How to conduct
MedsCheck
For patients with Mental Health Conditions
2013
“Tell me and I forget.
Teach me and I remember.
Involve me and I learn.”
Benjamin Franklin
Welcome to the Guild Pharmacy Academy MedsCheck Workshop. This interactive workshop has
been specifically designed to provide you with information on the rules regarding MedsCheck but
more importantly how you can conduct MedsCheck in your pharmacy
The interactive training course involving discussions and workshops will be facilitated by Belinda
Nankivell. Assessment will be carried out at the end of the session by completing a MedsCheck
Worksheet.
Agenda
Welcome, Introduction and aims of MedsCheck, Aim of the
Workshop
Criteria for providing MedsCheck
Patients who meet the criteria for MedsCheck
Strategies to provide the MedsCheck Service
Service Checklist
What MedsCheck is about
What affects Medication Adherence
Communication to be effective
Mental Health Treatment
Documentation and Claiming
Support
MedsCheck Exercise
We trust you get the most out of your Guild Pharmacy Academy training session. We also have
included an Evaluation Form to enable you to let us know what you thought of the session. We
value your opinions and encourage you to share them with us.
Please feel free to contact us any time on (02) 9467-7132 or at:
[email protected].
All the best
Carlene Smith
Carlene Smith
Guild Clinical Co-ordinator Training
LEARNING OBJECTIVES
FACILITATOR
BELINDA NANKIVELL
Belinda Nankivell is a pharmacist and is currently the Quality Care Manager at the Pharmacy Guild of
Australia NSW Branch. She Is a community pharmacist and graduated from the University of Queensland.
Belinda has spent over a decade in community working in all areas of these pharmacies. She was most
recently implementing professional services including MedsCheck, Diabetes MedsCheck and Cholesterol
Testing. Her passion is improving the uptake of pharmacists performing professional activities within
community pharmacy.
MedsCheck
M d Ch k
MedsCheck
Community Pharmacy Service for consumers who Community Pharmacy Service for consumers who live in the community:
live in the community:

 Cardiovascular Disease
Mental Health
Learning Objectives
By the end of the webinar pharmacists will be able to
• Explain the eligibility criteria for MedsCheck
• Discuss the type of questions needed in a MedsCheck to assess the patient’s adherence
• Complete an interview suitable for a patient with
depression
MedsCheck Aim

Identify problems that the consumer may be experiencing with their medicines

Help the consumer learn more about their medicines including how medicines affect medical conditions 
Effective use of medicines by consumers

Educate consumers about how to best use and store Improve the their medicines Investigate problems
Provide education and support
pp
Ensure effective use of medicines
1
Pharmacy Eligibility
 Section 90 pharmacy
 Be a Registered Pharmacist or have access to the services of a Registered Pharmacist through p y
p
employment or service contract relationships
Service Requirements
 Whilst conducting MedsChecks the pharmacist should not be responsible for other professional duties
 Suggest at least TWO registered pharmacists on duty
 Must be conducted in a screened area or separate room distinct from the general public area of the pharmacy.
 Ideally, computer, printer and internet Id ll
t
i t
di t
t
access in the screened or consulting area.
 Access to support resources on health
information, medications and monitoring devices.
www.5cpa.com.au/medscheck 
MedsCheck Consumers Eligibility Criteria  Be a Medicare and/or DVA cardholder;  Have not received a MedsCheck, Diabetes MedsCheck, HMR or
RMMR in the last 12 months;  Be living at home in a community setting;  Be taking five or more prescription medicines
or
the consumer has had a recent significant medical event 
2
Recent significant medical event in a MedsCheck
A significant medical event can be defined as a recent event or new diagnosis that has the potential to impact on the consumer’s medication adherence or knowledge of their medicine regime and may increase the risk of medication misadventure.
www.5cpa.com.au/medscheck 
Promoting your MedsCheck services
Once you have received written approval to provide the service….
 You can organise promotion using the brochures and posters
which are freely available from the Guild
o Download at www.5cpa.com.au/medscheck or order copies from
the 5CPA Help Line 1300 555 262
 Consider the local paper and some editorial space
Strategies for your MedsCheck Services
Once your pharmacy has received written approval DHS (Medicare) to provide the MedsCheck services…….
 Appointment ‐ have diary in the pharmacy
Train staff
staff‐ Assistants and Interns can discuss the service with
Assistants and Interns can discuss the service with
 Train
consumers about and make appointments on a specific day
 Pre‐prepare list of medicines from pharmacy history
 Privacy‐ ensure interruption free, private time
3
Service Checklist
 Outlines the requirements in each stage of the MedsCheck
process
 Available from www.5cpa.com.au
MedsCheck is …..
About Adherence, Education and Self Management
To find out about adherence you need to consider
 What are the factors that reduce adherence?
 What makes people change what they are doing with their medicines? ………………………………………………………..Communication
Adherence can be poor because….
 Lack of knowledge about disease state or medicines
 Lack of understanding about why they are taking their medicines
 Lack of belief that the medicines are working
 Confusion regarding the use of the medicines
 Lack of a routine to take their medicines
What would you  Poor vision
ask to find out about these  Poor hearing
topics?
 Poor dexterity
4
Communication can be crucial!
Asking questions to find out how the consumer feels about their medicines can be affected by the way we ask the question as well as what we ask!
Motivational
Show consideration and empathy
Non judgmental
Aim for better use of medicines
Consider the particular disease states
While there are some basic questions you will need to ask, some disease states will require you to ask extra questions
– Consider:
Patients with Mental Health Conditions
Mental Health Conditions
With Mental Health Conditions, it is important to communicate without being judgmental. It can be a difficult area to broach however adherence issues are significant with mental health patients. It is important to distinguish how well
mental health patients. It is important to distinguish how well they take their medicines.
We always need to start with the basics… what, when, how, why? 5
Mental Health Conditions
 Consider memory issues
 Do you sometimes forget to take your medicines? What
do you do?
 How do you know your condition is controlled?
 Do you feel well?
Do you have more energy?
Are you feeling stressed?
Mental Health Conditions
Other thoughts:
Consider diet and exercise
Consider other drugs and complementary medicines which may interact with anti‐
depressants
Consider some common adverse effects Consider the Types of Depression – Melancholic and Psychotic Depression which have identifiable defining features including observable psychomotor disturbance – Non‐Melancholic Depression includes a group of quite varying conditions. This group is associated with varying
presentations reflecting the contribution of life event stressors and personality style
stressors and personality style
In all three subtypes there is a mood disorder component. The key features include a depressed mood, decline in self esteem, self‐criticism, the mood state is present for at least 2 weeks and causes social impairment.
http://www.blackdoginstitute.org.au/healthprofessio
nals/depression/ourmodelofdepression/index.cfm
6
Treatment of Depression • For Melancholic Depression, ECT is highly effective.  Broader spectrum antidepressants are more effective than
’narrow spectrum’; TCAs,  MAOIs are better than > SNRIs (venlafaxine, mirtazapine,
duloxetine) > SSRI and other single‐action drugs.
 The superiority of TCA over SSRI antidepressants increases
The superiority of TCA over SSRI antidepressants increases
with age.
If antidepressant alone fails, brief augmentation of an antipsychotic may ‘kick‐start’ response
http://www.blackdoginstitute.org.au/healthprofessio
nals/depression/ourmodelofdepression/index.cfm
Treatment of Depression • For Psychotic Depression, there is a much greater dopaminergic contribution
 There is a need for a broad‐action antidepressant strategy, which is most generally achieved by an antidepressant plus
an antipsychotic drug
http://www.blackdoginstitute.org.au/healthprofessio
nals/depression/ourmodelofdepression/index.cfm
Treatment of Depression • Non‐Melancholic Depression is a serotonergic dysfunction
which probably underpins depressed mood features, and (commonly) drives anxiety  An SSRI is the treatment of choice if medication is
indicated.
• Psychological treatments play a key role in addressing:  personality vulnerabilities
 current stressors
 patient priorities
http://www.blackdoginstitute.org.au/healthprofessio
nals/depression/ourmodelofdepression/index.cfm
7
Issues to consider
• Check timing of doses
 Morning: SSRI’s, MAOI’s
 Night: TCA’s
• Side effects
 Be aware how they affect compliance eg weight gain
Serotonin Syndrome
Glucose intolerance
• Changing antidepressants
and wash out periods
Documentation

