Dose Administration Aid Service - information for General Practitioners and Local Medical Officers

The right dose

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Overview of the Dose Administration Aid Service

The Dose Administration Aid (DAA) Service builds on DVA’s Quality Use of Medicines programs, which include the Veterans’ Medicines Advice and Therapeutics Education Services (Veterans’ MATES) program, and aims to assist the veteran community to get the most out of their medicines and to reduce medication mismanagement.

The benefits from the DAA Service are far greater when provided in conjunction with a Home Medicines Review (HMR), Medicare Benefits Schedule Item 900. DVA therefore strongly recommends that veterans be referred by their GP for a HMR in regions where this service is available.

The DAA Service provides veterans, war widows and other eligible DVA clients a DAA at no cost, in conjunction with the ongoing care of their doctor and pharmacist. The need for a DAA may be identified by the veteran, carer, community nurse, GP or pharmacist.

The Pharmaceutical Society of Australia’s Guidelines and Standards (July 2007), refer to a Dose Administration Aid (DAA) as a tamper-evident, adherence device developed to assist medication management for a consumer by having medicines divided into individual doses and arranged according to the dose schedule throughout the day.  It can be either a unit-dose pack (one single type of medicine per compartment) or a multi-dose pack (different types of medicines per compartment). The term medicine includes prescription, non-prescription and complementary medicines.

The DAA is packed by the pharmacist who is required to comply with the Guidelines and Standards for pharmacists outlined by the Pharmaceutical Society of Australia.

The veteran receives the DAA Service on prescription from the GP for six months and is assessed near the end of this period by the pharmacist, who provides a report of the assessment to the GP. 

For further information on Home Medicines Reviews, Medicare Benefits Schedule Item 900, go to the following websites:

The Australian General Practice Network
Medicare Australia
The Pharmacy Guild of Australia

 

The term ‘veterans’ when used throughout this booklet refers to all eligible DVA clients.

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Aims

To improve veterans’ health outcomes through better, safer use of medication.

Objectives

  • better health;
  • lower mortality;
  • improved medication adherence;
  • reduction of solid medicines in veterans’ homes;
  • better health records; and
  • a cost effective service.

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Clinical evidence brief

Commencing in 2000 the University of Queensland carried out a 12-month randomised controlled trial of DAA usage involving 1010 veterans and war widow(ers) living in the community.  The study recommended implementation of a DAA program for veterans residing in the community.

Key Findings

  • Most users and health professionals found DAAs beneficial. The benefits included:better health
    • lower mortality
    • improved medication adherence
    • reduction of solid medicines in veterans’ homes
    • improved accuracy of doctors’ records.

The benefits of DAA usage may also be attributed to the additional focus of medical professionals during the administration of the DAA Service.

  • Those who benefited most from the DAA Service were:
    • severely ill veterans;
    • non-adherent veterans;
    • veterans who struggled to handle their medicines;
    • veterans who required assistance with activities related to daily living; and
    • veterans with a carer and a complex medication routine.
  • Those who may not benefit from the DAA Service:
    • have fewer than five solid oral medications;
    • may stop taking a medicine if they feel better; and
    • are on medicines not appropriate to be packed into a DAA such as liquids, suppositories, inhalers, or medicines that need to be refrigerated.

DAA Service – important information

  • GPs must obtain verbal consent from the veteran according to the eligibility criteria before they contact the Veterans’ Affairs Pharmaceutical Advisory Centre (VAPAC) to obtain an Authority Prescription for the veteran to commence the DAA Service.
  • Any registered GP may provide these services to veterans, however, only GPs who are registered as a Local Medical Officer (LMO) with Medicare Australia may claim the higher MBS fee that DVA pays LMOs (115% of the MBS fee for consultations and medical procedures). LMOs also receive a Veterans Access Payment for each item of service.
  • The term  ‘LMO’ and ‘GP’ are used interchangeably within this document.
  • The DAA Program to be implemented under the Australian Government’s 4th Community Pharmacy Agreement with the Pharmacy Guild of Australia provides for all patients.  The DVA DAA Service provides a different service for veterans through a coordinated approach linking the DAA to a recommended Home Medicines Review (Medicare Benefits Schedule Item 900) with regular ongoing assessment by the Pharmacist and GP.
  • Only Accredited Pharmacists can conduct a Home Medicines Review in accordance with the Medicare Benefits Schedule Item 900.
  • Section 90 (National Health Act 1953) pharmacies can provide a DAA Service, and conduct a Veterans Six Month Review (VSMR).
  • Section 92 and 94 (National Health Act 1953) pharmacists are unauthorized to provide the DAA Service.
  • The Pharmaceutical Society of Australia’s professional standards underpin the provision of DAAs in Australia, including the DVA DAA Service.
  • Gold, White and Orange card holders are eligible for the DAA Service.
  • DVA Orange Card holders are able to participate in the DAA Service as part of the established free pharmaceutical service, however, they are required to pay for related medical treatment.  This means GPs are required to directly invoice all Orange Card holders using the DAA Service for the assessment of the Veteran’s Six Month Review (VSMR) under DVA item CP42

