Love Conquers Alz

DR. DELON CANTERBURY, Geriatric Pharmacist: DEPRESCRIBING - Saves Lives and Money

August 29, 2022 Dr. DeLon Canterbury, Susie Singer Carter and Don Priess Season 5 Episode 60
Love Conquers Alz
DR. DELON CANTERBURY, Geriatric Pharmacist: DEPRESCRIBING - Saves Lives and Money
Show Notes Transcript Chapter Markers

Don and I had the pleasure of speaking with  DR. DELON CANTERBURY, Board Certified Geriatric Pharmacist and Founder of GeriatRX, a Deprescribing Accelerator Program based on the premise that the majority of patients taking 15-18 medications annually are aged over 65, preventable medication errors cost nearly $21 billion dollars annually, and the ongoing inappropriate , HARMFUL, use of medications in the senior population.

Too many Americans are dying from harmful medications and wasting thousands of their hard earned dollars on unnecessary prescriptions. Over 275,000 people die each year due to medication mismanagement. While other American's are wasting over $6,000 per year on unnecessary medications.

GeriatRX  is a pharmacist-lead consulting service that identifies that there is a lack of support for caregivers advocating for the elderly who need help in maneuvering a very difficult health care landscape by providing high quality evidence-based medication management for our most vulnerable patients, the elderly.  

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Singer:

When the world has gotcha down, and...

Don Priess:

Alzheimer's sucks, it's an equal opportunity disease that chips away at everything we hold dear. And to date, there's no cure. So until there is we continue to fight with the most powerful tool in our arsenal. Love. This is Love Conquers Alz. It's a real and really positive podcast that takes a deep dive into everything Alzheimer's, The Good, the Bad, and everything in between. And now, here are your hosts Susie Singer Carter, and me, Don Priess.

Susie Singer Carter:

Good morning. Hello! Good afternoon. It's Susie Singer Carter.

Don Priess:

And I'm Don Priess. And this is Love Conquers Alz. Hello, Susan.

Susie Singer Carter:

Donald.

Don Priess:

Yes. What do you have to say to me what's going on?

Susie Singer Carter:

Things things are going on, we're on a mission to do a documentary that's going to knock the world socks off about, you know, elder care and long term care and things that I saw that I can't unsee and things that are important to everybody, it's a harrowing experience though, because it's not the kind of subject matter that we are gonna have fun with, but it's subject matter that we need to, we need to do. So that's what we're doing. And, you know, just want to throw that out there. If you have a story of your own, having to do with any kind of nursing home neglect, abuse, get a hold of us, through our - through Love Conquers Alz on any of our contacts and share your story with us and maybe participate in this documentary because the more that we can talk about it and tell our stories, the more powerful we are. And and that's what we're trying to do. So that's that's that's where I'm at my head's there, Don?

Don Priess:

Yes. Yeah. And and my Yeah, so I mean, we've just spent three long nights finishing up the trailer for this and we can't wait to get it out there because we are looking to do something special with this with a long form documentary and we are we are open to any and all who have, uh,

Susie Singer Carter:

MONEY~

Don Priess:

something to say and money. Well, yeah. We want to we want to we're open to people with money not even for this just in general who just want to give in general

Susie Singer Carter:

In general, so there's well there's a there's a there it is my birthday next week. So I'm just saying. I'm just throwing that out there. Yeah, you know, I wouldn't be a Leo if I didn't, right.

Don Priess:

Absolutely. So send funds to Susie Singer Carter's birthday. Birthday/documentary extravaganza.

Susie Singer Carter:

Slash

Don Priess:

We're not proud.

Susie Singer Carter:

I'm a little proud. I'm a little proud. Yeah, so yeah, well, let's let's dive in. Unless you have something burning to talk about anything.

Don Priess:

I really don't. No.. I'm gonna golf later. That's that's I can't wait for that.

Susie Singer Carter:

Okay. So anyway, um, moving on.

Don Priess:

Let us move on.

Susie Singer Carter:

Our guests that you're going to to introduce, I'm just excited about it because I had my own issues, which I'll share. So why don't you dive in and

Don Priess:

I'm going to.

Susie Singer Carter:

introduce our guest so we can get we can get to the juicy part.

Don Priess:

I will. So Dr. Delon Canterbury is a board certified geriatric pharmacist who founded GeriatRx , a personal pharmacist led consulting service that focuses not only on chronic medication management, but identifies that there is a lack of support for parents that are caregivers and for the elderly, who need help in maneuvering a very difficult healthcare landscape. Dr. Canterbury was driven to find alternative natural solutions to our prescription drug crisis, not only for medical but also economic reasons. His own personal experience with his grandmother who suffered with dementia propelled him to provide families with peace of mind through high quality evidence based medication management. It is a noble cause indeed, and we are so proud to have him with us today. So let's say hello to Dr. Delon Canterbury. Hello DeLon

Delon Canterbury:

Hey, everyone, appreciate you guys having me on. It's really a pleasure to be here in support.

Susie Singer Carter:

Ah, well, we're excited to have you on. Thank you and I love what you're doing. I just, my fear is that we need like 1000 DeLon's everywhere. Because how, right? Like how what you're doing is so important, and so incredibly innovative and that are just empathetic and smart and all good words that that would describe a mission that you're on you do. It's more than just you're more than a pharmacist. You are you are mission driven. And like, yeah, tell us about your mission.

Delon Canterbury:

For sure I've been my mission is to internationally advocate for our elder patients by reducing harm reducing hospitalizations, reducing falls, you can name it. But basically we're getting rid of unnecessary and harmful medications. And it doesn't take being a clinician or pharmacist with advanced degrees and a ton of debt to do that. So, honestly, a lot of it comes down to advocacy and education. And when you start with that, and start with asking the right questions, you can truly change lives. And that is the whole point of me being here today with GeriatRx and doing my one on one services for my families and patients. But literally teaching other clinicians how they can do the very same thing. And it takes really not too much effort, but just a sense of passion and drive. So really hear speaking from the heart, and truly just hate the way our healthcare treats our seniors, I hate the way they toss him to the side and just use them as another number to fill a bed in a nursing home. It doesn't have to be that way. And I think when we start getting back to aging independently, more than just filling your quotas, we can really, really significantly change for the better.

