Deprescribing Antipsychotic Medications

The Quality Corner Show welcomes back DeLon Canterbury, PharmD, BCGP, Deprescribing Implementation Strategist and President/CEO of GeriatRx, Inc. , to talk about deprescribing antipsychotic medications in geriatric populations and why the Centers for Medicare and Medicaid Services is cracking down on nursing homes that overprescribe antipsychotic drugs.
Host Nick Dorich, PharmD, PQS Associate Director of Pharmacy Accounts, asks Canterbury how to safely deprescribe antipsychotic medications and how providers, patients, and caregivers define improving patient outcomes as it relates to these medications.

website:
Geriatrx.org

Transcript

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00:00:03:03 - 00:00:34:00
Speaker 1
Love it. Love it. So. Excellent question. There are quite a few things to have to consider. One ultimately is do we have buy in from our patient and caregivers? Do they want to be taken off of this if there's no mission for that? We have to make the conversation right. You want to have that provider or patient buy in first and you want to have a trusted conversation that looks at both the pros of prescribing and the potential costs, as well as the pros and cons of keeping the medicine right.

00:00:34:08 - 00:00:41:13
Speaker 1
So all of this needs to be done in a shared decision making model. So we want to have that buy in first.

00:00:43:17 - 00:01:08:10
Speaker 2
Welcome to the Pharmacy Quality Solutions Quality corner show where quality measurement leads to better patient outcomes. This show will be your go to source for all things related to quality improvement and medication use and health care. We will hit on trending topics as they relate to performance measurements and find common ground for payers and practitioners. We will discuss how the platform can help you with your performance goals.

00:01:08:20 - 00:01:32:10
Speaker 2
We will also make sure to keep you up to date on pharmacy quality news. Please note that the topics discussed are based on the information available at the date and time of reporting. Information or guidelines are updated periodically and we will always recommend that our listeners research and review any guidelines that are newly published. Buckle up and put your thinking cap on the quality Corner show starts now.

00:01:41:14 - 00:02:10:11
Speaker 3
Hello Quality Corner Show listeners. Welcome to the US podcast, where we focus on medication, use, quality improvement and how we can utilize pharmacists to improve patient health outcomes. I'm your host, Nick Dorich. In previous episodes of the Quality Corner Show, we have covered deep prescribing for geriatric populations, but not with a focus on this particular topic. So let me set the scene for everybody and what really got us going in thinking about this particular episode.

00:02:10:22 - 00:02:48:00
Speaker 3
Earlier in this calendar year 2023, the Centers for Medicare and Medicaid Services announced they were launching investigations into nursing homes in some other facilities based on the potentially inappropriate use of antipsychotic medications and to ensure that proper diagnoses were being made for these patients and for the use of the medications. Now, this announcement went on to note that increased use of antipsychotic medications, while these medications can be used, appropriate, they could also be used inappropriately with some of these patients in order to sedate or manage them in nursing home and other types of facilities.

00:02:48:11 - 00:03:14:03
Speaker 3
So based on the increased use of these medications shown from data, but along with complaints from patients and caregivers, this is what warranted a full and gate investigation by the agency. Now, this topic has been on my mind for a while, and I had the guest in mind to invite back to the show so we can dive into this topic and why pharmacy in particular should be further leveraged to ensure appropriate medication use.

00:03:14:16 - 00:03:27:12
Speaker 3
So our returning guest for the Quality Corner show is Dr. DeLon Canterbury, president and CEO of Geriatrx Inc. Dylan, how are you today and what's new since the last time you appeared on the Quality Corner show?

00:03:28:06 - 00:04:03:20
Speaker 1
Man So much appreciate you guys having me on board. It's been an amazing year in and just taking off for January. I mean, geriatrx has been going full steam ahead, rolling out another Deprescribing accelerator cohort as we speak, have tons of speaking again events with geriatric care managers across the country. And hopefully we'll have a presentation proposal submitted for ACP for Nationals, so hopefully we could keep spreading the mission on prescribing and showing how pharmacists are the quarterback for this.

