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Clinical Services

We know the skilled nursing and assisted living facilities we work with are required to adhere to strict state and federal psychiatric health regulations. MediTelecare helps you remain in compliance, with documented evaluations and visits that support the need for psychotropic prescriptions for the patients who take them. We also work directly with facility personnel and interdisciplinary teams to provide behavioral health care education and establish a managed care plan for each patient.

Behavioral health “in service” reviews are available via video link for facility staff members, including the administrator, medical director and social service director, throughout the year. Our clinical staff, including our Clinical Directors for Psychiatry or Psychology, will be available to discuss our services with any primary care/attending physicians who would like to learn more. We are also available to speak to state surveyors during their visits.


Behavioral Health Integration


Behavioral Health Integration is an added service that involves a more organized approach to behavioral health care in order to optimize positive outcomes for the patient and to reduce the risk of hospitalizations, behavioral health condition exacerbations, and poor outcomes such as falls and adverse medication side effects. Teams of nurse practitioners, psychiatrists, psychologists, and medical assistants work together to gather important information about the patient’s behavioral health ⁠— this is then used to develop an in-depth monthly behavioral health care plan. This system allows a patient to be tracked over time and all in one place.

Pharmacogenomic Testing


Here at MediTelecare, we offer a value-added clinical service that not only can help reach better outcomes for patients but can also lower overall healthcare costs.
Pharmacogenomics (PGx) also referred to as “Personalized Medicine” or “Precision Medicine” is the study of how genes affect a patient’s response to drugs. PGx testing reviews individual genetic makeup to identify the likelihood of efficacious treatment response and potential for adverse drug reactions (ADRs). Therefore, PGx testing can increase the likelihood of prescribing an effective drug treatment that encourages treatment continuity while reducing occurrences of serious adverse drug reactions that incur high healthcare costs.
Traditionally, medications have often been prescribed based on clinical treatment guidelines and recommendations for the best-known treatments. These treatment guidelines may be based on clinical trial literature indicating that a given drug works a particular way in “most” patients. However, psychotropic medications can have largely heterogeneous efficacy and side-effect profiles with immense inter-individual variability.1 In consequence, drug treatment selection for behavioral health and many other treatment areas utilizes mainly a trial-and-error approach. Pharmacogenomic testing can reduce the need for trial-and-error treatment planning as it facilitates the identification of biomarkers that can help clinicians optimize drug selection, dose and treatment duration while averting adverse drug reactions that may have occurred with other standard treatments.2
Strong evidence has been established for PGx testing in patients with depression. According to the World Health Organization (WHO), dementia and depression are the most common mental and neurological disorders affecting the world’s older population. Late-life depression can have serious consequences leading to an overall decrease in quality of life.3 Furthermore, antidepressants such as selective serotonin reuptake inhibitors have only small differences in efficacy, making it difficult to choose which antidepressant may be right for a patient. Studies have shown up to a 42% variance in antidepressant response based on common genetic variation.4 Therefore, pharmacogenomic testing can carry promising results when utilized for antidepressant decision-making. In addition, in a clinical cost-savings study, results showed an average of $5,962 per-patient in healthcare cost savings for patients that underwent PGx testing.5
Pharmacogenomic testing is recommended by the Food and Drug Administration (FDA) for a variety of different medications in many different treatment areas. Of note, there are more than 30 FDA-approved psychotropic drugs that currently have pharmacogenomic information included in their labeling. The FDA and many other healthcare industry leaders have recognized the efficacy, safety and cost-savings value of PGx testing. For that reason, we believe PGx testing is a valuable and essential opportunity for patients, clinicians, facility staff and family members.
About the PGx test we use:
We are currently utilizing the most extensive pharmacogenomic test on the market, spanning 50 genes and offering recommendations on over 300 medications. This test not only offers recommendations for psychiatric medications but also tests for areas such as neurology, cardiology, pain management (including opioid medications), infectious disease, oncology and many more. At MediTelecare, we understand that many patients have multiple chronic conditions in addition to psychiatric and neurological disorders. Therefore, we want to offer the most comprehensive pharmacogenomic test that gives insight on our patients’ health as a whole. In addition, the test we utilize offers recommendations on the proper drug dose, drug-drug, drug-food and drug-alcohol interactions. This allows our clinicians to recommend the most appropriate medications personalized to the patient.
Key Benefits of Pharmacogenomic Testing:
  • Reduces the need for trial-and-error treatment planning
  • Maximizes drug efficacy while minimizing adverse drug reactions
  • Increases cost-savings through proper drug selection and avoidance of serious adverse drug reactions
  • Lifetime utility of pharmacogenomic data, decreases the need for future testing – patient genes don’t change, so patient results won’t change
References:
  1. Pouget JG, Shams TA, Tiwari AK, Müller DJ. Pharmacogenetics and outcome with antipsychotic drugs. Dialogues Clin Neurosci. 2014 Dec;16(4):555-66.
  2. Wang L, McLeod HL, Weinshilboum RM. Genomics and drug response. N Engl J Med. 2011 Mar 24;364(12):1144-53.
  3. Fiske A, Wetherell JL, Gatz M. Depression in older adults. Annu Rev Clin Psychol. 2009;5:363-89.
  4. Perlis RH. Pharmacogenomic testing and personalized treatment of depression. Clin Chem. 2014 Jan;60(1):53-9.
  5. Maciel A, Cullors A, Lukowiak AA, Garces J. Estimating cost savings of pharmacogenetic testing for depression in real-world clinical settings. Neuropsychiatr Dis Treat. 2018;14:225-230.

Support & Learning


Nursing home residents with dementia require a specialized type of support founded in respect, understanding and proactive care. Caregivers must understand the perspective of demented patients, and commit to being with them “where they are” rather than where the caregiver is.

Instead of ‘reacting’ to needs or maladaptive behaviors, it is important that caregivers learn to connect with patients, building on their strengths and taking time to just be with them, sit with them, and listen to them. Often, what is perceived as problematic behavior is simply a response to the deficits that exist between a patient’s needs and the extent to which caregivers meet those needs.
In 2005, J. Cohen-Masfield and J.E. Mintzer published a paper about the benefits of non-pharmocological interventions in nursing home residents with dementia. In it, they wrote:
“Evidence shows that a large proportion of these so-called behavior problems stem from an incongruence between the needs of people who suffer from dementia and the degree to which their environment fulfills those needs. Thus, many “problematic behaviors” represent a cry for help, a result of unmet needs, or an inadequate attempt to fulfill those needs.”
At MediTelecare, we recognized the individuality of our patients and aim to help them feel validated as human beings – not just a number in the system. We work with facility staff members to help them better connect with their patients and eliminate the barriers that often separate patients with dementia from healthcare providers.
Source:
(1) Cohen-Mansfield, J. & Mintzer, J. E. (2005). Time for change: The role of non-pharmacological interventions in treating behavior problems in nursing home residents with dementia. Alzheimer’s Disease and Associated Disorders, 19(1), 37-40.
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