It is strongly recommended that you inform all Orange Card holders using the DVA DAA Service that:

  • they will be expected to have out-of-pocket expenses related to this Service.  At a minimum this could total $100 ($50 x 2) per year for item CP42.
  • they will not be able to claim a rebate from Medicare Australia or DVA for item CP42.
  • the Service does not count towards the Australian Government Pharmaceutical Safety Net.
  • they are required to pay for the prescribed medication packed in the DAA at a concessional rate.

Eligibility Criteria for the Service

  1. Patients must hold either a Gold, White or an Orange Repatriation Card.
  2. Veterans must be living in the community and not residing in a Residential Care Facility (either low level or high level care), hostel or hospital.
  3. Veterans must meet the criteria for a Home Medicines Review, Medicare Benefits Schedule Item 900. For more information on Home Medicines Review criteria, see Home Medicines Review (HMR) page on the Medicare Australia website.
  4. Veterans must be likely to benefit from the DAA Service. Doctors and pharmacists should consider whether:
    • Veterans are confused about which medicines to take, when to take them, or what they are for;
    • Veterans have a lot of medications or a complex regime;
    • Veterans have reported non-adherence; or
    • Veterans require help with activities of daily living
  5. Veterans must provide verbal consent to:
    • Having a Home Medicines Review, (if it is possible to receive this service), and the Veterans Six Monthly Review involving the community pharmacy, registered pharmacists, and other health professionals involved in their care;
    • Communication between their health care professionals, especially pharmacists and GPs;
    • Providing their DVA file number or card to the pharmacist and Medicare Australia for payment purposes;
    • Meeting any additional costs not covered by DVA including additional GP consultations (especially Orange Card holders);
    • Providing all solid oral medicines (including relevant non-prescription medicines) to their community pharmacy for packing;
    • Receiving the DAA weekly or fortnightly from the community pharmacist;
    • Informing the pharmacist of any changes to their medicines in a timely manner; and
    • Having the community pharmacy providing information to DVA to enable DVA to monitor and assess the veterans’ needs and the effectiveness of the intervention.

Steps for the veteran in using the DAA Service

The DAA Service is provided to you in 4 steps during a six-month cycle.

Ongoing care is provided by the the GP and pharmacist so that aservice is provided rather than simply a device.

Veterans Process Diagram

Download the printable version of the Veterans Process Diagram (PDF 549Kb)

 

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How to be involved

The GP’s role is to identify veterans who would benefit from the DAA Service, and to provide the Authority Prescriptions to allow the veteran to receive this service.

GPs will continue to be involved by monitoring veterans’ progress, and discussing the outcome of the Veterans Six Monthly Review with the pharmacist.

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Providing DAA prescriptions to veterans

Authority Approval

Prescriptions for the DVA DAA Service are provided to veterans through the normal Repatriation Pharmaceutical Benefits Scheme (RPBS) Authority approval process. GPs need Veterans’ Affairs Pharmaceutical Advisory Centre (VAPAC) Authority approval, which can be given over the phone (Free call 1800 552 580). Authority approval is required to prescribe the DVA DAA Service six-month cycle and for the Veterans Six Month Review.

Structure of the prescription

A prescription should be provided to the veteran for one weekly DAA with 25 repeats. Another prescription should be provided for the Veterans Six Month Review.

