dose administration aids - information booklet to pharmacies - department of veteran affairs

8/3/2019 Dose Administration Aids - Information Booklet to Pharmacies - Department of Veteran Affairs

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DOSE ADMINISTRATIONAID SERVICEthe right dose

Pharmacists

Information Booklet


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Commonwealth o Australia 2008

Tis work is copyright. Apart rom any use as permitted under the Copyright Act 1968, no part may bereproduced by any process without prior written permission rom the Commonwealth. Requests andinquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright

Administration, Attorney-Generals Department, Robert Garran Ofces, National Circuit, Barton AC 2600or posted at www.ag.gov.au/cca

ISBN 1 920720 98 7

Published by the Department o Veterans Aairs, Canberra, 2008Revised October 2008Second revision May 2009

Publication number: P01754

Disclaimer

Te inormation contained in this booklet is advisory only and any suggestions should be used in

conjunction with clinical knowledge and skills.


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Overview of the Dose Administration Aid Service ................................................2

Clinical evidence brief...........................................................................................4

Important information .........................................................................................5

Veterans eligibility criteria.................................................................................. 6

Steps for the veteran in using the DAA Service ..................................................... 7

How to be involved ............................................................................................. 8

Outline and summary of fees for pharmacists .................................................... 10

How to claim for the DAA Service ....................................................................... 12

Pharmacists FAQ ............................................................................................... 13

Advising veteransFAQ ..................................................................................... 15

Contacts............................................................................................... Back cover

Te information in this booklet is correct as at October 2008.

For current information please see the DVA website www.dva.gov.au .

Contents


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Overview of the DoseAdministration Aid Service

Te Dose Administration Aid (DAA) Service builds on DVAs Quality Use oMedicines programs, which include the Veterans Medicines Advice andTerapeutics Education Services (Veterans MAES) program, and aims to assistthe veteran community to get the most out o their medicines and to reducemedication mismanagement.

Te benets rom the DAA Service are ar greater when provided in conjunctionwith a Home Medicines Review (HMR), Medicare Benets Schedule Item 900. DVAthereore strongly recommends that veterans be reerred by their GP or an HMR

in regions where this service is available.Te DAA Service provides veterans, war widows and other eligible DVA clientsa DAA at no cost, in conjunction with the ongoing care o their doctor andpharmacist. Te need or a DAA may be identied by the veteran, carer,community nurse, GP or pharmacist.

Te Pharmaceutical Society o Australia Guidelines and Standards, July 2007,reer to a Dose Administration Aid (DAA) as a tamper-evident, adherencedevice developed to assist medication management or a consumer by havingmedicines divided into individual doses and arranged according to the dose

schedule throughout the day. It can be either a unit-dose pack (one single typeo medicine per compartment) or a multi-dose pack (dierent types o medicinesper compartment). Te term medicine includes prescription, non-prescriptionand complementary medicines.

2


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Te DAA is packed by the pharmacist who is required to comply with theGuidelines and Standards or pharmacists outlined by the Pharmaceutical Societyo Australia.

Te veteran receives the DAA Service on prescription rom the GP or six monthsand is assessed near the end o this period by the pharmacist, who provides areport o the assessment to the GP.

For urther inormation on Home Medicines Reviews, Medicare Benets ScheduleItem 900, go to the ollowing websites:

Te Pharmacy Guild o Australiawww.guild.org.au/mmr/content.asp?id=421

Te Australian General Practice Networkwww.agpn.com.au/site/index.cm?display=348

Medicare Australiawww.medicareaustralia.gov.au/provider/pbs/ourth-agreement/hmr.jsp

Te term veterans when used throughout

this booklet reers to all eligible DVA clients.

Aims

o improve veterans health outcomesthrough better, saer use o medication.

Objectives

better health lower mortality

improved medication adherence

reduction of solid medicines inveterans homes

better health records, and

a cost eective service.

