Pharmacy Practice Incentive (PPI) Program Clinical Intervention Definitions $97 million over the life of the Agreement (5 years)
Clinical Intervention - Definitions A clinical intervention: is a professional activity by the pharmacist directed towards improving the quality use of medicines and resulting in a recommendation for a change in the patient s: medication therapy; or medication-taking behaviour; or means of administration
Definitions continued A clinical intervention is the process of a pharmacist identifying, and making a recommendation in an attempt to prevent or resolve, a Drug Related Problem (DRP). There may be circumstances where other pharmacy staff may initially identify a possible DRP. This MUST be referred to a pharmacist to actually perform and document the intervention.
Definitions continued A DRP is an event or circumstance involving drug treatment that actually or potentially interferes with the patient experiencing an optimum outcome of medical care.
Definitions continued A clinical intervention MUST relate to a medicine, however the intervention does not need to occur at the time the medicine is dispensed or sold. A medicine must be included on the Australian Register of Therapeutic Goods (ARTG) available at (www.tga.com.au) and can fall under any of the following categories: Prescripti on Non- Prescription Over the counter (OTC) Scheduled (S2/S3) non-scheduled Complementa ry NOTE: For easy identification all medicines have either AUST L or AUST R on the label.
Under PPI a clinical intervention does NOT include: Routine prescriptionrelated counselling Generic medicine substitution CMI provision Definitions continued Activities undertaken during: HMR; RMMR; Medscheck; or Diabetes Medscheck services
Pharmacy Practice Incentive (PPI) Program Clinical Intervention Pharmacy Eligibility
Eligibility to participate and receive incentive payments Approved Section 90 pharmacy Maintain registration at www.5cpa.com.au Maintain accreditation by an approved Pharmacy Accreditation Program (such as QCPP) Must continue to publicly display and comply with the Community Pharmacy Service Charter and Customer Service Statement Meet all PPI Program requirements as outlined in the PPI Program Specific Guidelines (including QCPP requirements) Retain all records for auditing purposes for min. 2 years
Pharmacy Practice Incentive (PPI) Program Clinical Intervention Accreditation Requirements
Accreditation Requirements Eligible Community Pharmacies MUST deliver and record Clinical Interventions to the quality Standard. The Quality Care Pharmacy Program (QCPP) will audit all participating pharmacies every two years (accreditation cycle) to ensure this requirement is met.
Accreditation Requirements continued QCPP tools and resources available to assist with the delivery and recording of Clinical Interventions to the quality Standard. QCPP Requirements Manual (2011 edition) QCPP Fast Track resources Excellence Newsletter (bi-monthly) www.qcpp.com
Accreditation Requirements continued Participating pharmacies MUST develop a Clinical Interventions Policy as outlined in the QCPP Requirements Manual. P2H Clinical Interventions Policy Develop your policy File policy in your Operations Manual Update Table of Contents Source: Extract from the QCPP Requirements Manual (2011 Edition)
Accreditation Requirements continued Participating pharmacies MUST meet the mandatory requirements in the Clinical Interventions Checklist outlined in the QCPP Requirements Manual. T2G Clinical Interventions Checklist (mandatory requirements) Maintain access to approved guidelines for clinical interventions (i.e. PSA Standards and guidelines) Maintain and follow a system for providing clinical interventions (i.e. Clinical Interventions Policy) Maintain and follow a system for communicating with prescribers and other relevant health care professionals Maintain and follow a recording system for clinical interventions including the recording of specific details (If participating in the PPI Program the D.O.C.U.M.E.N.T. classification system MUST be used for recording) Source: Extract from the QCPP Requirements Manual (2011 Edition)
Accreditation Requirements continued Source: Extract from the QCPP Requirements Manual (2011 Edition)
Pharmacy Practice Incentive (PPI) Program Clinical Intervention Recording
Recording Clinical Interventions The D.O.C.U.M.E.N.T. classification system MUST be used when recording Clinical Interventions under PPI, however interventions under the M.E.N. components of the classification system cannot be claimed.
D.O.C.U.M.E.N.T. Classification system Drug Related Problem D Drug Selection O Over or under-dose C Compliance U Undertreated M Monitoring E Education N Not Classifiable T Toxicity or adverse reaction Recording continued All classifications should be used when delivering and recording clinical interventions however the M.E.N. components of this classification system cannot be claimed under the PPI Program.
