H o w

How to conduct
Diabetes MedsCheck
12th March 2013
“Tell me and I forget. Teach me and I remember. Involve me and I learn.” Benjamin Franklin Welcome to the Guild Clinical Diabetes MedsCheck Webinar. This interactive workshop has been specifically designed to provide you with information on the rules regarding Diabetes MedsCheck but more importantly how you can conduct Diabetes MedsCheck in your pharmacy The interactive training course involving discussions and workshops will be facilitated by Belinda Nankivell. An assessment will be carried out at the end of the session by completing a Diabetes MedsCheck Worksheet. Agenda Welcome, Introduction and aims of Diabetes MedsCheck, Aim of the Workshop Is your pharmacy eligible? Starting Diabetes MedsCheck Promoting Diabetes MedsCheck Strategies for providing the Diabetes MedsCheck service Adherence, barriers for adherence Consider disease States Communication, Claiming Documentation Diabetes MedsCheck Exercise We trust you get the most out of your Guild Clinical training session. We value your opinions and encourage you to share them with us. Please feel free to contact us any time on (02) 9467‐7132 or at: [email protected] All the best Carlene Smith
Carlene Smith Guild Clinical Co‐ordinator Training MedsCheck Webinar Facilitator Belinda Nankivell BPharm Belinda Nankivell is the Pharmacy Practice Officer at the Pharmacy Guild of Australia NSW Branch.
She helps to assist pharmacies to implement 5CPA services.
Belinda graduated from the University of Queensland and has a community pharmacy background.
She has been very active at a pharmacy level implementing professional services. Her passion for
pharmacy and its role in the community helps to create training that improves clinical knowledge
and is practical for pharmacists.
14/3/2013
MedsCheck
Diabetes MedsCheck Community Pharmacy Service for consumers who live in the community:
Community Pharmacy Service 
Cardiovascular Disease
for consumers who live in the community
MedsCheck Aim
 Identify problems that the consumer may be experiencing with their medicines
 Help the consumer learn more about their medicines including how medicines affect medical conditions  Effective use of medicines by consumers
 Educate consumers about how to best use and store Improve the their medicines Investigate problems
Provide education and support
d
Ensure effective use of medicines
Diabetes MedsCheck Aim
 Optimise consumer’s effective use of medicines
 Improve consumer’s effective use of BGM device
 Improve blood glucose control
 Reduce
Reduce the risk of complications associated with type 2 the risk of complications associated with type 2
diabetes
1
14/3/2013
Pharmacy Eligibility
 Section 90 pharmacy
 Be a Registered Pharmacist or have access to the services of a Registered Pharmacist through employment or service contract relationships
employment or service contract relationships
POLL
Are you performing MedsChecks or Diabetes MedsChecks currently?
Yes
Or No
2
14/3/2013
POLL
How many MedsChecks or Diabetes MedsChecks have you performed?
• 0‐5
• 6‐10
• 11‐20
• 21‐50
• 51‐100
DSM vs MedsCheck vs HMR
DSM
MedsCheck
HMR
Medicines & condition counselling in targeted disease
Medicine review, may include interactions
Clinical review
Patient concerns & disease management
Medicine review focussing on compliance & education
Comprehensive medicine
review incl all meds and management issues
Usually opportunistic, e.g. on script collection; can be g g
ongoing service
In pharmacy, usually with appt; Ideally in home, with appt; a service performed at most usually service performed at yyearlyy
most yearly depending
y
y p
g on need
No referral needed
No referral needed
GP referral needed
Advice and support to help patient to self manage
Tailored med advice, to identify med issues and need to
issue a report (incl action plan & meds list)
Provides GP with report on pt’s med management (med issues, strategies to resolve); Mgmt
plan disc w pt & copied to phcy
A service under PHC‐PPI; incentive
$60 or $90 (diabetes) fee/service
$200.92 per HMR
Service Requirements
 Whilst conducting MedsChecks the pharmacist should not be responsible for other professional duties
 Suggest at least TWO registered pharmacists on duty  Must be conducted in a screened area or separate room distinct from the general public area of the pharmacy.
 Id
Ideally, computer, printer and internet ll
t
i t
di t
t
access in the screened or consulting area.
 Access to support resources on health