Susie Singer Carter:

Amen

Don Priess:

Hallelujah.

Susie Singer Carter:

Amen to that. I second that emotion. And And third and fourth it because that, you know, when you say you want to help other clinicians do what you're doing, how do you incentivize them, because some people, I mean, I find have found in my journey with my mom, that not all clinicians and even clinicians in our, you know, niche community of dementia and Alzheimer's don't really care, or they're burnt out. Or they don't understand, they don't understand, they literally do not understand dementia, they don't understand Alzheimer's, they make wild assumptions. And and you know, and diminish, and, and, you know, they, they, they create these frames that don't really fit and put the little, you know, put elderly in in these boxes and and treat them all the same. And we're all different. We're all unique people.

Delon Canterbury:

Every dementia patient is different. There's no same case, really. But how do you incentivize them, okay, not everyone will be incentivize, we have a health system that doesn't really, really fund it. So really, what we do is show people that you can develop revenue generating streams while doing what's morally and ethically right, with deprescribing. So it's not just a matter of talking to a doctor and saying, let's stop all these meds. There's a number of processes that have to take place, the number one thing I find is that people in this particularly dementia, space, Alzheimer's space, they don't always do a med review. And they don't think to leverage their community pharmacists to ask, hey, what can I do to get rid of some of these meds because I'm telling you there are over the counter meds, there are pills that people are taking that they think is safe, that literally can throw someone into a nursing home, which is what exactly happened to my grandmother? So incentivizing them is, hey, do you want your loved one off of unnecessary meds? Do you want them to age independently at home? Do you want to really be assured that what they're taking is truly appropriate and life saving for them? And if it's not, then you probably have room to stop it. And the truth is, most meds can be stopped safely about 80% can be stopped pretty safely without really any side effects. So why aren't we incentivizing that. So there needs to be a nationwide policy change, one for reimbursing people who are actively deprescribing, that's gonna take a long time. But what we do in this program, and that's why it's called the Deprescribing Accelerator is to teach people that you can develop this type of service, you can get paid for this type of service. And truthfully, you're going to build your brand because you are value basing your company services and future proofing yourself because this is where CMS is going towards. So and that's the Center for Medicare Services, which reimburses health care, Practices done by providers, right? So we need and know that our elderly patients are getting older, and they're living longer. And we have a high growing population with less and less providers. So all this means is an opportunity for people in this space, to really develop a new service to monetize that service and then show that there's a way out that you're saving your patients lives and improving their quality of life. And that's going to lead to more money to you because now you're going to refer their loved ones who are going through the same thing. So if you want to make it about money, sure, it's not about money. It's truly about serving. It's about being authentic and our purpose as clinicians in this space. And when you're able to go to work and actually feel aligned with that you're gonna wake up with a fire, and you're gonna want to help more and more people.

Susie Singer Carter:

I love what you're saying, when you're talking about, you know, it's another revenue stream. And I do think you know, that there are more people that are that are wallet centered than heart centered, and that we, you know, and that are systemic issues, you know, just doing are just getting diving deep into what's been going on with my had been going on with my mom in the last six months, in this arena that you're talking about. Exactly. And then knowing what I'm up against, which is commerce. How does that work? Because if you would like to explain what a formulary is, and those kinds of things that we're up against in institutional living situations, where there are drugs that are pushed, and and they and they get kickback for it. So can you explain what a formulary is? And how do we jolt the system to work in our favor, and not their favor?

Delon Canterbury:

Sure. So the sad part is, it's not really all the system, it's the American way of life. We want stuff now he wants to quickly. And when you want stuff now and quickly, and you're put in a bind, if your patients may complain, because the doctor doesn't want to give you a pill, it's a tough position to be in that space. So when it comes down to it truthfully, there needs to be a rewiring of thinking, there needs to be a change in policy and how we reimburse this type of service, there needs to be a push towards more value based care. So yes, you may have some doctors out there who do get incentives and kickbacks to put people on whatever meds that's not every doctor, sure, but you will find it. I'm not going to negate that. But here's the thing. When we start looking at how say, say, someone finishes our Deprescribing Accelerator Program, and they say okay, Delon taught me that I can reduce falls in a nursing home by educating patients against not using Benadryl in dementia, right, which is a really common thing that I've seen patients send to the ER with and become confused and delirious. Imagine you help 10 People no longer go to the hospital because they you did a med review, or you talk to them about this match, right? Ten in your facility. Do you know how much money those facilities are doing? If someone falls - 10s of 1000s of dollars for one for one fall. So with saving these lives? Yes, it may be an indirect cost savings, but you're saving 10 People from falls. So what they're not going to go through the morbidity of being in that hospital, maybe getting another infection while they're there. Of course, having a lower quality of life. Now they're living longer in your facility. Now your facility isn't getting dinged for about, I don't know 250k +, because of those falls and injuries, and you're saying, now your patients live longer. And guess what they're in your bed so they can pay you, if that's the case. So they already have metrics that incentivize deprescribing. The problem is we don't use it universally. And unfortunately, we don't even pay people in this space to do the damn job. So you're gonna have people taking shortcuts, you're gonna have people faking diagnosis codes and nursing homes, and you can give them heavy anti-psychotics and sedate them, which is what happened to my grandmother. And that has actually been on the rise during COVID. And we're not talking about it enough. So again, this is more value based. But when you start seeing the numbers like, hey, in this intervention, we've kept X amount of people from falling or dying or maybe having opioid related constipation, right? These are all metrics that these facilities get reimbursed on. So when you're hitting those reimbursement numbers, you can quantify your savings and that is what's going to drive people to make change.