Drug Related Problem continued D Drug Selection Duplication (D1) Drug Interaction (D2) Wrong Drug (D3) Incorrect strength (D4) Inappropriate dosage form (D5) Contraindication apparent (D6) No indication apparent (D7) Other drug selection problem (D0) O Over or under dose Prescribed dose too high (O1) Prescribed dose to low (O2) Incorrect or unclear dosing instructions (O3) Other dose problem (O4) C Compliance Underuse by patient (C1) Overuse by patient (C2) Erratic use of medication (C3) Recording continued Intentional drug misuse including nonprescription medicines (C4) Difficulty using dosage form (C5) Other compliance problem (C0) U Undertreated Condition undertreated (U1) Condition untreated (U2) Preventive therapy required (U3) Other undertreated indication problem (U0) T Toxicity or Adverse Reaction Toxicity, allergic reaction or adverse effect present (T1)
D.O.C.U.M.E.N.T. Classification system continued Recommendation Recording continued Change of therapy Referral required Provision of information Monitoring Other When recording clinical interventions under the D.O.C.U.M.E.N.T. classification system you must also record a recommendation as outlined in the PSA Standards and guidelines
D.O.C.U.M.E.N.T. Classification system continued Recording continued Recommendation Change of therapy Dose increase (R1) Dose decrease (R2) Drug change (R3) Drug formulation change (R4) Drug branch change (R5) Dose frequency/schedule change (R6) Prescription not dispensed (R7) Other changes to therapy (R8) Referral required Refer to prescriber (R9) Refer to hospital (R10) Provision of information Education or counselling session (R13) Written summary of medications (R14) Recommend dose administration aid (R15) Other written information (R16) Monitoring Monitoring: Laboratory (R17) Monitoring: Non-laboratory test (R18) Other No recommendation necessary (R19) Refer for medication review (R11) Other referral required (R12)
The Pharmaceutical Society of Australia (PSA) has developed: Recording continued Standards and guidelines for pharmacists performing clinical interventions; and An online learning module on clinical interventions These include an explanation of the D.O.C.U.M.E.N.T. classification system and examples of how to use it. Available from www.5cpa.com.au and www.psa.org.au
Recording continued The following situations are clinical interventions and should be recorded under the D.O.C.U.M.E.N.T. classification system: The pharmacist identifies potential over-use or duplication of medicines, or overtreatment of conditions. The pharmacist identifies the need for preventive therapy, such as the requirements for adequate intake of calcium and vitamin D in a consumer with osteoporosis. The pharmacist identifies a medical condition (e.g. poorly controlled hypertension) which may require enhanced therapy or improved medication adherence. Source: Extract from the PSA Standard and guidelines for pharmacists performing clinical interventions
Upon a consumer request for non-prescription pain relief subsequent to the use of an HMG CoA reductase inhibitor (statin), the pharmacist uncovers a possible myopathy-associated DRP. Recording continued The following situations are clinical interventions and should be recorded under the D.O.C.U.M.E.N.T. classification system: A consumer requests further information regarding medicine or disease management. The pharmacist dispenses a repeat prescription from another pharmacy, and identifies that it had been previously dispensed incorrectly. Source: Extract from the PSA Standard and guidelines for pharmacists performing clinical interventions
Routine consumer counselling and provision of CMI, such as when a consumer has been dispensed a new medicine. Recording continued Many activities undertaken by pharmacists are NOT clinical interventions and should NOT be claimed under the PPI Program, these include: Routine assessment or management of minor ailments, such as provision of symptom relief for cold and flu, or assessment and treatment of allergic rhinitis. Substitution of medication brand unless the recommended brand has a unique characteristic to assist in the resolution of a DRP (e.g. calendar pack, braille, glutenfree). events (e.g. Administrative medicine ordering, prescription processing, determining PBS eligibility). Source: Extract from the PSA Standard and guidelines for pharmacists performing clinical interventions
Recording continued The PSA Standards and guidelines also include: a Paper-based recording for clinical interventions template; and downloadable DOCUMENT DRP and recommendation classification codes table
Recording continued Pharmacies can also record clinical interventions using an electronic system. The use of an electronic system will deliver a range of benefits as outlined: Ability to create reports for claiming incentives Providing evidence for pharmacy accreditation program assessments Integrating with the Personally Controlled Electronic Health Record (PCEHR), when available Facilitating the reporting of adverse drug reactions and Using the data for evaluation.