DAA ServiceInformation Booklet for Pharmacists 3


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Clinical evidence brief

Commencing in 2000, the University o Queensland carried out a 12-monthrandomised controlled trial o DAA usage involving 1010 veterans and warwidow(ers) living in the community. Te study recommended implementation oa DAA program or veterans residing in the community.

Key Findings

Most users and health professionals found DAAs benecial. e benetsincluded:

- better health

- lower mortality

- improved medication adherence

- reduction o solid medicines in veterans homes

- improved accuracy o doctors records.

e benets of DAA usage may also be attributed to the additional focus ofmedical proessionals during the administration o the DAA Service.

ose who beneted most from the DAA Service were:

- severely ill veterans

- non-adherent veterans

- veterans who struggled to handle their medicines

- veterans who required assistance with activities related to daily living

- veterans with a carer and a complex medication routine.

ose who may not benet from the DAA Service:- have ewer than ve solid oral medications

- may stop taking a medicine i they eel better, or

- are on medicines not appropriate to be packed into a DAA such as liquids,suppositories, inhalers, or medicines that need to be rerigerated.

4 DAA ServiceInformation Booklet for Pharmacists


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GPs must obtain oral consent from the veteran according to the eligibilitycriteria beore they contact the Veterans Aairs Pharmaceutical AdvisoryCentre to obtain an Authority Prescription or the veteran to commence theDAA Service.

Any registered GP may provide these services to veterans, however only GPswho are registered as a Local Medical Ofcer (LMO) may claim a higher MBSee.

e term LMO and GP are used interchangeably within this document.

e DAA Program implemented under the Australian Governments 4th

Community Pharmacy Agreement with the Pharmacy Guild o Australiaprovides or all patients. Te DVA DAA Service provides a dierent servicethrough a coordinated approach linking the DAA to a recommended HomeMedicines Review, Medicare Benets Schedule Item 900, with regularongoing assessment by the Pharmacist and GP.

Only Accredited Pharmacists can conduct a Home Medicines Review.

Section 90 (National Health Act, 1953) states pharmacies can provide a DAA

Service, and conduct a Veterans Six Month Review (VSMR). Section 92 and 94 (National Health Act, 1953) states pharmacists are

unauthorised to provide the DAA Service.

e Pharmaceutical Society of Australias professional standards underpin theprovision o DAAs in Australia, including the DVA DAA Service.

Gold, White and Orange card holders are eligible for the DAA Service.

Important information


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Veterans Eligibility Criteria for the Service

1. Veterans must hold either a Gold, Whiteor OrangeRepatriation Card.

2. Veterans must be living in the community and not residing in a residential careacility (either low level or high level care), hostel or hospital.

3. Veterans must meet the criteria or a Home Medicines Review. For moreinormation on Home Medicines Review criteria, seehttp://www.medicareaustralia.gov.au/provider/pbs/ourth-agreement/hmr.shtml

4. Veterans must be likely to beneftrom the DAA Service.

Doctors and pharmacists should consider whether: veterans are confused about which medicines to take, when to take them, or

what they are or

veterans have a lot of medications or a complex regime

veterans have reported non-adherence, or

veterans require help with activities of daily living.

5. Veterans must provide oral consent to:

having a Home Medicines Review, if it is possible to receive this service,and the Veterans Six Monthly Review involving the community pharmacy,registered pharmacists, and other health proessionals involved in their care

communication between their health care professionals, especiallypharmacists and GPs

providing their DVA le number or card to the pharmacist and MedicareAustralia or payment purposes

meeting any additional costs not covered by DVA including additional GP

consultations (especially Orange Card holders) providing all solid oral medicines (including relevant non-prescription

medicines) to their community pharmacy or packing

receiving the DAA weekly or fortnightly from the community pharmacist

informing the pharmacist of any changes to their medicines in a timelymanner, and

having the community pharmacy provide information to DVA to enableDVA to monitor and assess the veterans needs and the eectiveness o the

intervention.



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Steps for the veteran in usingthe DAA Service

Te DAA Service is provided to the veteran in our steps during a six-month cycle.