Susie Singer Carter:

Indeed, agreed 100% I mean that, I, being a, being a strong advocate for my mom who also was has was a victim to Depakote. And Depakote which is which is really not an anti psychotic drug. It's really meant for epilepsy. And they found that it was helpful in mentally tethering people with dementia and keeping them you know, quiet basically. And it's actually you can correct me but from you know, my research well, I when I when I was told that my mom was on Depakote, I was told by her GP, like five months after she was on it, and he said, Do you know your mom's on Depakote? It's a Black Label Drug, like this drug and I was like, What? What I had no idea. And no wonder my mom's been acting like a zombie and no wonder she's in a wheelchair and incontinent now, when she was walking five miles a day, and that drug, certifiably put her in a wheelchair for the rest of her life, and, and made her incontinent, and she never got it back. And, and it's so damaging to someone with with Alzheimer's, you know, as is a lot of drugs that we don't know about that, you know, like what you're saying, can, first of all, it can exasperate the progress of the disease. And, and it can have dire consequences, you know, physically mechanically, like you said, like with Benadryl and, and also just, you know, mentally, because they're already vulnerable, so vulnerable. It's, it's, it's so scary and so daunting, and I think, like, how...first of all, talk about your, your deprescribing? Like, how do you do that? How does one get involved in that? Can layman do it or is it? Is it? Or must you be a clinician?

Delon Canterbury:

Well, that's the funny part is everyone can technically do it. When it comes to the actual process of guiding a patient through stopping a medicine, yes, you're going to want your provider and your pharmacist on board to guide you along. Right. But what I'm finding in this space is that honestly, everyone has the ability to deprescribe, you know, it's it's pretty broad. And for instance, you in your intermark, you notice that she was on his antipsychotic you realize it was causing harm. Deprescribing is literally asking, Can we stop this? It's not harm, it's not helping, it's worsening the situation. So when I'm in this space, working with my patients, I'm literally just teaching them, hey, you can probably stop these for this is no longer necessary. This isn't effective. Ask your doctor and then you end up seeing where that goes. I'm not saying to put it on the patient. But when they work with me, I actually do the asking for them. I work with the doctor and we develop a plan together. So it's not a silo. But D prescribing is an active process. So you got to first have trust, you got to have someone who cares. You got to have someone who actually knows the drugs. And it doesn't necessarily take you going to pharmacy school but enough to know enough to ask all right. Why is my loved one on to heartburn medicine, right? That's one of the most commonly seen medications and seniors they've been on a Omeprazole and Prilosec. And all these drugs for literally decades, and no one thinks to stop. Those are the easiest ones to stop. However, people don't realize that those meds do have harm. They are associated with osteoporosis, they're associated with a ' ./////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////.false they reduce magnesium, which also correlates to how you may control your calcium and vitamin D levels in the body. And guess what? That all correlates to fractures, right? There's a pipeline of issues that come from these myths. And they're not as benign as you were, they were once used for me wrong, we need meds. But meds all have a timeline. And until you start asking, literally every quarter, not once a year, not once in a blue moon every quarter. If your loved one is on more than five or seven meds, you need to be asking straight up every visit. Hey, Doc, what can we do to safely get off somebody's next? Can we tape are some things here? Can we work on some diet to get off this cholesterol pill? Can we reduce our salt to get off somebody's blood pressure meds? So yes, there's lifestyle changes. There's diet, there's stuff you can also do for encouraging people with behavioral changes, right? But ultimately, the incentive is, do you want your loved ones to live gracefully and independently in the best possible way? Or do you want them slumped over in your house like a zombie, you're paying 15k a month to put them in a memory care unit, which could have been avoided because of one pill. That shouldn't be that way. It shouldn't be that we're so reactive are so reactive to healthcare. So why not proactively put the funds to help people do this and that's what we do, again, in our D prescribing accelerator program, which I lead and teach and we're literally training clinicians who have this fire to put this into place. So guess what, you're gonna get more people coming to you because now they're doing better. They're living longer, and oh, Susie's loved ones just found out from that blonde that they didn't need to take that med because it's worsening dementia like your grandma, right? We had one patient who was on 36 medications, okay. 36 medications. 70 year old frail woman barely 90 pounds, and was literally just a walking zombie. And she came to us from her daughter who was a caregiver who was concerned that it was the beds and not just her nap day declining and she was the one that seeing her every day. She was taken three different types of meds. I had Benadryl in it. She was taking Seroquel inappropriately. She was taking a seizure med inappropriately. It was I think it was Keppra levetiracetam for no reason. There were like seven men and she was taking the allotted a hard narcotic for no damn reason. She was on benzodiazepines for no damn reason. Oh, my gosh, but I want to know, and she had four different doctors. She had a neurologist, she had a cardiologist, he had a general practitioner, and no one

Susie Singer Carter:

knows me. And when my mom went into the hospital last, my mom just passed away three weeks ago, when my mom was in the hospital for the final two visits. And the emergency doctor goes well, you know, she, she had a wound, you know, a bedsore. And they were giving her antibiotics for that already. From the you know, she was still on this, like broad spectrum. And then he goes and on. I think it's, I'm seeing a little possibly some pneumonia now. So we'll probably get her started on some antibiotics. I go, Well, wait, wait, she's already on antibiotics. So what are you talking about? Like, what I said, did you look at her records? Have you seen what she's on already? You know, this is before I even knew of you. And I was like, Doesn't anybody? Look? I don't think people I think there's so rushed, you know, or I do think they're just overworked and rushed. But I literally was like, but you need to see what antibiotics she's already on right now, that probably isn't going to be the solution. Something else is causing this trifecta to happen this whole, you know, ripple effect, which which it was, anyway, sorry to interject. But that that is that happens so much. And you you're you know, as a as caregivers, we're in vulnerable positions. We're emotional, we're vulnerable, we're tired. And so we look to doctors to guide us to, you know, I can't tell you, Don, what's, what's the thing I heard the most in the past six months,

Don Priess:

what do you want? What do you want to do? What do you want to do? Like, here's what here's the that literally situations that are, you know, you have no idea you're not a doctor you've never experienced before. And they literally say what do you want to do? As opposed to giving you suggestions, options, and, and then making an educated guess about consequences?