00:04:04:15 - 00:04:23:09
Speaker 3
Yeah, I love the idea of the pharmacist being the quarterback for this for for this sort of initiative as it goes to patient care. Now, Dylan, we're going to jump into today's conversation in talking about Deprescribing in particular prescribing for antipsychotics in that geriatric population. But before we do, we need to make sure our audience knows who you are.

00:04:23:14 - 00:04:40:05
Speaker 3
Again, I mentioned you've been on the show, so I know you and some members of our audience may know you from either the prior episode or maybe they've checked out some of your work at geriatrics. But do you mind giving everyone for everyone's benefit a quick rundown on, you know, who you are and then what is Geriatrx?

00:04:40:15 - 00:05:08:22
Speaker 1
Yeah, most definitely. So thank you for that. Geriatrx is a telehealth based deprescribing service, and so we focus on not only helping patients and caregivers one on one get off of harmful prescriptions for our elderly, but we help to train and coach health businesses, senior care businesses, pharmacists, nurses, prescribers, how to use these prescribing practices sustainably and can monetize it.

00:05:09:06 - 00:05:31:04
Speaker 1
So I'm the creator and founder of Geriatrx great as company in 2020 Med after being a burned out pharmacist for quite a while, I work in the community setting as a pharmacy manager for about five years at Walgreens and just kept seeing a lot of our seniors call through the cracks and unfortunately we don't do the best job of using our voices to advocate for that.

00:05:31:04 - 00:05:54:01
Speaker 1
So like my grandmother, which is why today she is so near to me, she had dementia. She was in a facility and they gave her surprise again to manage, quote unquote, her behavior related issues with that dementia. And that worsened all of her symptoms. It got her kicked out of the nursing home and we didn't know until four months later from a pharmacist that it was the med that caused it.

00:05:54:01 - 00:06:02:07
Speaker 1
That's why I created geriatrics was to be that voice going forward and to give caregivers that power to stop harmful medication is excellent.

00:06:02:07 - 00:06:20:21
Speaker 3
I love the story and what you've done, how you've promoted that and you know what the mission and vision, I guess, with your team is, because that's really to me, it speaks to what we want to do as pharmacists, right? And that our true value is, is that is that medication expert and then working with a patient population that uses a lot of medication.

00:06:20:21 - 00:06:40:22
Speaker 3
Right. We know that and I'm using the the definition right, of that elderly or that geriatric population that's 65 plus using typically using more medications, which that can be useful, but that can also lead to some complications. And as we age medications work differently as we age because our kidneys, our liver don't work quite the same way.

00:06:40:22 - 00:07:08:07
Speaker 3
So sometimes Deprescribing is actually the right trick that's there. We'll get into that more and I would encourage you, if you haven't listened to our first episode that we did with Dylan previously, check that out on the Quality Corner show, another great episode that was a more broad coverage about what Deprescribing is. This episode we're going to talk particularly about antipsychotics, so we're going to get into it in just a moment after we hear a quick message from the PXP team.

00:07:08:07 - 00:07:32:07
Speaker 2
Now it's time for the breakdown as quality corner show host little as three main topic questions. Our guests will have a chance to respond and there will be some discussion to summarize the key points. This process worksheet for the second and third questions, which will wrap up the primary content for this, the 40 after that, it's next to on a closing summary, usually containing a bonus question.

00:07:32:22 - 00:07:39:14
Speaker 2
Now that we've described the process, let's jump into the questions.

00:07:39:14 - 00:08:12:17
Speaker 3
All right, DeLon, we're ready to jump into today's conversation. And in the introduction, I noted that the topic for today's show, antipsychotic use in the geriatric population and why or how we need to consider appropriate diagnosis and of course, potential deprescribing where medications are used inappropriately or perhaps even dangerously. To further get us into the topic, can you help explain why there may be an increase in these potentially inappropriate diagnoses and use of antipsychotic medications in that geriatric population?

