39
Speaker 3: So that has really helped because it takes. Yeah, it
24:42
Speaker 3: takes a lot of time to get everything from the
24:45
Speaker 3: patient and most of the patients.
24:48
Speaker 1: Yeah, and if we can streamline the process and a
24:51
Speaker 1: patient compliant portal access, that is huge. And I really
24:56
Speaker 1: love practice better because it's affordable for us as consultant.
25:00
Speaker 1: They have a lot of different options to what you
25:03
Speaker 1: are paying monthly to be able to operate on that system.
25:06
Speaker 2: I love it.
25:07
Speaker 1: It's really made my interactions with my own personal clients
25:10
Speaker 1: very seamless as well. So I'm happy to hear that
25:12
Speaker 1: you're utilizing it as well.
25:14
Speaker 3: Yes, And I think that has helped me so many times.
25:18
Speaker 3: And another thing was, yeah, weing we talk about the
25:23
Speaker 3: insurance and the liability part.
25:24
Speaker 2: Yeah, that's a that's a that's a big topics.
25:28
Speaker 3: You don't talk about that part as well, because when
25:30
Speaker 3: you were talking, because there are other because since it's
25:34
Speaker 3: a mental health practice, there are a lot of other
25:36
Speaker 3: licensed therapists or other there's a traditional Chinese doctor who
25:40
Speaker 3: comes in and does acupunture and other kind of curb related.
25:46
Speaker 4: Consultations with the patients.
25:48
Speaker 3: So yeah, so there were different things that we're working on,
25:52
Speaker 3: and the only thing was I just had to cover
25:56
Speaker 3: you know the slip and fall coverage, so.
25:59
Speaker 4: I was able to it covered through my current insurance career.
26:04
Speaker 4: So those saying that just in case.
26:06
Speaker 3: Anything happens, so the patient is not just doing the practice,
26:09
Speaker 3: and the practice takes on.
26:11
Speaker 4: So it was kind of something that did work for
26:16
Speaker 4: all of us. So there were these very few things.
26:18
Speaker 4: It did take a while to come up with all
26:20
Speaker 4: of these solutions. But now once I started working.
26:25
Speaker 3: With them, like starting with the third patient was in November,
26:29
Speaker 3: So we do just cash pay and then there are
26:32
Speaker 3: a lot of patients who have done the g inside
26:35
Speaker 3: or they do other kinds of stuff, and so.
26:37
Speaker 1: You're able to pull in their results interpret that for them,
26:40
Speaker 1: I would assume yes.
26:41
Speaker 4: Yes, yeah, for most of them.
26:43
Speaker 3: Yeah, So that's what we are doing and started in November,
26:45
Speaker 3: so we are still kind of in early initial phases.
26:48
Speaker 4: And the main thing was it wasn't like we're just
26:50
Speaker 4: going to do testing for all of the patients.
26:52
Speaker 3: We're just going to focus on a small set of
26:55
Speaker 3: population who really needs we have been struggling not for
27:00
Speaker 3: six months of the scheduling.
27:02
Speaker 1: I think that's wise because it allows you to kind
27:05
Speaker 1: of get your foundation set in terms of protocols, within
27:08
Speaker 1: the practice and really get the better management of those
27:11
Speaker 1: patients that are more complex.
27:13
Speaker 2: So love that.
27:14
Speaker 1: Plus, as it becomes more and more popular and patients
27:18
Speaker 1: become more and more aware that it's available to them,
27:22
Speaker 1: I find them wanting to get it on their own
27:24
Speaker 1: and researching it on their own is becoming way more
27:27
Speaker 1: accessible now in terms of especially because when we think
27:30
Speaker 1: about how insurance is billing for things these days, and
27:33
Speaker 1: you could literally build for a pharmacogenomics test, you could
27:35
Speaker 1: get a thousand dollars bill and you could be paying
27:37
Speaker 1: three hundred and fifty dollars sport out of pocket once
27:40
Speaker 1: in your lifetime. So it's it's really asinine to me
27:44
Speaker 1: how the insurance billing works as far as it's.
27:48
Speaker 2: Implementation in the space.
27:50
Speaker 1: But for those of you who aren't aware of how
27:53
Speaker 1: you can get it billed currently, it's typically done through
27:55
Speaker 1: other certain medicaid programs, but really primarily through Medicare. Medicare
28:00
Speaker 1: b is the primary payer on it through very specific
28:03
Speaker 1: diagnosis codes and things, and even in that space where
28:06
Speaker 1: we have polypharmacy rampant within the long term care population,
28:10
Speaker 1: it makes a lot of sense that it would be
28:12
Speaker 1: covered there more readily. But At the same time, it's
28:15
Speaker 1: not regularly utilized in that space because a lot of
28:18
Speaker 1: the practitioners there one overwhelmed.
28:21
Speaker 2: They have hundreds of patients that they're seeing.
28:24
Speaker 1: Their nurses as far as you know, helping with the
28:27
Speaker 1: oversight of the medication management is you know, overworked, overburdened.