Susie Singer Carter:

Right, right. It's like, here's what's happening with your mom, what do you want us to do? Well, I didn't go to school for that. I'm a writer. I write I write stories I make I make things up, you know, like, that's not me. But but can you tell me you went to school for it? Tell me what I you? What are my What are my options? And

Don Priess:

I think that's where it's Yeah, and that's where some of the and this all builds, because some of the options, use it. For a lot of doctors, the only option is a drug. That's, that's what they've learned. That's what they know. And so my question is, how do you overcome that mindset, that they don't know the alternatives? And then when you hear things like plant based alternatives, things like that, there, you know that a lot of them just look at that and or holistic anything, they go, that's not medicine. That's not how we do it. How do you overcome that? And I know it's with education. But I assume you get a lot of pushback. Is that the case?

Delon Canterbury:

No, I don't get pushback. I mean, not really. And it's because I come with evidence. I know how to speak their language, I understand how to give you clinical trials, I'm not telling people to just take Kava Kava, and all these pills, and suddenly, you're better on giving people options that align with what the patient wants, and what the doctor wants. The doctor wants their patients well and happy. And they don't want to worry about them coming back for stuff that could be fixed as wasting their time. So if I'm saying, hey, if we're able to get her up walking and have more fiber, there's no need for her to be on this prescription constipation Med, if we tackle that issue. So it's looking at the body holistically. And yes, I'm going against Western medicine, I get that. I believe in it, too. I think they all have a place here. But when it comes to these providers, honestly, they want to save time, and they want to see that whatever you're providing isn't BS and it's best for the patient and the patient wants it. The What do you want to do approach will work because if it is with guided evidence, not just free for all, like you can't just tell people what you want to do. You got to give them some options. But when you have that level of connection, and trust it it becomes a win win when the patient's winning. The provider is winning and I'm winning because now the pharmacist is integral it into that advanced care model that I think we don't do enough of. And people just think we're only associated with a pharmacy like, No, we are consultants and experts in drugs. And the doctors don't I don't know drugs, they get four to six weeks of school on pharmacology, yet legally. They're the ones prescribing. What the hell sense does that make?

Susie Singer Carter:

What the hell sense is that? You're right.

Delon Canterbury:

It doesn't make sense. It doesn't make sense. So they know and this is why I mean, Doctor group means all the time and Facebook and then we always talk about this, but they love pharmacists, pharmacists, doctors love us. So when I come with, Hey, you shouldn't do that. Okay, sure. Whatever you say it is a good catch. But the problem is pharmacists don't know how to monetize that. They don't know how to serve like that, and get paid for the value because guess what, we save lives every day. And we save our healthcare, tax payers who that are spending $600 billion each year just because of medications that are ineffective and causing harm. And that means this label 175,000 People die every year, because of medications, the 275,000, that's 750 seniors a day that are hospitalized because of a medicine. So the costs are there. And if you can show you're reducing costs, then you can sell that as a service. And that's why D prescribing is deeper than just stopping the pill. It's a whole win for our healthcare system.

Susie Singer Carter:

Oh My God, I love it so much. I think it's so I think it's it needs to be a part like you said, of the of the team, you know, it needs to have, right I mean, it needs to be because, honestly, I mean, how many times have you gone to the doctor and they're like, Hold on, let me just look up something and they're looking at a drug because they've heard of something that they think might help be helpful, but they don't really know what it is. They just they know, they're just trying to figure out something, because you're right. That's not That's not their expertise. So there is that and you also I don't know if you saw Dopesick on the

Delon Canterbury:

the, it's on my waitlist, I need to watch it.

Susie Singer Carter:

Okay, this is up your alley, you got to watch it. We had the Attorney General Rick Mountcastle, who was the subject of this on our show twice now because it's such a big subject and you know, and he, they went after Big Pharma who went after, you know, the formularies and nursing homes and targeted these places, you know, to, to use drugs that were, you know, not necessary, and

Delon Canterbury:

oh, yeah,

Don Priess:

And deadly, yeah, and deadly.

Delon Canterbury:

More than debt. Yeah. It's why we're in the middle of a opioid heroin epidemic today. And we actually dedicate a module in our Deprescribing Accelerator about how to deprescribe patients who are suffering from opioid use disorder. So we discuss ways to tackle, of course, behavioral support, we talk about medication assisted therapies like your Narcan that can save your life, or suboxone buprenorphine which is used to help people who suffer from that. But we also discuss how there are grant opportunities for this. You can literally get federally funded grants, helping people do right get off of these, you know hard narcotics, and be an impact in your community. Like you're going to be able to serve people and do it the right way and get paid for it. So again, it doesn't have to take nasty shady backroom pharmaceutical deals, to help and serve. You can Exactly. Yeah, literally do this now. But yeah, I need to see Dopesick, you guys should definitely watch The Pharmacist. That's another

Susie Singer Carter:

that's exactly the same. Yeah, Dope Netflix series that was out two years ago. And it's literally about our pharmacists who chase down the big Purdue pharma family that ruined his neighborhood in Louisiana. Sick. It was in West Virginia. And, by the way, my brother, my brother was also a victim to Oxycontin, and, and he's been forever changed by it. I mean, it's it's a nasty drug. Can can lay people, could I could I be that kind of deprescription counselor?

Don Priess:

Deprogrammer?

Delon Canterbury:

I think it's, yeah, I mean, you have a voice.

Susie Singer Carter:

Deprogrammer? That's literally it. You just gotta have a voice and passion. I will say our program specifically, is best suited for clinicians, but frankly, it's the clinician that's teaching the patient and the patient that's not advocating for their loved one. So really, anyone can be a D prescriber, and my wide. I think clinicians are best suited however, you have a voice that you can amplify and with the right strategic partnerships, of course you can. And the reason why I say that DeLon is because there used to be ombudsman that you could go to at, you know, at nursing homes and assisted living. And yes, in all, for all intensive purposes, they're there, but they're there. They're, they're fairly useless right now, because they're their hands are tied. But it would be great to have somebody like, you know, a drug ombudsman in a way that comes in and goes and really checks over and is the accountability monitor, for lack of a better word, right? Somebody that goes in and checks the records and goes, Okay, this person's on too many, let's look at this, you know, and obviously, not no changes will be made, but at least there'd be a red flag or something to, to, to alert.