00:08:13:07 - 00:08:53:10
Speaker 1
Yeah, it's a it's a great segway. You know, generally patients that are dealing with dementia already have a higher risk of polypharmacy, especially associated with behavioral issues. And so this world of playing the site game or is it the condition, is it the aging, whatever plays a role here? But unfortunately, patients who have dementia are the ones that are sent to the E.R. More have the highest risk of falls, the highest risk of honestly cost associated with their care and so as fortunately, these facilities, especially with COVID showing a of this, could not keep up with some of the isolation that came in.

00:08:53:20 - 00:09:18:18
Speaker 1
And so with the lack of staffing, with with turnover, with all types of labor issues, we're finding more facilities just kind of using the meds as a substitute for quality care or chemical attacks or chemical sedation. And then oftentimes it's inappropriate and it doesn't matter how it's a five star institute, one star to a $15,000 a month memory care unit or whatever.

00:09:18:24 - 00:09:46:19
Speaker 1
But the problem is it's across the board. And so since the early 2000, the FDA had created a black box warning, talking about how there's an increased mortality when it comes to these and I sites meds and this for behavioral management of dementia. But that's the problem. We haven't really acted on that in terms of prescribing habits. We still in 2011 had about 24% of people in long term care facilities using night sight meds in dementia.

00:09:46:19 - 00:10:18:03
Speaker 1
And now we're about plateauing about 15% nationally. So we still have a ways to go. Of course, it's not going to be zero, but there are a couple of laws with how they're reporting this to really show how people are using these medications. And that's that's why this renewed crackdown is taking place, because, yeah, we've seen that. We put this into action as a FDA guideline, but facilities are kind of just don't have the incentive right now to comply because they can say, hey, they have bipolar or they have schizophrenia.

00:10:18:07 - 00:10:28:23
Speaker 1
So that means we don't have to report how many people are actually on antipsychotics. So it really models the picture and gives room for us to really implement more e-prescribing there as pharmacists.

00:10:29:13 - 00:11:00:11
Speaker 3
Yeah, absolutely does. And I'll note a couple of details and a couple of statistics as it as it relates to. So when we're talking about antipsychotics and specifically, let's talk about a specific disease state where these medications may be used, schizophrenia or typically looking at is less than 1% of the population that has a diagnosis of schizophrenia. And what CMS and other agencies found in looking at how medications are being used or diagnosis codes for, you know, nursing home systems of some other facilities, is that the and I'm using air quotes here.

00:11:00:16 - 00:11:28:23
Speaker 3
Dylan can see me using air quotes. Our audience. You'll have to trust that I'm using air quotes here. But the data is showing that the diagnosis of schizophrenia in this population was much, much higher than that. So the reality is from that standpoint, either there's something wrong with the data or these groups are using the diagnosis inappropriately. And so in 2012, CMS started tracking this and had publicly available information around appropriate or incidence or use of antipsychotics for patients in the elderly.

00:11:28:23 - 00:11:50:07
Speaker 3
Since that time, that rate has dropped by more than 20%. That being said, there's still room to improve upon that. And then I think, you know, Dylan is you laid this out quite well the last couple of years. There's been some very real struggles when it comes to staffing and appropriate, you know, work in nursing homes and other facilities.

00:11:50:07 - 00:12:07:23
Speaker 3
So we don't want to downplay that. There's also issues there that need to be managed. But when it comes to patient care that there were that there's opportunities here where it's it's you really need to be taking care of the patient and not simply putting them on medications, which may be inappropriate. So that's the part that really needs to be addressed in CMS.

00:12:07:23 - 00:12:28:11
Speaker 3
How they've looked at this is has said for providers that, hey, this needs to this needs to change. This can't continue. This is putting the patients in even more danger, which is what we want to address. And that's what Deprescribing looks to address. So, Dylan, we've covered that. I want to move into that how we safely do that.

00:12:28:11 - 00:12:49:10
Speaker 3
Right? Because you've got a patient on this medication, especially a geriatric patient that may be considered medically frail. You don't go from just having them on a medication one day to, hey, it's Tuesday. The patient is stopping the medication. That right. We know that may create even worse problems. So what are the considerations when it comes to antipsychotic medications?