The pharmacist’s role

Pharmacists will provide DAA packs to veterans weekly and continually monitor the veteran’s progress. The pharmacist should check on the veteran’s progress each time a new DAA is collected, and is required to conduct a formal review towards the end of the six-month cycle (the Veterans Six Month Review).

In order to maintain continuity of supply to those veterans who are using their DAA successfully, this review must be provided to the GP towards the end of the six month period.

The Dose Administration Aid Service outline and summary of fees for LMOs

DVA DAA Service Flow Chart
30 April 2009

The DVA DAA Service provides a Dose Administration Aid (DAA) at no cost to eligible veterans.

To be eligible veterans must hold either a Gold, White or Orange Repatriation Card.Veterans who reside in a Residential Care Facility, hostel or are in hospital are not eligible.

A DAA is a compartmentalised box or blister pack type device used to aid the administration of solid or oral medications in accordance with requirements set out by the Pharmaceutical Society of Australia.

 

A veteran, or veteran’s spouse, carer, friend, pharmacist or community nurse may identify that the veteran is not managing their medication well, or the veteran may already be using a DAA, and would like to use the DVA DAA Service.
Step 1 The Veteran has a consultation with the GP to discuss the need and benefit of the DAA Service. The GP obtains verbal consent and explains that information will be shared with the Pharmacist.

GP claims MBS consultation item

 

 A Home Medicines Review (MBS 900) is strongly recommended prior to the DAA Service as part of the ongoing care for the Veteran.

GP claims MBS 900, Pharmacist claims HMR
Step 2 The GP is required to ring the Veterans’ Affairs Pharmaceutical Advisory Centre (VAPAC) 1800 552 580 for required Authority Prescriptions:
  • One Authority Prescription for the DAA Service for six months (original with 25 repeats)
  • One Authority Prescription for the Veterans Six Month Review (VSMR).  This Authority can be obtained at a later date prior to the VSMR.
This is repeated every six months while the Veteran remains on the program.

 

The GP provides an Authority Prescription to the Veteran for six months (one week with 25 repeats).
Step 3 The Veteran receives the DAA weekly from the Pharmacist for 26 weeks. The Pharmacist provides information on how to use the DAA and assists the Veteran.

Pharmacist claims 99647N $10 x 26 weeks
Step 4  

After Week 20, the pharmacist conducts a Veterans Six Month Review (VSMR) using a DVA from.  The VSMR ensures the veteran is managing with the DAA and makes a recommendation to the GP about continuing use.  The assessment is faxed to the referring GP.  The Pharmacist claims for the VSMR using the Authority prescription provided by the referring GP.

Pharmacist claims 99648P $100
Step 5 The Veteran returns to the GP for a consultation and if the continued use of a DAA is recommended and agreed to by the veteran, the GPi s able to prescribe, on Authority, the DAA Service for a further six months by returning to Step 2.

GP claims MBS consultation and CP42 $50

Please note;

  • A Home Medicines Review is strongly recommended in conjunction with the DAA Service for veterans.  However, if an HMR is not possible locally, prescribing the DAA Service is at the GP’s discretion.

VAPAC is the Veterans’ Affairs Pharmaceutical Advisory Centre. Tel: 1800 552 580 and is responsible for advice regarding the Repatriation Pharmaceutical Benefits Scheme (RPBS) and providing an approvals service for medication needing approval before supply to eligible beneficiaries

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Claiming process for LMOs only

DVA will pay 115% of the MBS fee to Local Medical Officers (LMO) who also receive a Veterans  Access Payment (VAP) for each eligible item of service.  No separate charges may be made for a DVA beneficiary.

The VAP can be claimed in accordance with the LMO Fee Schedule which can be accessed on the Service Providers section of this website.

NB: No VAP is eligible to be paid to LMOs or GPs claiming the Veterans Six Month Review (CP42) item.

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Claiming process for other general practitioners

Other GPs, that is those who are not LMOs, are paid 100% of the MBS fee (and 60 cents) for consultations provided to veterans.  For the DVA DAA Service, non-LMOs are able to claim the CP42 DVA item (assessment of the  Veterans Six Month Review) and will receive the full payment of $50 for this service.

Non-LMOs can also claim the Medicare Bulk billing Incentive item numbers 10990 or 10991 when providing eligible bulk billed services to veterans.