Delon Canterbury:

Right. Exactly. That's that's the point. We know that that's perfect.

Susie Singer Carter:

We need ombudsmento go that wil do it. But there needs to be, you know, Listen, everyone needs to get paid. I mean, I I want to know if there's a way to to monetize that for anybody that is already in this arena and is wanting to help their granny like you or my mom, like me or Don's mom, you know, or themselves.

Delon Canterbury:

Yeah, that's that's exactly what we cover in our course, again, we you can monetize this, you can be a straight up one on one service that you provide for people and educate you can conduct workshops, one of our past cohort members, is creating a deprescribing conference for nurses and nursing homes here in North Carolina in the fall, just to educate people on this, I have another one was a health coach who is going to leverage deprescribing for helping young adults using genetic testing. So that's another tool that you can use it a prescribe and sell you can we actually already have people who are like MBAs and nursing homes and pharmacy techs and social workers who do this and have shown cost savings. If you can show cost savings for anything, you can get paid for that. Okay, so we're going to monetize a lot

Susie Singer Carter:

That's amazing. Would Medicare cover that I mean, yeah,

Delon Canterbury:

Yeah, Medicare doesn't quite technically reimburse it now, not to the level that I am taking it. They reimburse for doing med reviews, but not like this, this is more like fine tune art, and Medicare and insurers are actually the ones who win the most. And I'm seeing more people looking into kind of these concierge model approaches. And the insurers are focusing more on patient satisfaction. So if you have someone who comes in and says, Hey, I've helped 100 of your patients get off 20 of these drugs, each, or whatever. And you can say not only are you no longer paying for these claims on your back end, but I'm telling you that these can also cause harm, they're not going to end up paying for the bill when that person is in the hospital and that are better. So there is a quantify that as well. So the monetization is already there. We literally have a consortium of grant funding that goes to educating people on deprescribing literally through nonprofits. We have it through the NIH, we have it federally through the US deprescribing network. So again, I give you all the tools in this Deprescribing Accelerator, so it's not you have to figure it out. give you...

Susie Singer Carter:

Sign me up, I want to be one of them. I want to do that. I'm telling you, you sign up you guys get or get your doctors to talk about this. This is so freakin important. It's so freaking.... We're gonna live everyone's living longer. You don't want to live longer unless you live quality. And and I'm telling you, you don't you don't want to live. I mean, it's doesn't make sense. I would tell my mom's doctors and her her nursing staff, I'd say, if she's not living quality, what's the point? Like? We don't want you know, the quote unquote, gray lumps in the bed. We don't we don't want that they don't want that. We want people that are living, like you said with grace and dignity and joy. And and, you know, at the moment, I'm here to tell you that and you know this, that that's not the majority of elder life quality. It's just not,

Delon Canterbury:

No, not in this country. I mean, we kind of have a culture of throwing people to the wayside. It's a dark thing to say but this the few people like us who actually no, unless you're thrown into caregiving, if you're not in that space, we don't really care about the elderly is let's be real, like look how we treat our vets. But honestly, there's there's a lot of room for improvement. And you're right about the quality piece but look, this is a problem that's not going away. It's only getting worse. So why not act now versus waiting till the issue hits the fan and you end up with some a situation you don't want to be in and you're unprepared. You're done. You're just wondering how to do this. And this shouldn't be this way.

Susie Singer Carter:

Beautiful. I love what you're doing so much. I can't I mean, I just think you, like I said, I, I feel like your job is daunting, because it's so like, you're so needed, what you're doing is so, so freaking important. And like, I'm, I'm just amazed that you've come forward and want to do something like this, and you're very unique in this field, you know? I don't know, because you're welcome. No, thank you. Because, you know, drugs are big money. And, you know, and so, anywhere, any time there's money involved in there's ways for people to make money and good a lot of it, you're going to have nefarious activities going on. And unless we step up as as a, as a society or as a community not to not to get on my soapbox, but hold on, let me step on it for a second. But I really have to take it in, we have to take responsibility into our own hands. Because when we say well, they'll take care of it. No, they'll is us. They is us.

Don Priess:

Yeah. So let's talk about the practical process. Because my mom personally is about to next week, start her life now in assisted living. And they the place they're going through, they are going to be taking care of her meds or administering her meds. And so we had a pre meeting before and they said, Okay, have come in and bring all your medications that you're on currently. And to my shock, there was a huge bag filled with all the medications she's currently taking, and what what would so I'm like, Okay, I don't want her on all these meds. I think it's partially responsible for the condition she's in right now. And I come to you, what is the process? As far as... Take, take, take us through the process? I come to you, and?

Delon Canterbury:

Yeah, so first thing we do is talk to you in the patient and see what all is she actually taking now, not what she's had for the last five years. So we'll do a med review. Basically, we'll do a comprehensive in depth med review. So first, we'll see what she has in that bag, we're going to put them all out on the table, we're going to literally go through each and every single one. And we're going to ask, Do you know what this is for? Do you know why you're taking this? How long? Have you been honest? Is it still working? Is it not working? Is it effective? Is it the right dose? Is it safe? Is it appropriate for your kidneys, and liver, blah, blah, blah, and then we go in and literally do a meticulous review should take about an hour to do all that. And we're going to look and see. All right, you don't quite need these, we're going to basically separate what's nonsense, and what's essential. So once we have this, what we also do is compile a risk of our I'm sorry, a list of our Deprescribing action plans. So basically, we look at based on your patient's age, health conditions, quality of life, their goals to caregivers goals, and we're gonna see All right, let's develop a plan and get this to your provider and see what they want to do. Once they have that list, it's going to be evidence base that will have the reasons why this is a you're going to be on the doctor's permission to approve with us stopping meds because legally, I cannot tell anyone to stop anything without a doctor's permission. That's for anybody. So when we're doing this, we're basically giving them the cheat sheet to make everyone's life easier. And additionally, we also provide genetic testing. So as a part of our medication Deprescribing efforts, we require all of our patients to get a genetic test, a cheek swab, we're able to see which medications are problematic based on your genes, not just based on your reception, or you know, just well the last 1000 patient did this. We're all different. And even though we're saying and leave the same, your responses to drugs are so different. So genetically, I have to know what is going on before I make strong recommendations. So that's also required. I ship that to you anywhere in the country. And that's included with our Deprescribing package. So now your doctor has a record of what is appropriate for you and trust me I have found rare sensitivity reactions I've found people that were clotting disorders. I found people who have a low reception to serotonin drugs, you name it, I found a lot. I read about it for myself and I I've got some genetic markers I wasn't even aware of so it's truly life saving having this level of knowledge because this is how far medicine has come. So why not mix that with the holistic stuff and do both that we know Oh, it doesn't. is evidence based.