00:12:49:20 - 00:12:58:12
Speaker 3
What should a pharmacist what should what should other members of that care team, what should they consider when it comes to prescribing for these types of medications?

00:12:58:20 - 00:13:29:24
Speaker 1
Love it. Love it. So excellent question there. There are quite a few things to have to consider. One ultimately is do we have buy in from our patient and caregivers? Do they want to be taken off of this? If if there's no admission for that, we don't have a conversation. Right? You want to have that provider or patient buy in first and you want to have a trusted conversation that looks at both the pros of deprescribing and the potential cost, as well as the pros and cons of keeping the medicine right.

00:13:29:24 - 00:13:53:19
Speaker 1
So all of this needs to be done in a shared decision making model. So we want to have that buy in first. So of course that's more non farm and socially, but that to that point, are we exhausting everything in our parameters, everything that's socially, Is it a nutrition based, you know, behavioral upset? Like we got to understand the aging population, they're not exactly studied in this in this clientele.

00:13:53:19 - 00:14:19:03
Speaker 1
And so we don't have that data that tells us, yes, this is how you prescribe this person each time. Right. So everyone's response is totally subjective, but there are guidelines, there are tools we can use. And so D prescribing that or lays out a pretty nice flowchart on how to reduce antipsychotics. Of course, before we get to the nitty gritty of the D prescribing taper and schedule, we got to still talk about the non farm approaches.

00:14:19:03 - 00:14:52:17
Speaker 1
So what are we doing to manage sleep hygiene? What are we doing to talk about, you know, making sure they're not exercising too late in the day? What are we doing there? Make sure we're ruling out any causes of the dementia, like, for instance, those segments that may be worsening there. And so the limited evidence tells us that there is still an increased mortality risk, an increased stroke risk, cardiovascular events when we're using psych meds in patients that have behavioral and psychological aspects of dealing with dementia, that's just a fact compared to people who don't have that.

00:14:52:24 - 00:15:20:16
Speaker 1
So are we having transparent conversations around that? Do we talk about the risk side effect profiles here? So if we're having those conversations and again, we're talking specifically for only symptoms of behavioral or psychological management of dementia, if we're dealing with these patients and we notice an FDA black box warning saying you shouldn't be on this, you may have an increased risk of death, How are we broaching that conversation to taper and get them off?

00:15:20:16 - 00:15:43:17
Speaker 1
And so, again, I like especially in this space to talk about how are we reducing environmental triggers out are a bunch of alarms going on that's giving this heightened state of stress and alert or is the patient even eating, are getting the adequate nutrition? Are they getting social engagement pretty playing chess or bridge with their friends? Do they have a community of people that just rap with?

00:15:43:21 - 00:16:04:23
Speaker 1
Because if you don't have those things, yeah, I'm going to lash out because I feel like I'm in a pretty good I don't have that space or that comfort to be myself and so exhausting and ruling out all things that may be causing it socially is going to be the number one thing before we start know saying, oh yeah, they're demented, so they need to be stuck on this pill.

00:16:05:12 - 00:16:28:02
Speaker 1
And so when we start talking about the actual deepness driving the recommendations from the prescribing board, which I they have a flow chart, check it out. They say to taper the dose by 25 to 50% over 1 to 2 weeks. So basically every 1 to 2 weeks you decrease and decrease by about 25, 20%. They, of course, say to go slow and make sure you have that buy in.

00:16:28:13 - 00:16:54:13
Speaker 1
So you don't want to rush this, guys. However, if the patient has been using that medicine strictly for insomnia related issues, there is a caveat that you can essentially cold turkey. Some of those because generally they're dosed very low. It's a high dose. You want to slowly taper. So as you're seeing people on stuff for insomnia, less than six weeks, they say, is enough for you to like safely cold turkey and is evidence that does support that.

00:16:55:11 - 00:17:08:07
Speaker 1
But if someone for behavioral management, they've been on for quite a while or at least three months, that's what the team prescribing network guidelines say. If they've been controlled for three months, you can have a D prescribing control and start tapering people off gradually.