information, medications and monitoring devices.
www.5cpa.com.au/medscheck 
3
14/3/2013
Consumer Eligibility Criteria
 Live at home in a community setting
 Have a valid Medicare number or DVA card
 Have not had a MC, DMC, HMR or RMMR in the last 12 months
MedsCheck
Diabetes MedsCheck
 They take 5 or more prescription medicines or
 They have had a recent significant medical event
 They have been diagnosed with type 2 diabetes in the past 12 months or
 Their type 2 diabetes is less than ideally controlled and
 They are unable to gain timely access to diabetes educator
Let’s consider this for a moment…….
Diabetes MedsCheck
 They have been diagnosed with type 2 diabetes in the past 12 months or
 Their type 2 diabetes is less than ideally controlled and
 They are unable to gain timely access to diabetes educator
How do you know they are not well controlled? How do you know about access to a Diabetes educator?
Diabetes MedsCheck Consumer Eligibility
Barriers to ‘timely access’ should be determined by the pharmacist based on the patient’s specific needs and may include:
 Appointment availability is not suitable to address the patient’s immediate needs  Distance to be travelled to the nearest diabetes education / health service is impracticable for the patient  There is a lack of accessibility to transport
www.5cpa.com.au/medscheck 
4
14/3/2013
POLL
Do you find it difficult to determine eligible patients for a Diabetes MedsCheck?
Yes Or No
Strategies for your MedsCheck services
Once your pharmacy has received written approval from DHS (Medicare) to provide the MedsCheck services….
 Appointment ‐ have diary in the pharmacy
 Train staff‐ Assistants and Interns can discuss the service with consumers about and make appointments on a specific day
 Pre‐prepare list of medicines from pharmacy history
 Privacy‐ ensure interruption free, private time
POLL
Do you have an implementation plan for these services?
Yes
Or No
5
14/3/2013
Promoting your MedsCheck services
Once you have received written approval to provide the service….
 You can organise promotion using the brochures and posters which are freely available from the Guild
o Download at www.5cpa.com.au/medscheck or order copies from the 5CPA Help Line 1300 555 262
 Consider the local paper and some editorial space
Service Checklist
 Outlines the requirements in each stage of the MedsCheck process
 Available from www.5cpa.com.au
MedsCheck is …..
About Adherence, Education and Self Management.
To find out about adherence you need to consider:
 What are the factors that reduce adherence?
What makes people change what they are doing with their
 What makes people change what they are doing with their medicines? ………………………………………………………..Communication
6
14/3/2013
Adherence can be poor because….
 Lack of knowledge about disease state or medicines
 Lack of understanding about why they are taking their medicines
 Lack of belief that the medicines are working
 Confusion regarding the use of the medicines
Confusion regarding the use of the medicines
 Lack of a routine to take their medicines
 Poor vision
What would you  Poor hearing
ask to find out about these  Poor dexterity
topics?
Communication can be crucial!
Asking questions to find out how the consumer feels about their medicines can be affected by the way we ask the question as well as what we ask!
Motivational
Non judgmental
Show consideration and empathy
Aim for better use of medicines
Consider the Diabetes
While there are some basic questions you will need to ask just as if it was a regular MedsCheck but because it is about Diabetes you will have some additional questions.
7
14/3/2013
Diabetes
 Start with the basic.. what, when how, why?
 Consider memory issues
 Do you sometimes forget to take your medicines? What do you do?
 How do you know Diabetes is controlled?
How do you know Diabetes is controlled?
 Do you know what your BGL is?
 Do you monitor BGL? How often?
 Do you ever feel dizzy or light headed?
Diabetes
Glycosylated Haemoglobin HbA1c
 glucose attaches to the haemoglobin molecule  Measurement can be taken If people with type 2 diabetes reduce their HbA1c level by 1%, there is a :
there is a :
• 19% reduction in cataract extractions
• 16% decrease in heart failure
• 43% reduction in amputation or death due to peripheral vascular disease
http://www.diabetes.co.uk/what‐is‐hba1c.html
Other thoughts......
 Consider diet and exercise
 Consider other drugs that can worsen condition
 Consider some common adverse effects
If Insulin is being used