Ongoing care is provided by the GP and pharmacist so that a service is providedrather than simply a device.

You, a carer, relative,

nurse, pharmacist or GP

identify that a DAA may

help you to manage your

medicine, or you might

already be using a DAA

It is possible that your

GP may refer you to a

pharmacist for a HomeMedicines Review to

assess your suitability

Step 2Your pharmacist packs

your DAA weekly and

provides information on

how to use itStep 4

Your pharmacist will

conduct a six-month

review to assess ifyou need extra help or

information in using your

DAA and to make sure that

you are managing safely

Step 3

You collect your DAA from the pharmacy

each week.

If you are unable to collect your DAA

someone else may collect it for you, or your

pharmacy may deliver it to you.

Step 1

You have a consultation

with your GP who

prescibes a DAA Service

for six months



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How to be involved

Pharmacists may identiy that a veteran is having difculty in managing theirmedicine and the veteran could benet rom a DAA. Te pharmacist may suggestto the veteran that they seek a prescription or a DAA Service rom their GP.

A veteran may already be using a DAA and be paying or this service. Te veteran iseligible to receive the DVA DAA Service, ree o charge, i it is prescribed by the GP.

It is strongly recommended that the veteran be assessed through aHome Medicines Review (Medicare Benets Schedule Item 900) so thatrecommendations can be made to the GP in relation to the veterans medication

regime and whether the veteran would benet rom or is continuing to benetrom a DAA.

I the service o a qualied Home Medicines Review pharmacist is not available,DVA will be advised by the GP at the time the GP seeks an Authority Prescriptionrom the Veterans Aairs Pharmaceutical Advisory Centre.

Te pharmacists role

Pharmacists will provide DAA packs to the veteran weekly and continuallymonitor the veterans progress. Te pharmacist should check on the veteransprogress each time a new DAA is collected, and is required to conduct a ormalreview towards the end o the six-month cycle (the Veterans Six Month Review).

DVA provide a VSMR orm or the pharmacist to complete while interviewing theveteran. Te interview may take place in the pharmacy or in the veterans home.

Te completed review must be provided to the veterans GP and the VeteransAairs Pharmaceutical Advisory Centre.

Te GP will need to take into account the recommendations rom thepharmacists review and discuss with the veteran the benet o continuing to usethe DAA.



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Standards and Guidelines

In providing the DAA Service the pharmacist must comply with thePharmaceutical Society o Australia (PSA) DAA Service Guidelines and Standards.

Te PSA has developed our checklists to assist pharmacists with: planning,implementing and maintaining a DAA service; ormalising a DAA service withthe consumer; packing the consumers DAA; and conrming and meeting the

consumers DAA service needs.

For urther inormation on the PSA Guidelines and Standards, go to:

9DAA ServiceInformation Booklet for Pharmacists

www.psa.org.au/site.php?id=2398


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Te Dose Administration Aid Service outlineand summary of fees for pharmacists

Te DVA DAA Service provides a Dose Administration Aid (DAA) at no cost toeligible veterans.

To be eligible veterans must hold either a Gold, White or Orange Repatriation Card.Veterans who reside in a residential care acility, hostel or are in hospital are noteligible.

A DAA is a compartmentalised box or blister pack type device used to aid the

administration o solid, oral medications in accordance with requirements set outby the Pharmaceutical Society o Australia.

S E P

1 Te Veteran has a consultation with the GP to discuss the need and benet o theDAA Service.It is strongly recommended that a Home Medicines Review (MBS 900) beconducted prior to the DAA Service as part o the ongoing care or the Veteran.

Pharmacist claims HMR

S E P

2Te GP is required to ring the Veterans Aairs Pharmaceutical Advisory Centre(VAPAC) 1800 552 580 for two Authority Prescriptions for the six month DAAService. Tis is repeated every six months while the Veteran remains on theprogram.