00:17:09:02 - 00:17:27:20
Speaker 3
DeLon, love your response there. This is something where you've clearly done your homework on this, which I would expect nothing less given as you know what are those kind of timelines for the guidelines. Right. And as it goes for any kind of guidelines, we preface this in every episode. Guidelines may change. So Dylan mentioned checking out D prescribing dot org.

00:17:28:10 - 00:17:52:11
Speaker 3
There's a number of other resources you can look into. So this is current information. As of March 2023, those numbers could be subject to change and other studies and other information, but it is going to be an important consideration. Dylan I'll also note I really love your your talk about the Nonpharmacologic approach or considerations, right? These patients were put on the medications likely for a reason.

00:17:52:11 - 00:18:14:06
Speaker 3
And when it does come to these patients and agitation, whether it's whether it is behavioral or whether it is sleep related, there are other aspects of our life that can impact that. So there's nonpharmacologic changes that can be made to a schedule or to a routine that can help. So this is not simply just, hey, we're removing the medication and patient is on their way where we're not.

00:18:14:06 - 00:18:33:24
Speaker 3
That's not going to be a positive result. It needs to be made as the decision with the patient and their care team, their their caregivers, care providers, all of those folks that are involved to really help support that patient so that we're not just taking things away and expecting the same result. We need to make sure that we are still addressing the inherent underlying needs for that patient.

00:18:33:24 - 00:18:53:16
Speaker 3
So great call out. I really love that you started with that, that part of it as well. Now, related to all of this, Dylan, that we're moving to our third and final question for this conversation, and it's something but we've changed a little bit in the show since the last time you were on. But we we've both kind of danced around this and what this means.

00:18:53:16 - 00:19:14:13
Speaker 3
But our last topic is always how do we define improving patient outcomes and how it's relevant to the topic of the day. So as it relates to use of anti-psychotic medications and deprescribing, how do we how do you as a provider, how do you define or look at improving patient outcomes?

00:19:14:13 - 00:19:38:24
Speaker 1
How all of it. So, you know, as we know that guys, this is a fairly subjective game, like how a person responds to prescribing is is going to be variable. So one objective measure one can consider is the neuropsychiatric inventory. Essentially, it's like a way of assessing, you know, if it's less than 15, essentially the capacities of someone who may have symptoms of dementia.

00:19:39:06 - 00:20:03:12
Speaker 1
And so when you're doing these tapering, you're going to want to have consistent follow up and monitoring. At least every 1 to 2 of these are going to be seeing and assessing for these side changes. So we're really looking for 50% reduction in education, reductions in restlessness, just any type of kind of related psych issue that we may see what we think we're treating the medicine with that will vary from patient to patient.

00:20:03:12 - 00:20:17:00
Speaker 1
And that's the beauty of patient centered care, is when I address my patients, I'm like, Hey, man, what do you want out of life? What do you want to do? Is going years and some of them are just I want to walk to the bathroom more times a day or I want to go up by the steps in Italy or ride a bike.

00:20:17:00 - 00:20:43:23
Speaker 1
It could be whatever. Claypool So you want to align this to our prescribing mission and why this relates to the patient. And if we're finding meds that can worsen falls. If you say gait, frailty, those are can be the goals like reducing the fall seen in that patient last month. These segments can cause or those static hypotension these same caused cognitive impairment they can worsen some other chronic conditions too.

00:20:44:06 - 00:21:03:06
Speaker 1
So we have to have this subtle conversation and it's got to align with either a reduction of the symptoms or C and we're going to also see, hey, how's the patient doing? How are they living? Are they content with where they're feeling or are they feeling like themselves again? That's something I always get from caregivers is I just feel like she came back, you know, like it She was gone.

00:21:03:06 - 00:21:21:24
Speaker 1
Like she was sat out for a bit because of the meds. I even had someone something today that they're just seen as mummies in some of these units. So not all of these facilities are bad. I think they mean well, I understand it's a very tough situation for them when you don't have people or even train people to take care of this.