Susie Singer Carter:

I love it. I love it. Wait, wait, DeLon, I gotta ask you this, so I, I work on my intuition and instinct because I'm not, you know, I'm not a doctor, but I am We blanket get morphine to everybody as a mommy and I've been, I get instincts and you know, intuition on things. And I've always I've always had that they transition, and what if it made them anxious? What if it feeling that we are all different and one drug for one person is not going to be the same for the other. Okay, I want to get into a darker subject because I'm it's been, it's this is my experience in the past year, which is hospice, you know, and and the first thing you hear about hospice is, well, we're going to put her on morphine, and she'll be fine. She's going to be really comfortable on morphine, don't worry about it. Well, what about Are you still going to suction her because she has pneumonia? She because she's having trouble breathing? No, she won't need that. Because that's invasive. We'll just give her more morphine that's going to make her comfortable. Is it going to make her comfortable? Or is it just going to make it so difficult for her to say, I'm uncomfortable? You know, I'm asking, because, because, and also, how do we know that morphine works the same on everybody? makes them feel like they're drowning? What if it, you know, whatever. And I kept, I literally kept saying, I hear you, I hear you. I don't want my mom to be uncomfortable, but I don't want her to be uncomfortable. So that's why I'm questioning you. Why are we giving her just morphine? Why aren't we keeping her comfortable by keeping her lungs clear? And you know, and anyway, I'm just, I'm just throwing that out there. Because, you know, my instincts told me, I don't know how my mom is. I don't know her reaction to morphine. I know that I'm allergic to certain things that may that may make you feel comfy, like, you know, like, Don, you love Ativan. It doesn't make me feel the same way. Right.

Don Priess:

But yeah, and also when she and she has Alzheimer's, and she can't communicate. So, you know, that's, that's the other issue when you when they can't tell you how it's made.

Delon Canterbury:

I mean, yeah, that's, that does make it much more tricky in the approach. But I mean, your instinct is right, people don't respond to the same to those type of drugs and opioids, in general, there's some people who take a pill and doesn't touch their pain. And there are some people who are completely over sedated with one pill, right, everyone's bodies change as we age, specifically there, but there were elderly. And so when you have these reduced responses, you're gonna have variable side effect profiles, people may be, you know, you know how that goes. But you're right, and, and when it comes to opioids, specifically, there actually is a genetic component to it. I think morphine is actually a drug that actually turns into codeine when it's in the body. And if you don't have that pathway, like regular in your body, genetically, then you're going to be more likely to have side effects, you're going to be more likely to be sedated and tired and not have any analgesia, which is pain relief, or they're people who are so good at clearing the drug, that it ends up working tenfold higher than it was supposed to. So that dose you don't, again, don't you don't know until you witness the patient, or you have a genetic test, which I provide one on one for anyone anywhere in the country. And I can tell you, hey, based on this, we can reduce harm by choosing another drug or switching to this or lowering the dose and seeing how that goes. So there is a genetic component. There's variability, but even just as we age, their bodies are so sensitive, so you have to treat them as babies Essentially, as...

Susie Singer Carter:

You're on to it. You got I mean, definitely, I agree with you. 100%. And I always tell people I was, you know, I think about like my brother who had an issue with Oxycontin, you know, for him, I remember him when he was first on it going, you know, because he was taking it for back pain. And he was like, Oh my God, I feel like Superman, like I he could, he'd be up for three days, he could, he could work for three days. He was in IT. And he you know, whereas if I took, I mean, just just Valium or Codeine, I'm out - Bye! See in a week, like I'm i It puts me out, you know, and and then you know, conversely, I can go to sleep on a cup of coffee and some you know, caffeine does nothing to me, like I it doesn't make me stay up or and you know, it's just everybody has different reactions. It actually can make me sleepy. If I take too much coffee, caffeine, I can get sleepy from it. So, you know, I think that I look at that and I go, you know, my brother got, he almost had like a Coke, a coke response from oxycontin giving him energy. Right? So and I've heard that from other people as well. But I think it's his, you know, he's weird, totally different chem- you know, just physically he's always been a big guy. He's always been, you know, over carried a lot of weight, we just different kinds of genetic we, we got the different you know, in the pool of genetics we pick we were given different genes. And so I just think if you look at what you're saying, It's so obvious, it's so obvious. And then like you said, we're as people age, they become much more vulnerable, like children, and much more delicate. And, um... Yup, Yup, yup.,

Don Priess:

So I think there's a, you know, there are perceptions about holistics. And you know, that true or not, you know, people like, okay, so we always want the easy fix, which is a pill. Pill is a very easy fix, I take it and I feel better. That's the concept at least, as we know, that's not necessarily the case. And so you're you're going to come back and say, okay, instead of this pill, you're going to take these three herbs or I don't know, I'm being coming a very unknowing position. But how do you deal with people not complying? Because it's more maybe it's more work? Instead of this one pill, I have to take these three things are, you know, because that compliance is everything? It's it's everything when it

