Editor’s Note: Klaus Petrulis is the CEO of Persocare, a company involved in the supply of Dose Administration Aids (DAA’s) for pharmacist packaging of patient medicines for a variety of settings.
PersoCare has a point of difference in their alliance with a system called Rx Right, a system for use in aged care facilities.
Customised software enables pharmacies to take advantage of the opportunities presented by “The Better Community Health Initiative”.
In a recent press release from the Department of Health and Ageing on the 20th August 2007 it was stated that...
"Older patients and people taking multiple medications are set to benefit from better packaging of their medicines by pharmacists.
The Commonwealth Government has provided up to $72.9 million to the Pharmacy Guild of Australia through the Fourth Pharmacy Agreement for the Dose Administration Aids program.
The program provides support to community pharmacists to help patients manage their medication by packaging it into individual doses that are arranged according to the dose schedule throughout the day. The packaging can be either a unit-dose pack (one single type of medication per compartment) or a multi-dose pack (different types of medication per compartment).
Participation in the program will be open to all community pharmacies nationally.
Information and registration forms will be available on the Pharmacy Guild of Australia’s web site during September 2007. All community pharmacies should also receive the kit in the mail during September and October.
Pharmacies can be eligible for payments totalling up to $13,700 over the course of the program (to the end of the Fourth Agreement in June 2010). To be eligible for payment, pharmacies need to register with the Department of Health and Ageing and provide complete and timely data during the course of the program."
Since the announcement that funding would become progressively available for the provision of Dose Administration Aids (DAA’s) services, through provisions contained in the Fourth Agreement, there have been many calls for information to fill a range of knowledge gaps.
It is already official that Veterans Affairs Department will provide $6.9 million over 4 years, to help veterans manage their medications more efficiently.
This was a result of a survey done by Prof. Michael Roberts at the University of Queensland. The assistance to veterans to manage medications programme is expected to start from March 1st 2008.
This program will see the implementation of a DAA service to eligible community pharmacies and will investigate which patients most benefit from the use of DAA as well as the clinical and cost effectiveness of the service as a health intervention.
This will be done in 2 stages.
The DAA Program
Stage 1 will be from late 2007 until June 2009 and will see pharmacist provided with a Service Incentive Payment for the provision of DAAs to community patients in line with their normal practice. This allows further investigation and evaluation to determine:
• Patient eligibility
• Identifying patient eligibility
• Pharmacy costs for the provision of DAAs
• The frequency and cost of repacking due to medication changes
• Patient’s willingness to pay a contribution
• The facilitators and barriers to providing the service
• The personal health benefits and costs involved in providing the service.
Stage 2 will be from July 2009 to 2010 and is anticipated to introduce a subsidised DAA service to eligible community patients based on information obtained during Stage 1.
This should see a subsidised DAA service:
• Provided in line with peer review professional guidelines
• Provided to at-risk patients who will most benefit from
• Providing for pharmacists to identify patient eligibility
• With a suitable payment model for pharmacy
(accounting also for updates and repacks)
• Which may include an acceptable patient contribution that will not deter those patients who would most benefit from DAA
The service developed and implemented within Stage 2 will also be evaluated for ongoing funding.
At the moment The Pharmacy Guild of Australia (PGA) is still negotiating a suitable payment. Some figures bandied around are that the Veterans Affairs will contribute $10.00 per patient per week.
The DAA national program and figure has not been fixed yet but $5000-$8000 per pharmacy per annum has been discussed as a starting point.
During Stage 1 pharmacy will receive a service incentive payment and be entitled to charge a patient contribution as per current practice. In return we are to provide information for evaluation purposes to assist in development of service protocols for Stage 2.
The DAA subsidised pharmacy under this program will need to:
• Identify the patient in line with professional guidelines;
• Include drug identification for individual compartments in line with professional guidelines;
• Pharmacies that supply DAA packs should provide interaction between the patient and the pharmacist and to allow pharmacist monitoring of the patient’s medication management; and
• Have tamper-evident packaging and provide against contamination (eg disposable).
• Devices which cannot be sealed, nor protect against contamination will not be acceptable for subsidisation;
• Devices in which individual compartments can be separated from the main pack will be required to have patient ID, dosage time and medication ID on each individual compartment; and;
• Situations requiring supply for periods of time longer than 7 days will be at the pharmacist’s discretion and shall be supplied as the exception rather than the rule.
In order to participate as a DAA provider, pharmacies must:
• Be a section 90 approved community pharmacy;
• Have the necessary equipment and software;
• Provide DAAs according to professional guidelines and program protocols;
• Have a location within the pharmacy to allow private interview with the patient of required (as for providing counselling or discussing health problems within a pharmacy setting);
• Apply to and be approved by Medicare Australia to be a DAA provider;
• Agree to provide DAAs to and collect data from a specified number of patients for evaluation purposes;
• Agree for inclusion of pharmacy details on a DAA provider register; and ensure staff are aware of professional guidelines and service protocols.
There will be randomised audits to ensure that participating pharmacies are providing the service in line with the program guidelines and protocols.
Patient Eligibility criteria for Stage 2
During Stage 1 pharmacists will provide DAAs in accordance with professional guidelines and current practice.
Data will be collected for a specified number of community patients (as informed by program evaluator) who;
• Are assessed by the pharmacist to benefit from the use of a DAA;
• Have a valid Medicare or DVA card;
• Have consent to use a DAA;
• Consent to the collection and provision of de-identified information for
evaluation purposes; and
• Are not in an aged-care home, correctional facility or hospital
Patient Eligibility criteria for Stage 2 will be determined from the information collected during Stage 1. Criteria to be investigated will be determined by the program evaluators in consultation with the Program Advisory Group and is anticipated to include factors such as:
• Unintentional versus intentional non-adherence;
• Patient age;
• Number of medications in patients regime;
• Patients living status (living alone, use of carers etc.);
• Referral of patient from external sources;
• Health management (e.g. Aboriginal Health Service, Community Mental Health Care Team, others)
All patient contributions for DAA service are GST free.
Stage 1 pharmacies will be paid service incentive payment of approximately $5000 per annum.Stage 2 suitable payment made for pharmacy will be developed.
Evaluators will access the clinical and cost effectiveness of the service, particularly that within stage 2 for review of ongoing funding beyond the 4th Agreement.
Funding for packing of medications for community is a step in the right direction towards assisting individuals in maintaining a correct medication regime and maintaining the best possible health outcomes.