Transcript AMS / CMS Update

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
• To share the plans being considered for
implementation of the service
Background & Policy
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%
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
General Description of the
Chronic Medication Service
Chronic Medication Service
(CMS)
Description
Purpose
• A system of
personalised
pharmaceutical care
to patients with long
term medical
conditions.
• To ensure patients
obtain optimal
therapeutic benefit
from their medicines
and minimise any
predictable undesirable
effects.
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
Core Infrastructure
GP
(1000)
CHI
NSS PSD
Patient
Registration
Service
A
Information
Services
Division
GP System
Elec msgs
via N3
network
ePharmacy
Message
Store
Payment process
Pharmacy
(1200)
ePay rules engine
A
Forms sent to PSD
CP System
Scanning and message
processing
The Three Stages Of CMS
Overview
Stage 1
Patient registration
Community pharmacy
Priority profiling
Stage 2
Pharmaceutical
care planning
Understanding
Reinforcement
Problem solving
Informed choice
Stage 3
Therapeutic
partnership
Serial prescribing &
dispensing
Disease protocol
Referral
Feedback
Mapping out the processes
Patient
Registration
Notification
message
Stage 1
Patient Registration
Stage 3
Serial Prescription
Risk Assessment
Stage 2
Care plan
based on
‘risk’
Identify Pharmaceutical
Care Issues
Monitor & Review
Formulate Care Plan
Stage 1: Registration
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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
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
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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
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
Web-based care Planning Tool
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?
PCR Search Screen
Finding a patient
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
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Name
Address
Postcode
Date of birth
CHI
Gender
Telephone number
• Dispensing history
PCR Medication Details
PCR Priority Profiling:
Medication Profile
Free
text box
for
notes
PCR Priority Profiling:
Patient Profile
Record priority
based on patient
and medication
profile:
Low, medium, high
PCR Care Planning:
Care Issue Summary
PCR Care Plan
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
Benefits
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Improved clinical outcomes
Improved concordance
Reduced wastage
Easier patient journey
Promotion of self care
Better utilisation of the workforce
Encourage team working
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/ne
wcontract/cms.asp
Implementation
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
Operationalisation Phase
• ‘Bedding in’ stage
• Phased from April to September
• CPs familiarise themselves with eCMS software
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Registration
Care planning
Serial dispensing
Reporting
• GPs familiarise themselves with eCMS software
– Serial prescribing
– Managing end-of-care treatment summaries
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
National Priorities for Next 2 Months
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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
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
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