Dose Administration Aid Service - Information for Pharmacists
The right dose - Information Brief for Pharmacists

Important changes to the DAA Service

Effective from 30 April 2009, it will no longer be necessary for Pharmacists to fax the Veteran Six Monthly Review (VSMR) Form to DVA (VAPAC).  The requirement to fax the completed VSMR form to the referring GP is still important as this must be received by the GP before an ongoing authority prescription can be issued by DVA (VAPAC).

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

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

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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.

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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
    • 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, or
    • are on medicines not appropriate to be packed into a DAA such as liquids, suppositories, inhalers, or medicines that need to berefrigerated.

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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 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 registred as a Local Medical Officer (LMO) may claim a higher MBS fee.
  • The term  ‘LMO’ and ‘GP’ are used interchangeably within this document.
  • The DAA Program 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 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.
  • 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.

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Eligibility Criteria for the Service

  1. Veterans must hold  either a Gold, White or 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. For more information 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
    • having the community pharmacy providing information to DVA to enable DVA to monitor and assess the veteran’s needs and the effectiveness of the intervention.

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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

Pharmacists may identify that a veteran is having difficulty in managing their medicine and the veteran could benefit from a DAA.  The pharmacist may suggest to the veteran that they seek a prescription for a DAA Service from their GP.

A veteran may already be using a DAA and be paying for this service. The veteran is eligible to receive the DVA service, free of charge, if it is prescribed by the GP.

It is strongly recommended that the veteran be assessed through a Home Medicines Review (Medicare Benefits Schedule Item 900) so that recommendations can be made to the GP in relation to the veteran’s medication regime and whether the veteran would benefit from or is continuing to benefit from a DAA.

If the service of a qualified Home Medicines Review pharmacist is not available DVA will be advised by the GP at the time the GP seeks an authority prescription from the Veterans’ Affairs Pharmaceutical Advisory Centre.

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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 to begin a six-month cycle and for the Veterans Six Month Review.

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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.

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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).

DVA provide a VSMR form for the pharmacist to complete while interviewing the veteran. The interview may take place in the pharmacy or in the veteran’s home.

The completed review must be provided to the veteran’s GP before an ongoing authority prescription can be issued by DVA (VAPAC).

The GP will need to take into account the recommendations from the pharmacist’s review and discuss with the veteran the benefit of continuing to use the DAA.

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Standards and Guidelines

In providing the DAA Service the pharmacist must comply with the Pharmaceutical Society of Australia (PSA) DAA Service Guidelines and Standards.

PSA has developed four checklists to assist pharmacists with: planning, implementing and maintaining a DAA service; formalising a DAA service with the consumer; packing the consumer's DAA; and confirming and meeting the consumer's DAA service needs.

For further information on the PSA Guidelines and Standards, go to Dose Administration Aids Service page on the Pharmaceutical Society of Australia website.

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

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 form. 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 (VSMR) 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 GP is 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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How to claim for the DAA Service

The pharmacy can claim the DVA DAA fee in the same way as non-listed PBS items.
The two pharmacy services that can be claimed in this way are:


99647N

$10 x 26

For providing the DAA on a weekly basis during the six months.

99648P

$100.00

For conducting the Veterans Six Month Review.

Veteran Six Monthly Review (VSMR) Form

This form is to be completed ONLY after the veteran's 20th week of DAA use:

Veteran Six Monthly Review (VSMR) Form

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Questions frequently asked by the pharmacist

Can I participate in the DAA program implemented by the Pharmacy Guild of Australia?

Yes, participation in the DVA DAA Service does not preclude a pharmacist from participating in the Guild’s DAA Program.

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.

Does a veteran need to have a Home Medicines Review before starting a DAA Service?

It is strongly recommended that a veteran’s medication regime be assessed through a Home Medicines Review before starting the DAA Service or while they are using the service. However, if the veteran lives in an area where it is not possible to obtain a Home Medicines Review, it is at the GP’s discretion to prescribe the DAA Service.

How do I claim the DAA Service?

DVA DAA service fees are claimed in the same way as non-listed PBS item fees.

What DAAs are approved for use by the DAA Service?

Eligible DVA DAA devices must comply with the Guidelines and Standards for Pharmacists outlined by the Pharmaceutical Society of Australia.

Key elements of the PSA DAA 2007 standards are:

  1. The pharmacist ensures that the DAA service provided meets the consumer’s needs.
  2. The pharmacist considers the needs and risks associated with provision of a DAA service.
  3. The pharmacist ensures that systems are in place to minimize the risk of packing errors.
  4. The pharmacist packs the DAA with reference to the consumer’s current medication regimen.
  5. The pharmacist minimizes the risk of instability of medicines packed into a DAA.
  6. The pharmacist ensures that the DAA carries complete details of the consumer, the medicines and the pharmacy that packed the DAA.
  7. The pharmacist ensures that no medicines returned to the pharmacy are reused.
  8. The pharmacist has a system to ensure that consumers using a DAA are regularly monitored.
  9. The pharmacist ensues that all DAAs are provided to the consumer in a timely manner.

Pharmacists must also comply with relevant State and Territory legislation in the provision of this service.

NB: Dosette boxes or other DAAs that are not filled by a pharmacist, or are able to be modified by the consumer, are ineligible for the DVA DAA Service.

DVA does not endorse or promote one brand of DAA over another.

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 six-month review.

Does the DAA count towards the Safety Net?

No.

Can the patient still have a Home Medicines Review?

The DAA Service does not prevent a veteran from receiving an annual Home Medicines Review. The Home Medicines Review should be ordered separately from the DAA Service.

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

Contact the Veterans’ Affairs Pharmaceutical Advisory Centre (VAPAC) on 1800 552 580 or go to DVA’s website www.dva.gov.au/health/daa/. Enquires may also be sent to DAA@DVA.gov.au

Questions frequently asked by veterans

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 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 without the requirement of a co-payment, but please note that DAA prescriptions do not count towards the safety net. DVA provide the doctor and pharmacist with payments for providing your DAA Service.

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. The cost of a delivery service is not covered by DVA.

How do I co-ordinate my prescription?

You will still need to obtain prescriptions for the various medicines that are being used in your DAA. Your community pharmacy will be filling your prescriptions and will advise you when your prescriptions are running out. Generally, they will advise you to see your doctor after your six-month review which will be undertaken after receiving the DAA Service for 20 weeks.

Talk to your pharmacist regularly to make sure there are enough prescriptions to fill your DAA. Without a prescription the pharmacist will be unable to fill your DAA

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