Once you have all the information, you can help the consumer improve their knowledge of the condition and
the medicines

If you find information consistent with adverse effects……………… you can recommend an HMR

If you find non adherence is an issue ……………………………...you can recommend a DAA

Give the consumer their medication list and the report should be attached and file all consultation documentation
for 7 years
Documentation and claiming
 There are 2 forms for Claims:
 MedsCheck Program Claim cover sheet
 MedsCheck Program Payment Application
 MedsCheck fee $60 (GST exempt)
$
 Claims submitted to DHS (Medicare) by the 14th of the month routinely paid in the next month
 File all consultation documentation for 7 years
8
Claiming Resources to help you
www.5cpa.com.au






Program Specific Guidelines
Factsheets & FAQs
PSA Standards and Guidelines
MMR Terms and Conditions
QCPP checklist
myCPD online MedsCheck modules – www.mycpd.org.au
Support and information
Visit: www.5cpa.com.au Email: [email protected] Phone:1300 555 262
TIP: make www.5cpa.com.au a favourite
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MedsCheck Worksheet
Name_
Mrs Gabriel Small is a long standing patient and is taking
1.
2.
3.
4.
5.
6.
Metoprolol 100mg bd
Perindopril 8mg d
Sertraline 100mg 1 d
Paracetamol 500mg 2 tds prn
Ventolin Inhaler 2 qid and prn
Fentanyl patch 5mg use as directed
Issues
Compliance
Pharmacy
Phone
Email
Questions
PRN meds Other meds
Self Sufficiency
B li f
Beliefs
Knowledge
Usefulness of meds
Adverse effects
Storage
Out of date meds
Lifestyle
Any other issues
Guild Clinical
The Pharmacy Guild of Australia NSW Branch
Thank you for your attendance, we hope you find MedsCheck
a useful service to offer to your patients
your patients
10
The Guild Pharmacy Academy
Professional training for community pharmacy including:
• All Pharmacists
• Interns
• Pharmacy Assistants
• Pharmacy Managers
Incorporating:
• Guild Training (Pharmacy Assistants)
• Guild Clinical Training (Pharmacists, Interns)
• Guild Intern Training (Interns)
• Guild Business Training (Pharmacists, Interns, Pharmacy Assistants, Pharmacy Managers)
My CPD
As part of national registration all pharmacists will need to keep records of their continuing
professional development (CPD) and you can record your CPD @ www.guildtraining.com.au
Any pharmacist may use this website to keep track of their CPD points, as required under
national registration. The site also includes a calendar of CPD eligible events for each State
and Territory.
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Telephone:
(02) 9467 7130
Facsimile:
(02) 9467 7165
Email:
[email protected]
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(Pharmacists, Interns)
Telephone:
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Facsimile:
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Email:
[email protected]
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(Pharmacists, Interns, Pharmacy Assistants, Pharmacy Managers)
Telephone:
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Facsimile:
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Email:
[email protected]
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(Interns)
Telephone:
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