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Chronic Medication Service

Chronic Medication Service. Objectives. To describe the background and policy context for the introduction of the Chronic Medication Service To outline the general elements of the Chronic Medication Service To look at each of the three stages of the Chronic Medication Service

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Chronic Medication Service

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  1. Chronic Medication Service

  2. Objectives • To describe the background and policy context for the introduction of the Chronic Medication Service • To outline the general elements of the Chronic Medication Service • To look at each of the three stages of the Chronic Medication Service • To share the plans being considered for implementation of the service

  3. Background & Policy

  4. The patient journey • Prescribing • Prescribing error rate 7.5% • Dispensing • Dispensing error rate 3.3% of all items • Compliance / concordance • non-adherence 30-50% • hospital admission due to ADR 2.7% - 6.5%

  5. Building on existing evidence • Repeat dispensing pilots • Paper based trials • Reduce wastage • Improve access • Pharmaceutical Care Model Schemes • Care of the elderly • Chronic disease areas • Medication review

  6. General Description of the Chronic Medication Service

  7. Purpose To ensure patients obtain optimal therapeutic benefit from their medicines and minimise any predictable undesirable effects. Description A system of personalised pharmaceutical care to patients with long term medical conditions. Chronic Medication Service (CMS)

  8. Purpose • Move focus from dispensing to clinical practice and quality • Patient centred, medicines focused • Building on what people already do • Based on a systematic approach • Document practice • Improve continuity of care

  9. GP System CP System Core Infrastructure CHI GP (1000) NSS PSD Patient Registration Service Information Services Division A ePharmacy Message Store Elec msgs via N3 network Payment process Pharmacy (1200) ePay rules engine A Forms sent to PSD Scanning and message processing

  10. The Three Stages Of CMS

  11. Overview Stage 1 Patient registration Community pharmacy Priority profiling Stage 2 Pharmaceutical Understanding care planning Reinforcement Problem solving Informed choice Stage 3 Therapeutic Serial prescribing & partnership dispensing Disease protocol Referral Feedback

  12. Mapping out the processes Patient Registration Notification message Stage 1 Patient Registration Stage 3 Serial Prescription Care plan based on ‘risk’ Risk Assessment Stage 2 Identify Pharmaceutical Care Issues Monitor & Review Formulate Care Plan

  13. Stage 1: Registration • Voluntary opt-in • Patients registers with pharmacy of their choice • Register with one pharmacy • Via the Patient Registration System (PRS) using CHI • Underpinned by explicit patient consent • Eligibility: • Patient must be registered with a Scottish GP practice • Patient must have a long term condition/s • Not resident in a Care Home • GP practice receives an electronic registration notification message

  14. Stage 1: Priority Profiling • Completed within three months of registration • Based on • Medication profile • Questionnaire on medicines and consequences • Yes, No, Not Recorded & free text field • Patient profile • General health • Medical conditions • Allergies & sensitivities • Patient factors • Supported by a web based care planning tool • Assign an overall priority rating: • low, medium or high priority

  15. Stage2: Pharmaceutical Care Planning • The patient and pharmacist • discuss and assess the patient’s condition/s, medicine/s and general health • identify any issues / problems • establish desired outcomes • agree any actions to address them • The pharmacist • documents the issues, desired outcomes and actions using the care plan system • Monitors, reviews and updates the care package • Supported by a web based care planning tool

  16. Web-based care Planning Tool

  17. Pharmacy Care Record • Web based • a secure system (holds patient data) • fully robust (data recovery, data replication to a backup site) • username and password protected • Hosts the pharmaceutical care plan • priority profiling • pharmaceutical care plan • Build in additional applications e.g. PHS?

  18. PCR Search Screen

  19. Search from: PCR Enter patient details Click search If ‘not found’ you can generate a PCR record by uploading data from your PMR PMR Link up from patient record on PMR Information uploaded from PMR: Patient demographics Name Address Postcode Date of birth CHI Gender Telephone number Dispensing history Finding a patient

  20. PCR Medication Details

  21. PCR Priority Profiling: Medication Profile Free text box for notes

  22. PCR Priority Profiling: Patient Profile Record priority based on patient and medication profile: Low, medium, high

  23. PCR Care Planning: Care Issue Summary

  24. PCR Care Plan

  25. Stage 3: Serial prescribing & dispensing • The patient’s GP • Eligibility based on age, medical and maternity exemptions • decides on their suitability for a 24 or 48 week serial prescription • selects dispensing intervals • The pharmacist • dispenses the prescription according to defined intervals • engages with the patient over the time period according to the disease specific protocols • Feedback • dispensing information with each dispensing episode • end of care treatment summary information • dispensing information and any specific relevant care information • can include a request for new serial prescription

  26. Benefits • Improved clinical outcomes • Improved concordance • Reduced wastage • Easier patient journey • Promotion of self care • Better utilisation of the workforce • Encourage team working

  27. Further information… Establishing effective therapeutic partnerships: The Ritchie Report http://www.scotland.gov.uk/Publications/2009/12/08131756/0 NES CMS Implementation Resource Pack: http://www.nes.scot.nhs.uk/pharmacy/newcontract/cms.asp

  28. Implementation

  29. CMS Dates • Commence roll out from 1 April 2010 (final date still to be agreed) • Operationalise working processes from April – September 2010 • CMS ‘live’ from September 2010

  30. Operationalisation Phase • ‘Bedding in’ stage • Phased from April to September • CPs familiarise themselves with eCMS software • Registration • Care planning • Serial dispensing • Reporting • GPs familiarise themselves with eCMS software • Serial prescribing • Managing end-of-care treatment summaries

  31. Current position • All GP and Pharmacy IT system suppliers on course for April delivery • NSS PSD system changes in place • Patient Registration Service (PRS) • ePay • ePharmacy infrastructure in place • ePharmacy Message Store (ePMS) • Pharmacy Care Record (PCR) • Early Adopter phase underway in NHS Fife

  32. National Priorities for Next 2 Months • GP and Practice Manager NES Packs • PCR User Manual • PCR ‘test’ patients for training on PCR • PCR user name and password processes • Identifying a process to issue user names and passwords • Finalising and distributing CMS patient leaflet • CMS disease specific protocols

  33. Supporting Implementation Locally • Local awareness sessions • Identifying community pharmacists who require PCR user names & passwords • Issuing user names & passwords • Agreeing local working processes • Endorsing NES sponsored GP & CP workshops (May & June 2010) • Supporting practitioners during the implementation phase

  34. Milestones • Agree final service specification • During March 2010 • Finalise national implementation plan • During March 2010 • Agree CMS start date • During March 2010 • Delivering CMS! • From April 2010

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