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Medication Review in the Walk-in Setting

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Sarah Zhao

on 26 April 2013

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Transcript of Medication Review in the Walk-in Setting

Applying the Pharmacy Services Framework Medication reviews in the walk-in setting Goals of Presentation Final Thoughts 1) Explore the steps involved in the completion of a comprehensive annual care plan (CACP) or a standard medication management assessment (SMMA) in the walk-in setting.

2) Discuss the potential challenges to completing medication reviews in this setting and possible solutions. -A member of the Alberta Health Care Insurance Plan
-The resident meets the criteria of "complex needs" as defined by the Compensation Plan for Pharmacy Services document.
-The resident or resident's agent has provided written consent.
-The med review can be done in person with a pharmacist registered under the clinical registrar. Who qualifies? Follow up! Now What? There is a Clinical Services Tracking Sheet that can be faxed to Melanie at PFC along with all the documentation.

In the walk in setting, it may be easier to just see the entire process through and bill right after the documentation.

CACP: $100
SMMA: $60
+ 25% with APA

Follow ups: $20 +25% with APA The Part Where We Can Make Some Money -Scanning to Kroll?

-Automatic reminders for med reviews based on patient's medical histories?

-Advertising to patients?

......There are definitely still kinks to iron out and the procedure will change with each changing policy. There will always be trial and errors but finding the balance will never happen if there is no try. Scheduling The challenge: there are many variables in the walk-in setting that impact your ability to conduct a medication review.

1) Pharmacists overlap
2) The patient's time
3) Your own time
4) Access to the EHR and patient's medical history

As a result, scheduling a medication review can be a hairy process!

BE FLEXIBLE! Even if you schedule a time with a patient, things can change. This is why you must have a process in place. Always have a stack of medication review forms ready at your disposal, know what kind of "go to"documents you like to use, and get familiar with the patient's history ahead of time, if possible. Chronic Diseases -Hypertensive Disease
-Diabetes Mellitus
-Heart Failure
-Ischaemic Heart Disease
-Mental Health Risk Factors -Tobacco
-Obesity (BMI >35)
-Addiction SMMA: one chronic disease and minimum 4 schedule 1 medications. CACP: a minimum of 2 chronic diseases or 1 chronic disease and 1 risk factor First of all: why do we do this? 1) Pharmacists are starting to play more of a clinical role in their day to day interaction with patients.
2) There is more emphasis on interdisciplinary collaboration.
3) With budget cuts to pharmacy, making use of the Pharmacy Services Framework will bring in funding and also have tangible proof of pharmacists' interventions in patients'health

Mr. Winnie Thepooh walks into your pharmacy, Hundred Acre Wood Drugs, for a refill on his metformin tablets.

Looking at his pharmacy profile, you realize that Mr. Thepooh recently transferred all his prescription medications to your pharmacy so you are not very familiar with his medical history. You wonder if he would qualify for a CACP (comprehensive annual care plan) or a SMMA (standard medication management assessment). Case Study Thankfully, you have Netcare open and are able to see from a physician consultation that Mr. Thepooh has an approximate BMI of 36. You know that Mr. Thepooh has diabetes since it is acceptable to confirm an official diagnosis from the patient’s prescription drug history. Mr. Thepooh would qualify for a CACP! You wonder how you can go about to make the time for a medication review. Case Study The Assessment "What is your biggest concern regarding your medications today?" A complete medication list
if packaging patient: use their compliance label
for all others: Kroll has a variety of printable reports that can generate a medication list. Ex: plain paper TMR, medication review...or stick with the old fashioned handwritten BPMH
Consultations on Netcare (great for gathering diagnoses and medical history)
6-12 months lab flow sheet on Netcare (great for monitoring parameters)
6-12 months of medications on Netcare (great for checking polypharmacy and compliance) Your Tools TIP! Melanie at PFC will print and fax these off to you if you call and give her ample time. If you find yourself doing a review on the spot you may not have time to grab all this information. In this case: aim for a medication list from Kroll and a lab flow sheet. All other information can be gathered from the patient.

This is the case with Mr. Thepooh. Let the patient's chief concern guide your process.

Focus on 2 or 3 DRPs that can be implemented first and allow follow ups to occur for the rest. You don't want to overwhelm yourself or the patient.

Follow the medication review form as it will prompt you to ask all the demographic questions.

This is the part that really relies on your own process and having all the information you can access available to you. Implementing the care plan How do both parties stay accountable? Having an action plan helps summarize the main DRPs for the patient and can act as a copy of their care plan.
Writing down the actions creates accountability for both the patient and pharmacist. Physician actions can also help patients keep their doctors accountable as well as summarize the care plan for the physician.
It can be easily filled out during the medication reviews and handed to the patient at the end. Use your own action plan to keep yourself accountable. If you say you will follow up in 2 weeks, make sure to schedule yourself in.

The easiest way to do this is use Kroll's "follow up"or "notes"notifications. The patient's "encounters"notes can also link directly to a follow up.

Make sure that the original careplan is documented and stored in the respective binder so that someone else can easily pick up where you left off. Note: right now billable follow ups have to be done in person but may soon change to include phone follow ups! Case Study S: Mr. Thepooh admits that cost is a big issue for him, o bother. His strips are getting expensive and he uses 4 a day to test his sugar levels. Plus he seems to always get some diarrhea every time he takes his metformin in the morning when he wakes up and right before he goes to bed.
O: A1C done 7 months ago was 6.1%. Sugars trend between 7-9 according to his logbook. Mr. Thepooh has been following his exercise regimen (30 minute moderate tree climb everyday) in an attempt to shed some weight and has been cutting back on the honey intake. Mr. Thepooh only takes metformin for diabetes.
A: Metformin does not cause low sugars and testing 4 times a day on a steady regimen is only going to contribute to cost. A1C suggests good control but has not had a test done recently. Taking metformin with food may alleviate diarrhea symptoms. Who gets what copy? Patient: a copy of the most accurate medication history and the care plan

Physician: a copy of the care plan. Summarize in a letter and get to the point. Are there actions that you require from the physician or is this for information only. If an action is required, list the choices along with the safety and efficacy parameters. The action plan given to the patient is also a good thing to fax so the physician knows what the patient knows.

Pharmacy: all documentation must be stored for 10 years. Can bill only once a year

Can bill as often as needed within reason Questions???
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