Please note, non-LMOs are not eligible to claim the Veterans Access Payment for consultations provided to DVA patients.

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Item CP42

A CP42 is $50 remuneration for the GP/LMO to case conference with the Community Pharmacist to discuss the recommendations of the VSMR, the veteran’s performance in managing their medication regimen while using a DAA, and the veteran’s suitability for a further six months use of the DVA DAA Service.  GPs and LMOs may claim Item CP42 when the veteran returns to the GP for a consultation and the outcomes of the case conference have been discussed with the veteran in this follow up consultation.  The GP may claim a MBS consultation item at the same time as Item CP42.

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Questions frequently asked by GPs/LMOs

Do I need to refer the veteran for a Home Medicines Review?

Since most veterans are elderly and often suffer from a number of chronic medical conditions that require multiple medications, it is strongly recommended that that they be referred for a Home Medicines Review (HMR) in accordance with the Medicare Benefits Schedule Item 900.  The HMR report will be able to identify if the veteran will benefit potentially from the DAA Service.

If the veteran has had an HMR in the last six months and wants to receive the DAA Service, you must assess whether the veteran requires another HMR or can begin the DAA Service without it.

If there are no qualified pharmacists in your region to provide a HMR, DVA will accept the GP’s recommendation that the veteran will benefit from the DAA Service.

Can the patient still have a Home Medicines Review?

The DAA Service does not prevent a veteran from receiving an annual HMR. The HMR should be ordered separately to the DAA Service.

Does the patient need to consent to the DAA Service?

Yes. Patients will need to provide verbal consent to the DAA Service, consent to the GP and pharmacist sharing the patient’s medication records, and consent to the DAA Service Veterans Six Month Review.

Does the DAA count towards the Safety Net?

No.

Where can I access more information about the DVA DAA Service?

Contact DVA for further information. Enquires may also be sent to DAA@DVA.gov.au

Who can I contact to obtain an Authority Prescription?

Contact the Veterans’ Affairs Pharmaceutical Advisory Centre (VAPAC) on 1800 552 580.

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Questions frequently asked by veterans

How often will I need to visit the GP?

You will need to visit your GP to:

  • discuss the need for the DAA Service
  • obtain a referral to your pharmacist for a Home Medicines Review if this service is available for you in your community
  • obtain a prescription for a DAA Service for six months
  • obtain a prescription for a Veterans Six Month Review
  • obtain prescriptions from your doctor for medicines which your pharmacist will pack into a DAA for you
  • discuss your regular six month review.

How do I use the DAA?

DAAs have special compartments that hold each of your solid medicines (tablets and capsules) labeled with the day and when in the day you should take them.  Your DAA is packed to your requirements by your community pharmacist who will be able to answer any questions that you might have about it. Your doctor and pharmacist as a team monitor your use of the DAA.

How much does it cost?

Eligible veterans are provided the DAA Service free of charge, but please note that DAA prescriptions do not count towards the safety net. DVA pays the doctor and pharmacist for providing your DAA Service.

What do I need to tell the pharmacist?

Your community pharmacy needs to know about all of the medicines (including non-prescription medicines) that you are taking so that they can be considered for the DAA Service.  If possible, choose just one pharmacy to dispense all your prescriptions. This will help you and your pharmacist to keep track of your medicines. If you use more than one pharmacy, ensure that you hand the new medicines to the pharmacy supplying your DAA.

How often will I need to visit the pharmacy?

Since DAAs will usually contain enough medicine for seven days, you will need to have your DAA prescription filled weekly at your community pharmacy. Discuss a different routine with your pharmacist if this is not suitable. If you are not able to collect the DAA yourself every week, a carer may be able to collect it for you or your community pharmacy may have a delivery service.

What consent is required?

You will be asked to provide verbal consent to the DAA Service, your GP and pharmacist sharing your health records, and the six-month review.

Do I need to register for the DVA DAA Service?

No.

When can I start providing a DAA to eligible veterans?

The DVA DAA Service commenced on 1 March 2008. The service was revised from 1 July 2008 to make the service more accessible to veterans.

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Veteran Six Monthly Review (VSMR) Form

Veteran Six Monthly Review (VSMR) Form
This form is to be completed ONLY after the veteran's 20th week of DAA use.

 

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