00:21:22:14 - 00:21:40:24
Speaker 1
But when it comes to those goals, me, I want you address lumens as possible. That's the baseline, the lot. Right? But ultimately, we want to have to make sure our categories have that same quality of life. So we want it to be aligned. We wanted to make sure we're still hitting those health care measures. And the most important thing is we're doing no harm.

00:21:40:24 - 00:22:05:01
Speaker 1
We don't want to make sure that there's anything positive. So to me that's more a subjective goal. But ultimately, when we're looking for a site manager, looking for sustainability with dose reduction and, you know, monitoring for withdrawals, we're looking for, you know, gradually tapering off as much as we can safely and supervise. And we're looking again to make the providers life easy.

00:22:05:01 - 00:22:14:02
Speaker 1
So we're not worrying about preventable side effects. So it's it's a number of goals to say the least. But they all played an important role when it comes to this.

00:22:14:22 - 00:22:39:07
Speaker 3
Yeah, DeLon, when I think about Deprescribing, I go back and check that actual textbook definition of what deprescribing it is and it is the reducing or stopping of medications to improve patient outcomes or patient experience, right? So it doesn't mean that a patient has to stop. And that's as you said, that's the conversation, that's the subjective approach with the patient, with the care team, with the patient's caregivers.

00:22:39:23 - 00:22:59:17
Speaker 3
You know what do we want to achieve and why do we want to achieve it? So reducing the medications, whether it's reducing the dosage or frequency or number of medications that all can have positive effects. And as you said, for our geriatric population, we want to be able to have them have the best care that they can have with the least amount of medications.

00:22:59:24 - 00:23:20:09
Speaker 3
I always point that out to folks that are non pharmacists that, you know, as a pharmacist, we want to manage the patient's medications effectively. That's very different than thinking that that how the public may perceive it as pharmacist. Want people taking more medications. No, we want people just taking the right medications. And that's what the prescribing is focused on as well.

00:23:20:09 - 00:23:49:09
Speaker 3
Well, excellent. Dylan, before we get to our closing and our little bit of fun of this episode, I'll give just kind of a quick summary. And if you've got any additional thoughts on this topic before we move, I would love to hear it. But what we talked about today, prescribing for antipsychotics in the geriatric population, this has been a hot topic as it relates to this specifically nursing homes and other facilities where there's been some marked increase or use of these medications or have opportunities around inappropriate diagnosis as well.

00:23:49:16 - 00:24:10:06
Speaker 3
And this is something that's been tracked for a number of years and where pharmacists can absolutely be involved to reduce the use of these medications where where appropriate. So involving a pharmacist to identify these patients that may be put on these medications due to behavioral issues or due to sleep management, among other things. But those are likely the common causes.

00:24:10:12 - 00:24:37:14
Speaker 3
This is a great opportunity to have pharmacist as part of the care team to review the medication profile, come up with a safe and effective plan with the patient, their caregiver care or caregivers and the provider team to reduce that dosage in a way that may be cold turkey. It may be a tapered approach over a period of time and ultimately we want to have the patients on the we want to have them on the least amount of medications possible to effectively manage any symptoms, any disease.

00:24:37:14 - 00:24:44:17
Speaker 3
States that they may have. So they can they can move forward on anything that I missed there in the summary or anything you want to you want to especially call out.

00:24:44:22 - 00:25:07:05
Speaker 1
Oh, you definitely nailed it. I absolutely want to call out two things. The first one being is we literally cover deprescribing for patients with dementia. Within our prescribing accelerated. We dedicate an entire march to this. Yes, because my grandmother experienced it, but because why not make it easy for people to have the tools to make this your business plan?

00:25:07:05 - 00:25:41:02
Speaker 1
You can make this type of service of deprescribing as a high ticket offer for these senior care businesses. One two. I have to highlight the work that ACP is doing along with the Alliance of Agency Research, CHADD was and Sue Paschen, who's the president of that organization, created this awesome coalition called Project Pause. And essentially it's the really the combined forces of looking to ways to use psychoactive appropriate use for safety and effectiveness.

