Review of pharmacy services for high needs

10 November 2010

BY RAJESH KUMAR Pharmacists have the opportunity to have their

say on the way pharmacy services are delivered for people living in aged
care and community residential support services. DHB New Zealand
has released two discussion documents on the subject and is inviting
views of consumers, pharmacists, carers and interested sector groups
about how pharmacy services currently cater for people in such facilities
and what improvements should be made. The documents titled
Community Pharmacy Service Options for People in Age related
Residential Care and Community Pharmacy Service Options for People
with Disabilities living in Community Residential Support services are
available through the DHB NZ website here. Pharmacists have until 30
November 2010 to provide their feedback, either through a website or by
emailing the completed survey to PharmacyARRC@dhbnz.org.nz for the
age-related residential care survey; or use a website or email
PharmacyCommunity@dhbnz.org.nz for the community residential
support services survey.

Pharmac also inviting feedback Concurrent to the above, Pharmac is also

inviting pharmacy feedback on the review of Pharmaceutical Schedule rules
related to close control, distribution of special foods and higher cost products
to patients following recommendation by the Pharmacy Services Steering
Group (See further below). The Pharmaceutical Society is encouraging all
pharmacists to read all the documents (Pharmac and DHBNZ) and provide
feedback before 30 November. “This is your opportunity to influence the
direction of a key part of the Pharmacy Services Agreement (PSA),” chief
pharmacist advisor Euan Galloway says. The DHBNZ and Pharmac
documents will contribute to the 2011 PSA between DHBs and community
pharmacists. The process is being overseen by a steering group, representing
DHBs, Pharmac, pharmacies, primary care and the Ministry of Health. DHBs’
spokesperson Sharon Kletchko, in a written statement, says it is the first time
in many years that a review has been carried out that looks at the needs of
specific groups of people with high health needs, medicine use, hospital
admissions and care requirements. “We want to understand more about
how, and how well, pharmacy services currently support best health and
wellbeing outcomes for residents and whether a new or revised service model
could operate more effectively and efficiently,” she says. The DHBs also
intend to make better use of pharmacists’ clinical skills through medication
management services and want to align these with the new pharmacy
contract scheduled to come into force on 1 September next year. The project
is supposed to go through three stages between October 2010 and May 2011.
The first two stages provide opportunities to hear the views of people living in
residential care as well as key members of the multidisciplinary team: such as
practitioners, pharmacists and facility staff and national professional
organisations and advocacy groups. After consideration of the discussion
document feedback, a formal consultation proposal will be released following
which a preferred service model will be finalised. In the third phase, DHBs will
consult pharmacy agents on service directions for the pharmacy agreement
from 1 September 2011 and develop an agreement package. DHBs also
want to consult on improving the design of the pharmacy service model. The
current model includes dispensing and supply of medications, provision of
advice and counselling, maintenance of patient records, compliance with
legislative requirements, and maintenance of linkages with related
professional services. These services are currently paid for on a fee-for-
service basis, with each prescription item attracting a fee of $5.30 plus 4%
mark up. “We want to understand whether the current service, funding and
contracting design is the most effective way to provide services to the people
in age residential care who have high health needs, are on multiple
medications, and may have frequent hospital admissions,” the consultation
document on aged care services says. “We are interested in your feedback
on design options that might be safer, more effective in using pharmacists’
clinical skills and provide better value within the funding available.” Dr
Kletchko hopes the discussion documents will be circulated widely throughout
the sector and affected individuals and groups will take the time to complete
the survey questions. “People in age related care facilities and supported
accommodation represent a significant percentage of pharmaceutical
consumers. They are often frail and vulnerable and without close advocates
so it is important their voice is heard,” she says. Review of Pharmaceutical
Schedule rules Pharmac is also inviting pharmacy feedback on the review
of Pharmaceutical Schedule rules related to Close Control, distribution of
special foods and higher cost products to patients following recommendation
by the Pharmacy Services Steering Group. The group comprising
representatives of community pharmacy, DHB, Pharmac, Ministry of Health
and primary care has agreed to five strategic projects that will contribute to
the shape of the 2011 Community PSA. This review covers three of them.
Pharmacists have until 30 November to send their feedback either by email
to schedule.review@pharmac.govt.nz or by fax (04 460 4995) or mail (PO
Box 10-254, Wellington 6011). They can also complete the survey online
Pharmac will consider the feedback in December and expects that proposals
for each project will be issued for consultation in late January 2011, with a
formal consultation with the sector throughout February 2011. The
Pharmaceutical Schedule rules being reviewed to determine whether the
current Close Control rules are effective in managing access to certain
pharmaceuticals for eligible patients, and if changes are required, consider
which other services should or could be specifically reimbursed; examine
options for the distribution of special foods to patients and review the
mechanisms for distributing higher cost products to eligible patients. The
review follows on from Pharmac’s pharmaceutical subsidy eligibility & delivery
review in October last year and the January 2010 Special Foods consultation
proposal to change access criteria and funding for a number of special foods.
Pharmac says the recent changes announced by the government to
regulations under the Medicines Act 1981 are not included in the scope of this
consultation document. The timing of the above consultation coincides with
the earlier mentioned DHB reviews of community pharmacy services to aged
related residential care and community supported accommodation. This is to
enable people to consider the DHB and Pharmac discussion documents
together, because of the linkages between them. Contact Rachel Mackay on
04 9167508, 021 911 865, or rachel.mackay@pharmac.govt.nz for any
clarification