Delon Canterbury:

eo, that that to me, is a good question. But comes to... it's the opposite of what I do. I'm not going to make your life harder if I'm developing a plan for you. So I'm not going to Like to St. John's wort and things like that you don't know substitute more stuff and supplements just because it's a natural, if you want that, sure. But I'm not going to put that on you, I can give you the option. But that's to me the opposite of Deprescribing. My point is to get you off of everything. Herbal OTC lotions, eyedrops as much as possible. So I don't want you on herbal as if it's not even working. And that's not always the best clinical judgment anyway, because you're telling someone to take something that isn't quite clinically proven to do something. But anyway, needless to say, when it comes to being open to that some patients want that right, I have patients who are all natural, right. And they don't even understand that some of those natural meds have just as much harms as the prescription or they're not regulated, or they have contaminants. I had one patient who was taking like cayenne pepper and cinnamon to help with, like appetite suppression, right, and, and weight loss. And she didn't realize that that was what was causing like chronic GERD and acid reflux and heartburn. And she ended up taking medicine prescriptions, expensive prescriptions for it, and failed them twice. And it took her two years to realize when she met me that she didn't need to take those herbal supplements because that was what causing her issue. So she stopped them, her stuff got better. But now I think she has residual acid reflux. naturals aren't always safe. So I asked her that we literally have a module where we talk about the dangers of herbal supplements and over the counter medications because guess what our seniors are the highest consumer of that 40% of our country, that people will buy that they're they're older, they're elderly. So if you don't know those generic interactions, I mean, it's just as dangerous as taking minocycline (?). about and it sounds it's yeah, That's a huge one.

Susie Singer Carter:

And like, and also there's, there's so much advertising, you know, in our, to our vulnerable, you know, that population and it's like, try Previgen and you know, it helps my....

Delon Canterbury:

Yeah, I hate Previgen. I hate Previgen so much. With this, there are only two countries in the world that allowed direct to consumer marketing of drugs. It's US and New Zealand for some reason. I don't know why, but they're only two in the world. Everywhere else. It's illegal to directly market to consumers. But here we are. So yes, there is a dark side to this, but there is a way that this could be done

Susie Singer Carter:

This is confusing, I mean this is why you're so important. Because it is so confusing. It's like wow, you know, because listen, we weren't, Don has been working in marketing his whole career as a, you know, editor and a producer. And you know, we know how how, how powerful marketing is right? It's really powerful. And you have like you said Previgen and all these other kinds of drugs and then and then the you know, the typical rattle off of of caveats at the end, and they and Tell your tell your doctor, tell your doctor that you're allergic each and every one of them says and if you're allergic to this drug, please don't take it. Well, how the hell do you know if you're allergic to it until you take it? to if you have an allergy to Previgen.

Don Priess:

or, or a human if you're breathing Yeah.

Delon Canterbury:

In 2019, FDA also claimed that the company that is advertising for Previgen in failed to disclose 1000s of adverse reactions including seizures strokes work, worsening symptoms and multiple sclerosis, chest pains, tremors, and fainting as well as memory impairment and confusion, the complete opposite of what it's supposed to do. So, again, you can't just take things at face value, you got to really, really do your homework and have a an advocate, a deprescribing advocate, a pharmacist as your best friend. So you can avoid these unnecessary expenses and waste of time.

Susie Singer Carter:

We need you I'm telling you, we need we need we need you. We need like a whole, like, this should be something that you graduate and get a certificate for that you You're just one person. You're just, you're need to go to college. And that it should be required in every

Delon Canterbury:

that's what I provide. But but you get a certificate. just a lovely human being, you know, and we need you. We need you. But we need more of you. We need people to jump on board. Yeah. Oh, no worries that my Deprescribing Accelerator is literally building an army of people. So this will be my third cohort this fall. So I already have seven Deprescribing people just like me now since they graduated my program. Yeah, so more will come and I only launched this year. So there's more to come.

Susie Singer Carter:

You're going Nobel Peace Prize. I'm telling you, you're amazing.

Delon Canterbury:

And it's going to be CE accredited to so people who just need to get their CE's for the year, they can use it as a layman, It's Continuing Education. And it's required for people who are working in a field to maintain your license every year. So that means it's easier to get.

Don Priess:

So the service that you are providing is obviously it's invaluable. It's it but there's probably a value to it. I mean, there's a cost is, is that a cost that is that pretty much everyone can handle? Is it something that hopefully in the future that insurance may cover? Because it seems to be that's something that they would want to get involved in? What are what are the costs? And and yeah, I mean, where are we at on that? Right now?

Delon Canterbury:

Are you talking about for patients who need help.

Don Priess:

Let's say for my mom, let's say my mom has the this, I want to get her involved in your program. And she doesn't have a lot of money. And you know, obviously, I don't think insurance covers this right now. So what are the realities of using this for the person who either has no income, low income or you know, wherever they're at?

Delon Canterbury:

Well, unfortunately, my prices are, my model is cash based, I can't bill insurance. So there is a bit of an investment. However, I know how it is to be on a fixed income, and our seniors, average 20k, 23k a year in retirement. So they're getting a very, very small pension for Medicare a check to survive. So what I do to work with them is develop a financial plan, I do installments I do payment plans for people. But it's gonna still take an investment because I need you to have the energetic exchange, to tell me you want to change, you know, you're not going to pay four figures and not change, you know, you're gonna need some buy in. And the level of service this can provide, if I'm say, keeping someone out of a hospital or taking someone off of four pills, because they're working out more, you're going to end up saving more than that hospital bill you could have gotten just because you left it on managed. So when you work things differently, like, Hey, do you want to pay a couple 100 or 1.,000 now, or do you want to pay later when you're in a nursing home and you're forced to do it, and you don't have the money or whatever? Or you know, so you got to see how people may want to consider if it's best for them now, like are they ready to make that change? Is there a is there a motivation behind it? But is it feasible? Yeah, it's feasible? Yeah, I'm not I'm not gonna, I'm not in this game to make it hard for people. I want people to get this service. And there are times where I've done it for free. And people have paid me after because how much I've helped them. And so that I can do that, then I know I'm worth it.

Don Priess:

Is it ongoing? I mean, how does it work? As far as let's say, you know, somebody like my mom, who was, you know, 88 years old, and sure we, you know, hopefully she'll be rooting for quite a long time. And her conditions may be changing. So is it? Is it a one time fee? Is it ongoing? Is it a monthly or as used? How does that work?