00:25:41:02 - 00:25:59:22
Speaker 1
That's what Project Power stands for. But it's really just this coalition of awesome professionals who are here to really put in the legislate feature to really have better monitoring with Heider using these site meds in these facilities. So they really have an aligned mission in reducing the harms associated with this. So if you really want to get involved, go ahead.

00:25:59:22 - 00:26:17:14
Speaker 1
You can join ACA, CPA, you can even consider just joining a project prize committee. I just want to highlight what they're doing because they're trying to make the legislature a bit more transparent. That's the issue, is all we're doing is reporting who is on site meds, but we're not reporting if it's inappropriate or appropriate. And that's one of the problems we're seeing.

00:26:17:14 - 00:26:19:07
Speaker 1
So got to shout out what they're doing.

00:26:19:11 - 00:26:37:10
Speaker 3
I love that. There's a lot of folks Well, I live physically in the District of Columbia. There's a lot of folks in a lot of different agencies that come and help support pharmacists, public health and patients that that are here on a federal level, but also state level. So, Don, I especially love that your shout out for that, knowing and understanding.

00:26:37:10 - 00:26:58:14
Speaker 3
That's an important aspect of it as well. Great. DeLon, we're going to move to our closing part of the episode and we're going to make sure that folks can hear from you to find out where to find you, where to get more information, how to contact you. But before we get to that part, we've got a couple of questions for you that help shine a little bit of a light on on who you are and and how people understand you as a person.

00:26:58:14 - 00:27:04:04
Speaker 3
So these are meant to be some rapid fire questions, not necessarily related to health care. So are you ready?

00:27:04:17 - 00:27:06:06
Speaker 1
The EMTs do it.

00:27:06:06 - 00:27:10:17
Speaker 3
Question number one, are you a morning person or a night owl?

00:27:11:10 - 00:27:13:14
Speaker 1
I am a night owl or a night owl.

00:27:15:04 - 00:27:27:01
Speaker 3
I think most people that we've been asked this question so far have been the morning person. So I appreciate someone on the other other side of things. What now? What do you define as night owl? What is usual bedtime for? For DeLon?

00:27:27:15 - 00:27:36:02
Speaker 1
My usual bedtime is midnight, but it's generally one or two. Yeah, because I don't sleep midnight.

00:27:36:02 - 00:27:51:04
Speaker 3
Got it. That you are definitely more of a night owl than I am. That is for sure. All right, Second question. Do you prefer to read the book or watch the movie? And if you have any particular examples that relates to this question, you can feel you can feel free to throw that in into your response.

00:27:51:15 - 00:28:14:08
Speaker 1
Oh, man, that's a great one. I am more of a movie person. I would say if I were to read the book, I was really a big fan of Angels and Demons. Dan Brown So I really like going into the Illuminati, you know, historical kind of adventures. So that was one time I would say, yeah, I would read the book over the movie, but I'm usually the Hopi guy.

00:28:14:18 - 00:28:39:03
Speaker 3
That I have to really agree with your answer really kind of on both levels that that is definitely one where the book is way, way better than the movie itself. But from a time standpoint, I'm a movie guy as well. Next question. And I said that these questions weren't necessarily related to health care, but this one this one is what is your personal recommendation to anyone who wants to be living a healthier life?

00:28:39:16 - 00:28:58:06
Speaker 1
I recommend to feed your inner child that you've neglected and nurture that date yourself. You know you love Warhammer you play with that. I don't know if that's childhood or adult, but my point is you have that passion. So live that don't wait for someone to tell you to do that.

00:28:59:00 - 00:29:19:05
Speaker 3
I would say my my passion on that part. DeLon It's probably a childhood passion, but an adult being able to afford it is the difference there. And that part I know. And actually it's a great call because I see even on your social media, you know, you do a really great job of this and your promotion of geriatrics and other things, really living a balanced life, I think.