One Authority Prescription is required or the DAA Service or six months (originalwith 25 repeats)

One Authority Prescription is required or the Veterans Six Month Review (VSMR)Both Authorities can be provided by VAPAC at the beginning o the six monthcycle.

Te GP provides an Authority Prescription to the Veteran or six months (oneweek with 25 repeats).



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S E P

3

S E P

4

Te Veteran receives the DAA weekly rom the Pharmacist or 26 weeks. TePharmacist provides inormation on how to use the DAA and assists the Veteran.

Pharmacist claims 99647N $10 x 26 weeks

After Week 20, the Pharmacist conducts a Veterans Six Month Review (VSMR)using a DVA orm. Te assessment is to ensure that the Veteran is managingwith the DAA and to make a recommendation to the GP or continuing use. Teassessment is axed to the reerring GP.

Pharmacist claims 99648P $100

S E P

5

Te Veteran returns to the GP or a consultation and i the continued use o a DAAis recommended and agreed to by the veteran, the GP is able to prescribe, on

Authority, the DAA Service or a urther six months by returning to Step 2.

Please note:

It is strongly recommended that the veteran receive a Home Medicines Review inconjunction with the DAA Service. However, i the veteran lives in an area whereit is not possible to obtain an HMR, it is at the GPs discretion to prescribe the DAA

Service.VAPAC is the Veterans Aairs Pharmaceutical Advisory Centre Tel: 1800 552 580 and is responsible for the provision of advice regarding theRepatriation Pharmaceutical Benets Scheme (RPBS) providing a prior approvalsservice or medication needing prior nancial approval beore being supplied toeligible beneciaries.



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How to claim for the DAA Service

Te pharmacy can claim the DVA DAA ee in the same way as non-listed PBSitems.

Te two pharmacy services that can be claimed in this way are:

99647N $10.00 x 26For providing the DAA on a weekly basis duringthe six months.

99648P $100.00 For conducting the Veterans Six Month Review.

Te orm or the Veterans Six Month Review is available on the DVA websitewww.dva.gov.au/health/daa/index.htm or by contacting the Veterans AairsPharmaceutical Advisory Centre (VAPAC), telephone 1800 552 580.



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Questions frequently asked by thepharmacist

Can I participate in the DAA program implemented by thePharmacy Guild of Australia?

Yes, participation in the DVA DAA Service does not preclude a pharmacist romparticipating in the Guilds DAA Program.

Do I need to register for the DVA DAA Service?

No.

When can I start providing a DAA to eligible veterans?Te DVA DAA Service commenced on 1 March 2008. Te service was revised rom1 July 2008 to make the service more accessible to veterans.

Does a veteran need to have a Home Medicines Review beforestarting a DAA Service?

It is strongly recommendedthat a veterans medication regime be assessedthrough a Home Medicines Review beore starting the DAA Service or whilethey are using the service. However, i the veteran lives in an area where it is

not possible to obtain a Home Medicines Review, it is at the GPs discretion toprescribe the DAA Service.

How do I claim the DAA Service?

DVA DAA service ees are claimed in the same way as non-listed PBS item ees.

What DAAs are approved for use by the DAA Service?

Eligible DVA DAA devices must comply with the Guidelines and Standards orPharmacists outlined by the Pharmaceutical Society o Australia.

Key elements o the PSA DAA 2007 standards are:1. Te pharmacist ensures that the DAA service provided meets the

consumers needs.

2. Te pharmacist considers the needs and risks associated with provision oa DAA service.

3. Te pharmacist ensures that systems are in place to minimize the risk opacking errors.

4 Te pharmacist packs the DAA with reerence to the consumers current

medication regimen.



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Questions frequently asked by thepharmacist

5. e pharmacist minimises the risk of instability of medicines packed intoa DAA.

6. Te pharmacist ensures that the DAA carries complete details o theconsumer, the medicines and the pharmacy that packed the DAA.

