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

Purpose

• To ensure patients obtain optimal therapeutic benefit from their medicines and minimise any predictable undesirable effects.

Chronic Medication Service Chronic Medication Service (CMS)(CMS)

Description

• A system of personalised pharmaceutical care to patients with long term medical conditions.

PurposePurpose

• 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

A

A

GP (1000)

Pharmacy (1200)

NSS PSD

GP System

CP System

ePharmacyMessage

Store

InformationServicesDivision

Payment processElec msgs

via N3 network

Elec msgs via N3

network

CHI

Forms sent to PSD

PatientRegistration

Service

ePay rules engine

Scanning and messageprocessing

Core Infrastructure

The Three Stages Of CMS

OverviewOverview

Stage 1 Patient registration Community pharmacyPriority profiling

Stage 2 Pharmaceutical Understandingcare planning Reinforcement

Problem solvingInformed choice

Stage 3 Therapeutic Serial prescribing & partnership dispensing

Disease protocolReferralFeedback

Mapping out the processes

Patient Registration

Risk Assessment

Serial Prescription

Identify Pharmaceutical Care Issues

Monitor & Review Formulate Care Plan

Care plan based on

‘risk’

Patient RegistrationNotification

message

Stage 1

Stage 2

Stage 3

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

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

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– 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

• 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/newcontract/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

– 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

• 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