Department of Health | Welcome to the Department …...RMMR Evaluation Appendix A - Methodology Department of Health and Ageing CR&C 1074 Please note that, in accordance with our Company’s

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Evaluation of the Residential Medication Management Review

Program

Appendix A Methodology

Prepared for

Department of Health and Ageing

GPO Box 9848 Canberra ACT 2601

May 2010

RMMR Evaluation Appendix A - Methodology


CR&C 1074

TABLE OF CONTENTS

1. Methodology ....................................................................................................................... 1

1.1 Key stages for the project ............................................................................................ 2

1.2 Desktop Research........................................................................................................ 2

1.3 Stakeholder Consultations ........................................................................................... 3

1.4 Call for Submissions .................................................................................................... 3

1.5 Qualitative Research with Health Professionals .......................................................... 7

1.6 Quantitative component—Accredited Pharmacist Case Studies............................... 11

1.7 Qualitative component of the Case Studies............................................................... 15

1.8 Quantitative Research with Health Professionals...................................................... 15

2. Qualitative Research Discussion Guides ...................................................................... 20

2.1 Accredited Pharmacists Discussion Guide ................................................................ 20

2.2 Non-RMMR Community Pharmacies Discussion Guide............................................ 24

2.3 Non-RMMR Community Pharmacist Discussion Guide............................................. 26

2.4 Director of Nursing Discussion Guide........................................................................ 28

2.5 GP Discussion Guide ................................................................................................. 31

INDEX OF FIGURES

Figure 1: Project Plan Diagram .....................................................................................................2

Figure 2: Advertisement for the Call for Submissions...................................................................4

INDEX OF TABLES

Table 1: Table of Submitters ........................................................................................................5

Table 2: PhARIA regions..............................................................................................................9

Table 3: Field visit locations .........................................................................................................9

Table 4: Health Professionals interviewed by PhARIA Region..................................................11

Table 5: PhARIA Regions Covered............................................................................................13

Table 6: Accredited Pharmacists Survey Field report ................................................................17

Table 7: GP Survey Field report.................................................................................................18

Table 8: Aged Care Home Survey Field report ..........................................................................19



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Please note that, in accordance with our Company’s policy, we are obliged to advise that neither

the Company nor any member nor employee undertakes responsibility in any way whatsoever

to any person or organisation (other than the Department) in respect of information set out in

this report, including any errors or omissions therein, arising through negligence or otherwise

however caused.



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1. Methodology

In collaboration, Campbell Research & Consulting and the Department developed a multi-

faceted methodology. A wide range of views were sought to inform this evaluation, from peak

bodies and stakeholder organisations through to everyday health professionals. This approach

sought to maintain the independence of the research, ensuring that no single group or

stakeholder had any significant influence on those recruited to participate, or on the research

findings. The key research stages (Figure 1) included:

• Desktop research, including Review of RMMR data provided by Medicare

Australia through the Department

• Consultations with stakeholder organisations and peak bodies (the

Stakeholder Consultations)

• A publicly advertised call for submissions (the Call for Submissions)

• Qualitative research with grass roots health professionals (the Qualitative

Research).

• Quantitative surveys administered to Aged Care Homes (ACHs), GPs,

Accredited Pharmacists and non-Accredited Pharmacists

• Diary-based case studies conducted with Accredited Pharmacists,

encompassing qualitative interviews with the pharmacist, a GP and a DON

from one of the ACHs where they provide Reviews, and analysis of a diary

kept by the pharmacists for the period of a month while they conducted

Reviews.

The earlier stages of the project were used to inform subsequent stages and provide

hypotheses to be tested.



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1.1 Key stages for the project

Figure 1: Project Plan Diagram

1.2 Desktop Research

Campbell Research coordinated the analysis of RMMR data provided by the Department. These

data included claiming data from RMMR Providers. Campbell Research also reviewed a range

of relevant documents, including policies and guidelines from the Department and Medicare

Australia and from the Pharmaceutical Society of Australia (PSA) and other organisations. In

addition Campbell Research looked at the prior review of the RMMR program, conducted in

1999.

Phase 1

Desktop

Research

Phase 2

Stakeholder

Consultations

Phase 3

Call for

Submissions

Project

Establishment

Final Report

Phase 5

Quantitative

Research –

Health

Professionals

Phase 6

Case Studies—

Accredited

Pharmacists

Phase 4

Qualitative

Research –Health

Professionals



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1.3 Stakeholder Consultations

The objective of the Stakeholder Consultation stage was to capture a range of views from

people with experience of different aspects of the RMMR Program to add depth to the

Department’s understanding of professional and community perceptions of, and experiences

with, the RMMR Program.

The lines of enquiry for the Stakeholder Consultations were designed to focus on the views of

experts in the field who were involved in policy development and implementation. A range of

questions were developed to address the overall project objectives. The emphasis of the

stakeholder consultations varied according to the experience and perspective of stakeholders.

A flexible questioning technique was maintained, as different stakeholder groups worked at

different levels of the RMMR Program and responded from different perspectives.

