Page 46 - Demo

CONTINUING PROFESSIONAL DEVELOPMENT
SUPPORTING PHARMACY PRACTICE
Assessing the need
A patient may be considered a candidate for the staged supply service by a health care professional such as their doctor or pharmacist for a number of reasons, including1,4:
• history/risk of medicine abuse, misuse or diversion
• history/risk of self-harm or harm to others
• inappropriate home environment to store
medicines (e.g. situations where there is a
possibility of theft)
• confusion surrounding medicines
• concern or history of poor adherence
• the class of medicines taken
• regulatory requirements (e.g. treatment orders).
The reasons mentioned above may also influence the interval between collections.5 Initially an unstable patient may be on shorter intervals such as daily, and as they become more stable and can manage their medicines better, the interval may increase.5 Exceptions to the staged supply interval may be necessary for pharmacy closures, public holidays and patient circumstances. The patient, pharmacist and prescriber should work together to arrange alternative supply arrangements in these situations.
Medicines which are commonly seen in a staged supply program include4:
• antipsychotics
• anxiolytics
• hypnotics and sedatives
• antidepressants
• opioid analgesics
• psychostimulants.
This is by no means an all-inclusive list, and most medicines can be considered.
How to provide staged supply
A staged supply service involves the initial dispensing of the medicine plus re-packing the required quantity of medicine into an appropriate container with appropriate labelling for each supply.6 As the medicine is held at the pharmacy it is important to store it according to Commonwealth and state/territory legislation, and in a manner that maintains privacy and confidentiality.1
Before initiating a staged supply service with a patient, an agreement should be signed which outlines the expectations and responsibilities
of everyone involved in the service. Both the pharmacist and consumer/agent should keep a copy of the record.1 The PSA standard and guidelines provide details of what should be included in the service agreement. It is important that a patient is
aware of what the service involves and is involved in the partnership, as having a good understanding initially can reduce issues and misunderstandings at a later date.1
A staged supply record form should be kept,
which should include the patient’s name and address, prescriber details, medicine details (name, strength, form), dosing instructions and supply interval. At each supply the date and time should
be recorded, as well as how many tablets and number of days supplied, tablets remaining, and the pharmacist’s and patient’s signature. Other notes such as payment details and reminders for a new prescription may also be included in a comments column. However, a separate communication document may also be used. See Appendix 3 of the PSA standard and guidelines for a staged supply record template.1
Keeping accurate records is crucial as patients may attempt to claim their medicines sooner than the supply period allows, state they have not been given the correct number of tablets, or may just be confused as to when they presented last.1 Record- keeping is also important when there are changes in pharmacy personnel (e.g. locum pharmacists), and provides information on consumer adherence to the staged supply arrangements.1
The medicine should be re-packed into an appropriate container and labelled correctly, including appropriate ancillary labels, at each supply.6
Financial component
Applying a service fee to your staged supply service is not mandatory and is a choice for your pharmacy to make. As the service takes time, with tasks such as re-packing medicines and counselling, and requires additional consumables, when considering a fee pharmacies should consider both the individual consumer’s circumstances and the activities required that are likely to incur a cost.1 According to the staged supply review in 2010 (before remuneration was offered via PPI claiming) a service fee of around $5 was charged by most pharmacies.4 It should be noted that cost may be a barrier to some patients utilising the service, therefore a blanket cost may not be appropriate in all situations.1
As mentioned previously, under the 6CPA pharmacies that meet the requirements are able
to receive annual incentive payments for the
staged supply service.2 All community programs and services, including the staged supply service, administered under the 6CPA will be reviewed by an independent health technology assessment group to assess clinical and cost effectiveness.7,8
“Before initiating a staged supply service with
a patient, an agreement should be signed which outlines the expectations and responsibilities of everyone involved in the service.”
44 Australian Pharmacist January 2017 I ©Pharmaceutical Society of Australia Ltd.