00:29:19:23 - 00:29:38:13
Speaker 3
And what that means and that, yes, we are the individual that we're working and we're being professional, but you have to have time to kind of cool down, decompress. I know you do a great job, especially I know you're a big food guy and where you live in North Carolina. I know it's a great place. So that recommendation I particularly love, I think it's a great, great call.

00:29:38:13 - 00:29:53:06
Speaker 3
Up. Final question for you, in this section of this interview today, what is one goal that you are currently working towards? And it could be something on the personal side of things. It could be something professionally for Geriatrx. Leave it up totally to your discretion.

00:29:54:01 - 00:30:22:18
Speaker 1
You know, it's always an ongoing, you know, flagpole or whatever. But I really want farmers this to be synonymous with the prescribers. Like I want that to be the standard of care for all aging adults. And we're too quick to throw pills at them. So my job is to incorporate our prescribing accelerated program into as many grad schools, medical schools and nursing practitioners.

00:30:22:24 - 00:30:37:07
Speaker 1
Training pays social workers. I literally see a world where we have prescribing pharmacy technicians, prescribing medical assistance. So my mission is to make that happen across the world and not stop until it does.

00:30:37:21 - 00:30:56:14
Speaker 3
Excellent. Well, we definitely need to have more people that have that relentless mindset like you do and in furthering. It's something that I like here and in your approach. It is about furthering the role of the pharmacist, but it's very much it's improving patient care and it's in a way we know that uniquely pharmacist are positioned to do so.

00:30:57:11 - 00:31:14:01
Speaker 3
In a lot of ways. I sense a kindred spirit between you and I as as it goes towards towards that goal and really applaud your efforts and your intentions, Don. So I'm glad to have you back on the show. I'm glad that we've been able to be connected for the last couple of years and we'll look forward to connecting with you again in the future.

00:31:14:01 - 00:31:20:16
Speaker 3
I I'm assuming this won't be the last time we have you on the show, so don't be surprised when I reach out to you again. All right?

00:31:20:16 - 00:31:22:14
Speaker 1
Perfect, man. I'll be there. Ready for it.

00:31:23:05 - 00:31:34:15
Speaker 3
Excellent. So, DeLon, before we go, we need to have people. We need to tell them or you need to tell them where can they find you? So how do they contact you and where can they find out information about Geriatrx?

00:31:35:01 - 00:31:56:13
Speaker 1
Yeah, my websites, geriatrics dot org G e r i A t r x as in x ray dot org. But you can find me on any social media at geriatrx, particularly on LinkedIn, because I'm most accessible there. You can shoot me a direct message or connect with me. I'll happily say hi, but I'm everywhere, man. You could find me on my own.

00:31:56:13 - 00:32:09:04
Speaker 1
YouTube channel, Twitter, LinkedIn, Social, Instagram, Facebook, all at geriatrx. Or you can just look at my name, DeLon Canterbury. You'll find that all there, too. All right.

00:32:09:04 - 00:32:30:18
Speaker 3
Excellent. Dylan, thank you very much. Appreciate having you on the show again. And it's a great episode. And for our audience, hope you make sure to connect with DeLon if you have an interest in deeper scribing and learning about how you can further support pharmacist e-prescribing and improving patient health outcomes. So with that, we have now wrapped up our episode for today, and we thank you for joining us.

00:32:30:24 - 00:32:39:15
Speaker 3
We hope you listen to our next episode of The Quality Corner Show or we go. We have one final message from the PQS team.

00:32:39:15 - 00:33:00:11
Speaker 2
The Pharmacy Quality Solutions, quality corner Show has a request for you. Our goal is to spread the word about how quality measurement can help improve health outcomes. And we need your help in sharing this podcast to friends and colleagues in the health care industry. We also want you to provide feedback. Ask those questions and suggest health topics you'd like to see covered.

00:33:01:05 - 00:33:23:10
Speaker 2
If you are a health expert and you want to contribute to the show or even talk on the show, please contact us using email info at pharmacy quality dot com. Let us know what is on your mind, what we can address so that you are fully informed. We want you to be able to provide the best care for your patients and members, and we wish all of you listeners out there well.