Delon Canterbury:

Yeah. So you can choose two options. There's a one month plan where we do everything I pretty much said today, and I just give you all the recommendations and you take forth and go and conquer. And then there are those who are maybe a little more complex and they need ongoing services. And so that's where there's a monthly retainer package where you can have me 24/7 concierge text me need me anything and that's what I have for someone patients. Now I've had them for a couple years, and they just pay me on retainer, and that's fine. So essentially how you have your own lawyer on retainer, this is what pharmacists are doing. And this is what I'm doing and what I'm teaching people how to do. So it depends on your needs. I don't want to take your money if you're fine after one month, if you're fine. After one month, boom, we've done our job, we can go ahead. But yeah, it's an ongoing process. Deprescribing isn't a one stop shop, you have to continuously do this until you're on as little meds as possible.

Susie Singer Carter:

It needs to be and I'm sure you already have this in your radar. And it's or you're doing it now is that, you know, like I said, getting somebody that is that liaison between the patients or the residents

Don Priess:

Actually work, you know, who are actually in each nursing home who actually in every hospital.

Delon Canterbury:

Yeah, it they. So that's my personal mission. The sad part is, they kind of have that, and they're not... They are not effective like they. So the sad part is some of Good? these nursing homes have - it's not a sad part, but what I find is some of these nursing homes have these long term care pharmacies within them, right. So they do the pharmacies in house and they give it to the patients. They actually have people that are supposed to audit and go through all of their beds, all their patients, and they're called technically, consultant pharmacists, and they're contracted with LTCs. Now, they are strictly looking at Medicare laws that say, you can only take this drug for 14 days, or they do they literally do have processes where people are doing this. The issue is they are not incentivized to D prescribe not so to speak. They're not incentivized to get everyone off of everything. They're just like, Okay, what does Medicare say? Can I do that? Okay, boom, boom, boom, all right, you're good. And the problem is, I think these consultant pharmacist want to do what I'm doing. They're just tied, because they are still working for the pharmacy, which depends on those pills to be filled. And and get that reimbursement. So They're not patient-centered. They can do it. But they don't. They're not. They're supposed to. And then guess what, it's one pharmacist is doing med reviews for 30-50 beds, it's clinically impossible to do the best care in that model.

Susie Singer Carter:

It's also a different job.

Delon Canterbury:

If you were to read. It's a different job. It's a whole different job. It's not just see, I'm not going in looking at a Medicare checklist and auditing. I am going in with what are you on? What can we get you off of them and save you money? And how can I improve your quality of life. And that doesn't always translate to those Medicare metrics it does for the patient. But it doesn't make the money or the bottom line for some of those consultant pharmacists. So I'm giving people a twist on that say, Hey, you guys have the intellect, let's get you paid off of how much money you've saved the company because you've reduced X number of opioid prescriptions in your clinic, or you've stopped NSAID use in people that have heart failure, or dementia Benadryl, you've stopped, you know, little things like that, because you can't always quantify it. But if you're living longer, you've got your beds filled, you can get that claim back. So there's a hole. And then of course, we haven't even talked about insurers that actually want to pay for this type of stuff. Because there are Medicaid plans that are dying to have people like me consult in this space because they're reducing unnecessary spend, and our patients are doing better. So there's a bigger picture to (?), workmen's comp is another one, that's a billion dollar industry that isn't talked about, a lot of seniors don't deal with that. And we can provide other ultimate ways to get people better care, and not have workman's comp pay for all these opioids that the patient still ends up having pain six or seven out of 10, which is often the case.

Don Priess:

And other another side effects, yeah, and other side effects causing other things that they then need to take a pill for. I assume you're gonna get some, once you get to a position where you are prominent, you're gonna get pushback from probably Big Pharma, because you're basically taking money out of their pockets. And I think if that happens, it'll be proof that what you're doing is great, and is correct and is righteous. Because if they're pushing back, that means you're doing something right. And I'm sure have you gotten any pushback? Have you heard anything from that community at all or

Delon Canterbury:

Not from pharma, but I guess we'll see in a couple of weeks when I speak at a conference to healthcare advocate summit where a lot of them are paying and sponsoring the event. So I'll be calling out some of them but I'm nothing on that scale yet. I don't think I'm on the level of Zendaya and Dopesick but um, I guess I'm approaching it differently, but um, I can't wait to get it because it means I'm doing the right thing. Right.

Susie Singer Carter:

So we this hour flew. God is a huge subject. I first of all, thank you so much. Is there anything you wanted to say that we didn't touch on and that you think would be important information or just just,

Delon Canterbury:

Um, just don't be afraid to advocate for people over medicated man and you don't have to worry about your license or where you stand but if you literally are seeing someone on 10-20 meds, ask what have they done to talk to a pharmacist and how can I get them off safely? Now, regarding the work I'm doing, I'm all over social media. So I'll be doing a video campaign where I'm detailing the info about our Deprescribing Accelerator. So follow me on LinkedIn, you can look up my name Dr. DeLon, Canterbury or check out my website GeriatRx.org. I'm all over Facebook, Twitter, Instagram, you name it. You can search GeriatRx or just search my name DeLon Canterbury. That's GeriatRx . G-E-R-I-A-T-R-X as in x ray.

Susie Singer Carter:

I love the title. I love you. And I love what you're doing. And I think you and your and your granny will is so proud of you. And yeah, for sure. Yeah, for sure. And you know, in at the end of the day, it's like it's love is what is what's why we say you know what we say always say so powerful. And what happens like what, what do we say Don?

Don Priess:

We do say that love is powerful. Love is contagious, and Love Conquers Alz. We thank everyone for listening today. Please follow us. Like, subscribe, do anything you can do so we can get that word out there. And and and to have such important wonderful guests like Dr. DeLon Canterbury and hopefully we'll hear and see you next time

Susie Singer Carter:

Thank you, DeLon, so much and bless your heart, seriously.

Opening
Dr. DeLon Canterbury Introduction
Incentivizing LTC's to Deprescribe