Right Drug. Right Dose. Right Time.
Mental Health Issues In Canada • 1 in 5 people suffer from mental illness in Canada • Study shows that workplace stress is one of the main causes of mental health issues. • 68 per cent of employees reported that they could only maintain their optimal performance for less than 70 per cent of their workday. • According to Stats Canada, in any given week: ü Approx. 355,000 Canadians are unable to work due to disability (mental and/or behavioral disorders) ü Approx. 175,000 full-time workers absent from work due to mental illness. 1. Mental Health Commission 2. Globe and Mail and Morneau Shepell 3. Stats Canada
Economic Burden of Mental Health Issues • The economic burden of mental illness in Canada is estimated at $51 billion per year. • With Bill 127 effect since Jan 1st 2018: Some workers with chronic mental stress will be entitled to (WSIB) benefits. • The cost of a disability leave for a mental illness is about double the cost of a leave due to a physical illness. • The burden to the employer- ü Employees on disability ü Increased employee absenteeism ü Loss of employee productivity 1. Mental Health Commission 3. Stat Canada
Challenge with Mental Health Condition Prescription Medication • Not Effective? • Toxic? • Wrong Dosage?
Trial and Error Treatment for Patients with Mental Illness • 40 percent of psychiatric medications fail the first time • Adverse reactions are common and can be severe (e.g. obesity, suicidal tendencies etc.) • It is hard to know if mental illness is under control
Medications should be helping not hurting • In Canada, severe adverse drug reactions affect 200,000 patients annually causing10,000- 22,000 lives lost • 1 out of 4 hospital admittances are drug related • Costs us up to $17.7 billion per year
Personalized Prescribing Plan (P3): Part of XAP @ Beneplan Prevent Drug -related Disability of Employees with Mental Health Issues!
P3 - Pharmacogenomic Test • It is a genetic test to identify how a person will respond to medication • Help to select the right drug an dose on the outset of condition without trial and error • This does not predict risks of developing diseases • Simple saliva sample is used to conduct the analysis • Test results are available within 5-7 business days
P3 - Pharmacogenomic Approach Genetic Factors Drug breakdown Drug response Clinical Factors Environmental Factors Age Nutrition Sex Smoking Liver function Alcohol Renal function Physical activity Pharmacogenomics Therapeutic effects Adverse effects
P3 - Unique Feature • Most extensive test panel in Canada- ü > 50 genes ü >150 drugs ü proprietary • Comprehensive Summary Report by in-house Pharmacist • Employee education campaign **** • Follow-up with employees ** • Continuous support for employees and physicians
P3 Implementation • Employee Benefit Format (XAP): Similar to EAP • Pay-As-You-Go Format
Employee Eligibility Employees and their dependents are eligible for a personalized drug evaluation if they are prescribed or currently are taking a medication that is included on our drug list.
The Process Employees collect simple Employee contacts P3 Consent form and DNA saliva sample and send to directly 1(844) 943 0210 Kits sent to the employee Laboratory Results are sent to Pharmacist reviews the Laboratory conducts the employee and to results and prepares test and digital report is employee’s doctor Summary Report prepared
No Employer Liability • Employees requisition the test voluntarily with consent • Solves the issues of privacy, confidentiality and discrimination concerns stated in the Genetic Non-discrimination Act, 2017 • Protects the employer from potential liability
Employee Privacy & Confidentiality Assured • P3 keeps the employer at “arms-length” • P3 assigns a “barcode” to the “name” • Till the results are dispatched, the samples are kept barcoded • Only P3 can match “report” and “barcode” to identify the employee
Benefit from P3 - Pharmacogenomic Test • Saves money on medication waste • Less employees on disability • Less medication-related absenteeism • Increased employee productivity and morale
Thank you Sanjida Ahmed, PhD Email: Sanjida@personalizedprescribing.com
Consulting Pharmacist P er ersonalized ed P rescr cription To help resolve medication P lan lan: issues: • Side-effects • Drug interactions • Dosage optimization • Medication Counselling • Genetic Drug Compatibility Test To Make Personalized Recommendations
• Cardiovascular Conditions (high blood pressure, cholesterol, diabetes) • Mental Health (depression, anxiety, ADHD, schizophrenia) Me Medication ons • Pain (muscle or neuropathic) Te Tested • Immune Conditions (Psoriasis, Crohn's, Rheumatoid arthritis) • Oncology • Smoking Cessation and Opioid Use Disorder
• All info discussed with pharmacist (including genetics) is kept private • NOT shared with: • Employer • Insurance company Privacy & • Government Confidentiality • Doctor (unless consent provided) • Info. sent to the lab is kept barcoded to maintain privacy • Illegal in Canada for insurance companies to ask for your genetic information to determine coverage.