Electronic systems currently available to record clinical interventions: Guildcare Aquarius Corum FRED NOTE: when using any electronic system to record clinical interventions under the PPI Program ensure you use the D.O.C.U.M.E.N.T. classification system. Recording continued This list of electronic systems (software) available to record clinical interventions was correct as at June 2012
Date of the intervention Pharmacist performing intervention Patient identifier (does not need to be patient name, can be unique number) Patient age range (not specific age) Patient gender Medicines involved Recording continued Whether you use a paper-based or electronic system to record clinical interventions the information recorded should be the same. You must include: Clinical notes detailing the intervention and any relevant medical history Classification of the intervention Recommendation/follow-up actions Any communication with other health care professionals or consumer/agent NOTE: The above information to be recorded is consistent across the PPI Program, QCPP Clinical Interventions Checklist and PSA Standard and guidelines Any other relevant information
Pharmacy Practice Incentive (PPI) Program Clinical Intervention Claiming
Clinical Interventions Incentive Payments Eligible pharmacies will be paid 4 times per year for meeting the PPI and QCPP requirements when delivering a clinical intervention. Payments are calculated based on a complex formula for each claiming period that considers: the available funding pool for that period; no. of pharmacies claiming for that period; service volume (no. of Clinical Interventions for that period); and claimable prescription volume for that period.
Claiming Incentive Payments Periodic payments 4 times per year Eligible Community Pharmacies must lodge a VALID Pharmacy Practice Incentive Periodic payment application form (claim form) to Medicare by the Claim Due Date for each eligible Claiming Period NOT fee for service Claim form available on the Medicare website or www.5cpa.com.au
Claiming continued Must provide the total number of clinical interventions recorded under D.O.C.U.T. for the eligible Claiming Period.
The claim form MUST be completed correctly and lodged with Medicare no later than the Claim Due Date for each eligible Claiming Period to be VALID. Pharmacy name Pharmacy address Claiming continued Pharmacy PBS Approval Number Eligible Claim Period applicable and year Total number of clinical interventions recorded under D.O.C.U.T. classifications throughout the claiming period Source: Extract from the QCPP Requirements Manual (2011 Edition) Authorised Pharmacist s name, signature and date
IMPORTANT If your pharmacy has a change in circumstances such as a change of PBS approval number you MUST: 1.Notify QCPP within 14 days and complete a Change of Pharmacy Status form available at www.qcpp.com and fax to QCPP on 02 6270 1885 AND Claiming continued 2.Amend the pharmacy s PPI Registration on the 5CPA website using the link contained in the 5CPA Registration Receipt Notification email and your 4 digit PIN code. If your PBS approval number is not current with QCPP or on the PPI registration system your PPI payments will be delayed.
Pharmacy Practice Incentive (PPI) Program Clinical Intervention Pathway to other Professional Services
Pathway to other Professional Services Performing clinical interventions may provide a pathway to other professional services if appropriate, such as: Dose Administration Aids HMR or RMMR Medscheck or Diabetes Medscheck Staged Supply service Disease State Management and/or Screening and Risk Assessment services DR P
Pharmacy Practice Incentive (PPI) Program Clinical Intervention Working with Others
Clinical Interventions and Working with Others Collaborations with other health professionals registered with AHPRA resulting from a clinical intervention should be documented as evidence for the Working with Others priority area if the pharmacy is participating in this PPI. To perform clinical interventions in an efficient manner, it is critical to have effective collaboration with, and communication between, relevant members of the healthcare team, including GPs, medical specialists, other pharmacists, consumers, carers, nurses and other healthcare providers. * * Extract from the PSA Standard and guidelines for pharmacists performing clinical interventions
Official PPI Program Information and Resources www.5cpa.com.au PPI Registration PPI Program Specific Guidelines Forms (claim form and declaration) The Charter (and Statement) FAQs Brochures (PPI and Charter) Factsheets (PPI Priority Areas, Claiming and Recording) DAA Worksheet Support: 5cpa Help Line 1300 555 262 or support@5cpa.com.au and State Based officers (Guild Branches)
Additional resources to assist in delivering the PPI Program Pharmacy Accreditation Program (QCPP) www.qcpp.com QCPP Requirements Manual -Policies -Procedures -Templates QCPP Fast Track resources QCPP Excellence Newsletter Support: QCPP State Managers QCPP Helpline Professional Practice Standards and guidelines www.psa.org.au Standards and guidelines for pharmacists providing DAAs, Clinical Interventions and Staged Supply. Online learning for Clinical Interventions and Staged Supply Paper template for recording Clinical Interventions Electronic recording options currently available Guildcare Clinical Interventions Staged Supply Primary Health Care Working with Others Dispensing and other Software Clinical Interventions recording e.g. Aquarius, Corum, Fred, etc.