28:32
Speaker 1: And that's where I feel like the consultant pharmacist in
28:34
Speaker 1: those spaces really should be championing this to be able
28:37
Speaker 1: to bring that information into the provider and also create
28:41
Speaker 1: their medication action plans and accordance to that. So that way,
28:45
Speaker 1: within a certain timeframe, the provider, if it's introduced to
28:48
Speaker 1: them in that environment through certain recommendations from the pharmacists,
28:52
Speaker 1: the consultant pharmacists.
28:53
Speaker 2: They have what I think it's thirty days to act
28:55
Speaker 2: upon it.
28:56
Speaker 1: So that is kind of more of a pressuring of
29:01
Speaker 1: using it, but still making them aware of it and
29:04
Speaker 1: having those conversations is a big deal.
29:09
Speaker 2: Yeah.
29:09
Speaker 4: And one more thing that I wanted to add was
29:12
Speaker 4: with these offices, another thing was when you get the
29:18
Speaker 4: test results, right, we have everything you did the first session,
29:21
Speaker 4: we have the history, their supplements, whatever else they're taking.
29:25
Speaker 2: Their lab don't forget supplements.
29:28
Speaker 4: Yeah, yeah, that's a big one. Now we have peptites
29:30
Speaker 4: coming yeah, and you have oh yes, yes.
29:34
Speaker 3: So a lot of these things when they do come
29:37
Speaker 3: in is to basically make the reports simpler and just
29:41
Speaker 3: add what are the actionable items that the patient needs
29:45
Speaker 3: right now? And if we have any recommendations, what I
29:48
Speaker 3: like to do is I like to explain why I'm
29:51
Speaker 3: recommending this change or what's the.
29:54
Speaker 2: Yeah, what does that look like?
29:56
Speaker 1: So you're obviously you're counseling with the patients. I would imagine, yeah,
30:00
Speaker 1: you're having one on ones with them.
30:01
Speaker 3: Yep, that's right, yes, yeah, because we're really it's different,
30:04
Speaker 3: but it makes a lot more difference once they're sitting
30:08
Speaker 3: right in front of me.
30:09
Speaker 4: And this is what has happened because you know, with
30:11
Speaker 4: the testing it does take.
30:12
Speaker 3: Like fourteen days no matter how quick it is now
30:15
Speaker 3: the turnering towns are getting better, but still the patient
30:18
Speaker 3: might not be available.
30:19
Speaker 4: It takes about like two to four weeks when I
30:22
Speaker 4: see the patient next time and the medication is start
30:24
Speaker 4: to finish.
30:25
Speaker 2: Yeah.
30:26
Speaker 3: Yeah, So that's another thing with the office, and I
30:28
Speaker 3: have that flexibility that I can call doctor con and
30:31
Speaker 3: ask or with the office manager what has.
30:33
Speaker 4: Changed and every time is that there is a change
30:36
Speaker 4: in the medication whenever it's utilized.
30:40
Speaker 2: I'm happy to hear that. That's great.
30:42
Speaker 3: Everything has and some of the time before I'm like
30:45
Speaker 3: compiling everything, something that's changed either they have discontinued.
30:50
Speaker 2: So yeah, well, a.
30:52
Speaker 1: Helpful thing that I've learned to make sure that the
30:55
Speaker 1: providers are when they're doing their medical charting, that they
30:59
Speaker 1: are making notes of the utilization of the PGX testing
31:02
Speaker 1: so that when we do go back within the record
31:04
Speaker 1: we can kind of quantify and create some statistical analysis
31:08
Speaker 1: around it as well.
31:10
Speaker 2: So that way even as they.
31:11
Speaker 1: See it, as you know, it's a cost savings for
31:15
Speaker 1: them for less time management over the medication management, but
31:18
Speaker 1: also lowering the amount of times that they're having to
31:23
Speaker 1: adjust the medications for the patient and just getting better
31:26
Speaker 1: overall treatment, getting them into remissions the goal.
31:29
Speaker 4: Right.
31:29
Speaker 3: So yes, yes, it's true because at the end of
31:33
Speaker 3: the day, we all want better patient outcomes.
31:36
Speaker 1: Yes, that's the big why for me is that I
31:40
Speaker 1: want all information being utilized to make sure that when
31:44
Speaker 1: we are having complex patients on multiple medications, that we
31:48
Speaker 1: just have all the information in front of us, because
31:50
Speaker 1: that's ultimately it's our job to do no harm to
31:53
Speaker 1: our patients, and providers know this as well, so for
31:57
Speaker 1: us to be able to help them implement that, it is.
32:00
Speaker 2: In my opinion, crucial. It really is. It should be
32:03
Speaker 2: a standard of care, and in Europe it is.
32:05
Speaker 1: It's the pharmacogenomic testing is more prevalent in Europe and
32:09
Speaker 1: it's used more as a proactive method of treatment and
32:12
Speaker 1: testing early on. So in the United States we are
32:15
Speaker 1: definitely behind with that regard because it's just a corrupt
32:20
Speaker 1: system out there. Unfortunately, when it comes to when we
32:22
Speaker 1: think about PBMs and reimbursements for pharmacists, and then when
32:25
Speaker 1: we also think about just the amount that we pay
32:28
Speaker 1: into our insurance companies for coverage of things, and then
32:31
Speaker 1: they deny us on just you know, certain things that
32:34
Speaker 1: we haven't tried yet.