• Patient: 45 yr, female • Conditions: Rheumatoid Arthritis, Chronic Pain • Job function: Physician • Coverage: CMA Case Study • History: Prescribed Methotrexate for her RA and developed bone fractures in her ankle. #1: RA Medication was discontinued but patient still had persistent pain. The pain was so severe that the patient exclaimed: “I wish I can cut my leg off!” • Test Process : Employee called PPI, pharmacist gathered comprehensive history and ordered pharmacogenetic test.
• Test Result: Kiera has a rare genetic variation in her MTHFR gene that leads her to a deficiency in the active form of folic acid. Case Study: RA
• Pharmacist Interpretation: Methotrexate also depletes folic acid levels, and though physicians generally prescribe a folic acid supplement, Kiera was not able to convert this supplement Case Study: into a usable form. Thus, she suffered some of the symptoms of folic acid deficiency (i.e. bone RA fractures and heightened pain sensitivity). • Recommendation: Supplementation with the active form of folic acid ( Leucovorin ).
Case Study #2: Anxiety • Patient: 30 yr., Female • Conditions: Anxiety, Heart condition (enlarged ventricles), Asthma, Tobacco Use Disorder • Job function: Administrative Assistant • History: As soon as she started medications (Cipralex, Venlafaxine), she felt even more anxious and her heart condition worsened (i.e. dizziness and fainting spells that resulted in hospitalizations and days lost from work). Patient’s also uses her asthma rescue inhaler >3 time/week due to shortness of breath. • Test Process : Employee called PPI, pharmacist gathered comprehensive history and ordered pharmacogenetic test.
Pharmacist Interpretation: - Certain antidepressants (i.e. Venlafaxine and Citalopram ) can cause changes in electrical activity in the heart, which can increase risk of Case Study: heart palpitations and heart malfunction - Patient had genetic risk factors (HTR2A and Anxiety CYP2D6) and clinical risk factors (structural heart abnormality) for this side-effect as well - The patients chronic use of Ventolin can further increase adrenaline, heart palpitations and anxiety.
Result: • When the pharmacist called Jane for a follow- up discussion (a month later), Jane informed the pharmacist that the physician has discontinued the Venlafaxine and has started her on the Bupropion and Flovent inhaler. • Jane experienced decreased anxiety and Case Study: increased motivation and she was able to reduce the number of cigarettes that she smoked/day. Anxiety • Though Jane still experienced bouts of dizziness, she no longer had any fainting spells, and could function well at work. • Jane was informed that the pharmacist is available at any time, if she needed more help with smoking cessation.
Case Study #3: ADHD • Patient: 14 yr., Male • Conditions: ADHD • Coverage: Student (Dependent) • History: Mark previously tried multiple stimulants (i.e. Adderall and Concerta), and though there were slight improvements in impulsivity, he also had major side-effects (i.e. irritability, emotional inhibition, appetite loss and insomnia). The patient was currently on a combination of Concerta and Atomoxetine. • Test Process : Employee (mother) called PPI, pharmacist gathered comprehensive history and ordered pharmacogenetic test.
• Pharmacist Interpretation: Mark is a CYP2D6 poor metabolizer which means he has a reduced ability to metabolize ADHD medications, and he is at high risk of dose-related side-effects (i.e. irritability, insomnia, appetite loss). In addition, there is a Case Study: drug interaction between Strattera and Concerta. • Pharmacist Recommendation: ADHD • Discontinue Concerta and Strattera • Consider Drug Holliday • Supplementation with Omega-3 1000 mg once daily • Consider Aerobic exercise (30 mins 2-3 x week) • Try other alternatives not metabolized by CYP2D6 (i.e. Desvenlafaxine)
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