7. Te pharmacist ensures that no medicines returned to the pharmacy arereused.

8. Te pharmacist has a system to ensure that consumers using a DAA areregularly monitored.

9. Te pharmacist ensues that all DAAs are provided to the consumer in atimely manner.

Pharmacists must also comply with relevant State and erritory legislation in theprovision o this service.

NB: Dosette boxes or other DAAs that are not lled by a pharmacist, or are able tobe modied by the consumer, are ineligible or the DVA DAA Service.

DVA does not endorse or promote one brand o DAA over another.

Does the veteran need to consent to the DAA Service?

Yes. Veterans will need to provide oral consent to the DAA Service, consent to theGP and pharmacist sharing the patients medication records, and consent to theDAA Service six-month review.

Does the DAA count towards the Safety Net?

No.

Can the veteran still have a Home Medicines Review?Te DAA Service does notprevent a veteran rom receiving an annual HomeMedicines Review. Te Home Medicines Review should be ordered separatelyrom the DAA Service.

Where can I access more information about the DVA DAAService?

Contact the Veterans Aairs Pharmaceutical Advisory Centre (VAPAC) on180 552 580 or go to DVAs website www.dva.gov.au/health/daa/. Enquiries may

also be sent to [email protected]



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Questions frequently asked by veterans

What do I need to tell the pharmacist?

Your community pharmacy needs to know about all o the medicines (includingnon-prescription medicines) that you are taking so that they can be consideredor the DAA Service. I possible, choose just one pharmacy to dispense all yourprescriptions. Tis will help you and your pharmacist to keep track o yourmedicines. I you use more than one pharmacy, ensure that you hand the newmedicines to the pharmacy supplying your DAA.

How do I use the DAA?

DAAs have special compartments that hold each o your solid medicines (tabletsand capsules) labelled with the day and when in the day you should take them.Your DAA is packed to your requirements by your community pharmacist who willbe able to answer any questions that you might have about it. Your doctor andpharmacist, as a team, monitor your use o the DAA.

How much does it cost?

Eligible veterans are provided the DAA Service ree o charge, but please note that DAA prescriptions do not count towards the saety net. Veterans will still have the

co-payment or the medicines used to ll the DAA.DVA provides the doctor and pharmacist with payments or providing your DAA Service.

How often will I need to visit the pharmacy?

Since DAAs will usually contain enough medicine or seven days, you will need tohave your DAA prescription lled weekly at your community pharmacy. Discussa dierent routine with your pharmacist i this is not suitable. I you are not ableto collect the DAA yoursel every week, a carer may be able to collect it or youor your community pharmacy may have a delivery service. Te cost o a delivery

service is not covered by DVA.

How do I coordinate my prescriptions?

You will still need to obtain prescriptions or the various medicines that are beingused in your DAA. Your community pharmacy will be lling your prescriptions andwill advise you when your prescriptions are running out. Generally, they will adviseyou to see your doctor ater your six-month review which will be undertaken aterreceiving the DAA Service or 20 weeks.

alk to your pharmacist regularly to make sure there are enough prescriptions to

ll your DAA. Without a prescription the pharmacist will be unable to ll your DAA.



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Notes



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Contact Who can use the contact? What is it for?

VAPAC

Veterans Aairs

Pharmaceutical

Advisory Centre

1800 552 580 GPs/LMOs and health

proessionals ONLY.

For DVA DAA Service

enquiries.

Te Pharmacy

Guild of Australia

www.guild.org.

au/pps/pps_

search.asp

GPs/LMOs and health

proessionals.

To search or

pharmacies by

postcode which

provide Proessional

Pharmacy Services,

including DAAs.

DVA 133 254 Health proessionals and

veterans.

For enquiries relating

to DVA services and

benefts.

DVA [email protected] Pharmacists, health

proessionals and

veterans.

To re-order veteran

booklets which can be

provided to veterans

when they frst receive

a DAA.

DVA 1300 556 906 Veterans For veterans enquiriesabout the DAA service

Contacts

VAP01754

05.2009

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dose administration aids - information booklet to pharmacies - department of veteran affairs

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