32:35
Speaker 2: Which is absurd. It's just a difficult system to work in.
32:39
Speaker 1: But that's the cash paying business because it really allows
32:43
Speaker 1: us to circumvent around that and we can actually make
32:46
Speaker 1: it more of a price conscientious experience for the patient,
32:51
Speaker 1: especially when we think about that.
32:53
Speaker 4: That's true, that's true, and there is a very big
32:55
Speaker 4: population that is willing.
32:58
Speaker 3: To pay if they know that the HUSS that they
33:00
Speaker 3: are getting would be valuable and it would last them
33:03
Speaker 3: for a longer time. That's why in Texas, I'm not
33:06
Speaker 3: sure about other states, but in Texas, their primary care
33:10
Speaker 3: providers there are you know, the amount of services that
33:15
Speaker 3: they're providing has increased tremendously in the last couple of
33:20
Speaker 3: years as compared to a traditional model, because people people
33:24
Speaker 3: have money, they can pay and they want good service, some.
33:28
Speaker 2: Better quality of care. They're tired of getting this, you know,
33:32
Speaker 2: subpar meet you for five minutes kind of care.
33:35
Speaker 4: And unfortunately they have been waiting hours for that fifteen minutes.
33:39
Speaker 1: So and specialists too, that's why so many up psychiatry,
33:45
Speaker 1: A lot of people go, especially for children, with their
33:48
Speaker 1: pediatrician for actual prescribing verse because to get in with
33:52
Speaker 1: a psychiatrist it is darnier and possible within a month
33:57
Speaker 1: to be able to see them, so that's another delay
33:59
Speaker 1: of care. So I find a lot of conversations that
34:03
Speaker 1: I have with pediatricians a lot, especially when parents are
34:05
Speaker 1: trying to explore medications for whatever diagnosis we're looking at.
34:11
Speaker 1: They want more information because many times these kids haven't
34:13
Speaker 1: been on anything.
34:14
Speaker 2: In their life. So this is very, very very useful
34:17
Speaker 2: for that situation too.
34:19
Speaker 1: Where let's say our pediatricians are reversed on using mental
34:24
Speaker 1: health medications, but they're strongly going off of protocol and
34:28
Speaker 1: then trial and error. So this is a very big
34:30
Speaker 1: space that I feel like that that's where we could
34:32
Speaker 1: get a lot of use and better management over these
34:38
Speaker 1: kids early on too.
34:40
Speaker 4: That's true. That's true.
34:41
Speaker 3: I totally agree, and there are some of the providers
34:43
Speaker 3: who are willing to do do that. Sometimes they're just
34:46
Speaker 3: you know, the hands are tied because of how the system,
34:50
Speaker 3: how there's things run in the system. Even though somethings
34:52
Speaker 3: have their own practices, they don't have that type. So
34:56
Speaker 3: pharmacists and you know, kind of fill that gap because
34:58
Speaker 3: we are working as team. There's no one's ego coming in,
35:03
Speaker 3: so it because at the end of the day, we're
35:05
Speaker 3: working for what's best for our patients.
35:08
Speaker 2: Absolutely well.
35:10
Speaker 1: I do want to kind of have a full circle
35:12
Speaker 1: moment here because thank you so much for sharing your
35:15
Speaker 1: story today and just giving us some insight into how
35:18
Speaker 1: you're practicing, how you're utilizing precision medicine, and just what
35:21
Speaker 1: you're doing for the pharmacy practice in general as a whole.
35:24
Speaker 1: I plaud you in every facet that you're exploring and utilizing.
35:28
Speaker 1: But I'm really excited for our second part of this series.
35:31
Speaker 1: That way we can have a full circle moment collaboration
35:35
Speaker 1: meeting between yourself, doctor Con, and me on the next
35:39
Speaker 1: episode of this series. So that way we can get
35:41
Speaker 1: an MD's perspective on this kind of interaction and how
35:45
Speaker 1: it's been going. And I'm sure we'll hear rave reviews.
35:50
Speaker 4: That sounds great and I look forward to that conversation
35:53
Speaker 4: as well.
35:55
Speaker 2: Perfect.
35:56
Speaker 1: Thank you so much for being on today's episode with me,
36:00
Speaker 1: and please I encourage you to stay tuned for our
36:03
Speaker 1: next episode with doctor Con and Saba and the conversation
36:07
Speaker 1: surrounding how working with the pharmacists in the psychiatric space
36:11
Speaker 1: has been utilized, implemented, and used to the benefit of
36:14
Speaker 1: your patients.
36:16
Speaker 2: I'm very excited for that one to come. Thank you
36:17
Speaker 2: so much again for joining me.
36:19
Speaker 4: Thank you, Melissa,