Storage is important
8
14/3/2013
Documentation

Once you have all the information you can help the consumer improve their knowledge of the condition and the medicines

If you find information consistent with adverse effects……………… you can recommend an HMR

If you find non adherence is an issue ……………………………...you can recommend a DAA

Give the consumer their medication list and the report should be attached and file all consultation documentation for 7 years
Documentation and claiming
 There are 2 forms for Claims:
 MedsCheck Program Claim cover sheet
 MedsCheck Program Payment Application
 Diabetes MedsCheck fee $90 (GST exempt)
 Claims submitted to DHS (Medicare) by the 14th of the month routinely paid in the next month
 File all consultation documentation for 7 years
Claiming 9
14/3/2013
Resources to help you
www.5cpa.com.au






Program Specific Guidelines
Factsheets & FAQs
PSA Standards and Guidelines
MMR Terms and Conditions
QCPP checklist
myCPD online MedsCheck modules – www.mycpd.org.au
Diabetes MedsCheck Worksheet
Name:………………………………………………………………………………
……
Mrs Gillian Fish is a long standing patient and is
Pharmacy:………………………………………………………………………
taking
• Diaformin 1G tds
…….
Phone:……………………………………………………………………………
• Gliclazide MR 60mg d
……
• Amlodipine 5mg 1d
Email:………………………………………………………………………………
• Atorvastatin 40mg n
……
• Paracetamol 665mg 2
Column
1
and
3
are
issues that
affect
medication
taking, what
questions
would
you
ask
to
help
tds
identify if there are any issues to resolve? Consider what the potential outcomes of the MedsCheck may be, in the
last line
Issues
Questions
Issues
Questions
Usefulness
Compliance
of meds
PRN meds Other
meds
Adver
se effect
s
Self Sufficiency
Storage Out of date meds
Lifestyle
Beliefs
Knowledge
Any
clinical issues
Potenti
al Outcom
es
Of MedsCheck
Potential Outcome
s Of MedsChe
ck
The Pharmacy Guild of Australia NSW
Branch
Fax Back to 02 9966 9750 or scan and email to
[email protected]
Support and information
Visit: www.5cpa.com.au Email: [email protected] Phone:1300 555 262
TIP: make www.5cpa.com.au a favourite
10
14/3/2013
Thank you for your attendance, we hope you find MedsCheck
a useful service to offer to your patients
your patients
11
The Guild Pharmacy Academy
Professional training for community pharmacy including:
• All Pharmacists
• Interns
• Pharmacy Assistants
• Pharmacy Managers
Incorporating:
• Guild Training (Pharmacy Assistants)
• Guild Clinical Training (Pharmacists, Interns)
• Guild Intern Training (Interns)
• Guild Business Training (Pharmacists, Interns, Pharmacy Assistants, Pharmacy Managers)
My CPD
As part of national registration all pharmacists will need to keep records of their continuing
professional development (CPD) and you can record your CPD @ www.guildtraining.com.au
Any pharmacist may use this website to keep track of their CPD points, as required under
national registration. The site also includes a calendar of CPD eligible events for each State
and Territory.
Make a commitment to quality ...
For more information on Training Courses, please contact:
Guild Training
(Pharmacy Assistants)
Telephone:
(02) 9467 7130
Facsimile:
(02) 9467 7165
Email:
[email protected]
Guild Clinical Training
(Pharmacists, Interns)
Telephone:
(02) 9467 7132
Facsimile:
(02) 9467 7181
Email:
[email protected]
Guild Business Training
(Pharmacists, Interns, Pharmacy Assistants, Pharmacy Managers)
Telephone:
(02) 9467 7132
Facsimile:
(02) 9467 7181
Email:
[email protected]
Guild Intern Training
(Interns)
Telephone:
(02) 9467 7124
Facsimile:
(02) 9467 7125
Email:
[email protected]
s
n
o
ti
lu
So
e
ic
rv
Se
&
s
ct
u
d
o
Pr
ti
o
n
CPD by the SEA - NSW Convention
u
ca
(incorporating Zone Leaders Conference)
g
-
Ed
Friday 22 - Sunday 24 February 2013
Novotel Manly Pacific
w
o
rk
in
Catch the early wave & secure your CPD Credits!
N
et
www.cpdbythesea.com.au
NSW based events provide the opportunity to secure 50+ CPD credits.
Open to everyone in pharmacy, nationally!
N
www.nswpharmacy-nce.com.au
et
w
o
rk
NSW Pharmacy - National Convention & Exhibition
in
g
-
Friday 21 - Sunday 23 June 2013
Ed
u
ca
Sydney Convention & Exhibition Centre
Darling Harbour
ti
o
n
Pr
Learn to survive & THRIVE!
o
d
u
ct
s
&
Se
rv
ic
e
So
lu
ti
o
n
s