Stakeholder organisations were sent a primary approach letter, introducing the qualitative

research project and advising them that the person in the organisation most knowledgeable

about the current implementation and/or practice of conducting RMMRs would be invited to

participate in an interview. Follow up calls were made by Campbell Research staff to secure

interviews with appropriate stakeholders.

Interviews were conducted face-to-face where possible, with a mixture of telephone interviews

when this was more cost effective and convenient for the respondent. Interviews were

approximately 45 minutes to one hour in length. Stakeholders were asked for permission for

recording of the interview and were reassured about confidentiality of the interview.

Over June and July 2009, seven in-depth interviews were conducted with stakeholders from a

range of organisations including:

• Medicare Australia

• Australian Association of Consultant Pharmacy

• Pharmacy Guild of Australia

• The Society of Hospital Pharmacists of Australia

• Pharmaceutical Society of Australia

• National Prescribing Service

• Aged and Community Services Australia (ACSA)

An important component of the stakeholder consultations was the advance notice of the Call for

Submissions, together with the facilitation of communication to the constituents of the

stakeholders consulted of the Submission process. Stakeholders foreshadowed their intention

to submit a more detailed and considered submission through the Call for Submissions process.

1.4 Call for Submissions

The Call for Submissions aimed to expand on the views identified in the Stakeholder

Consultations and information gathered during the desktop and qualitative research stages, to

facilitate attributable, detailed and considered input by stakeholders, interested parties and the

community beyond those explicitly invited or recruited to participate.



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On 18 July 2009 the Call for Submissions was advertised in the national press (The Australian

newspaper), on the Department’s website and distributed through Stakeholder channels.

Submissions were accepted by Campbell Research in digital or hardcopy format over a period

of four weeks. Over this period 67 submissions were received, from a range of stakeholder

groups including: Academics (3); GPs (2), accredited and non-Accredited Pharmacists (21);

Aged Care Homes (18); Health Services (11); Peak Bodies (12) (Table 1).

The Submissions were manually reviewed to identify key themes and salient issues, which were

then considered in light of the project objectives.

Figure 2: Advertisement for the Call for Submissions



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Table 1: Table of Submitters

Organisation name Name of submitter

Aged and Community Care Victoria Paul Zanatta (Manager)

Aged and Community Services Australia Greg Mundy (CEO)

Aged Care Association Australia Rod Young (CEO)

Aged Care Queensland Carolyn Hale

Aged Care Services Australia Cameron Blanchard

Alzheimer’s Australia Anne Eayrs

Angel Medicine Kaye Hazel (Clinical Pharmacist Consultant)

Australian and New Zealand Society for Geriatric Medicine

Catherine Yelland (President)

Australian Association of Consultant Pharmacy William Kelly (CEO)

Australian Medical Association Belinda Highmore (Manager, Medical Practice and eHealth Section)

Australian Nursing Federation Ged Kearney (Federal Secretary)

Blue Cross Corporate Medication Committee Anthony Sirgiannis (faculty manager)

Care Services Sadie Burling (Group Manager)

Clinical Pharmacy Services Deanne Gorman

Consultant Pharmacy Services Shane Jackson

Country Health, SA Amanda Sanburg (Pharmacist)

Dept of Rural and Indigenous Health, School of Rural Health, Monash

Hanan Khalil

DutchCare Anny van Duuren (clinical coordinator)

DutchCare Hiske Carville

East Wimmera Health Service Cheryl Watson (Director, Acute and Aged Care)

Epping Aged Care Michelle Scully (Exec DON)

Ethnic Communities’ Council of Victoria Irene A. Bouzo (Policy Officer)

Glen Waverly Nursing Home and Kalimna House PNH, respectively

Shirely Frigo and Charlie Edwards

Greater Southern Area Health Service Miss Heather Gray (CE)

Hall and Prior Aged Care Organisation Graeme Prior

Hallam Medical Group Stuart Rumble (Dr)

Kyneton District Health Service Gudrun Bakogianis

Martin Luther Homes Boronia Peter McErlain (DON)

Meditrax Paul Hannan/ Gerard Stevens (Senior Consultant Pharmacist/Managers)

Nazareth House Robyn White (Care Manager)



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Northern and North East Valley Divisions of General Practice (NDGP)

Jenny Gowan

Nursing in General Practice, Rural Palliative Care Project

Margaret Mogg (Program Officer in Aged Care)

Olivet Aged Person’s Home Penny West

Parkwood Aged Care Services Mary Sofoclis (Quality Manager)

Peter Cook Amcal Chemist David Gerald Manuel

Pharmaceutical Society of Australia Kay Sorimachi (Director Policy and Regulatory Affairs)

Pharmacy Consulting Debbie Rigby

Pharmacy Guild of Australia Erica Vowles

Port Augusta City Council Bernice Racanati (Care Manager)

Prague House Tina Melrose (Manager)

QMMR Services Julie Grint (independent AP)

Rockingham Kwinana Division of General Practice Helen Brown (QUM Manager)

Scalabrini Villages Sonali Pinto (Clinical Governance Manager)

School of Pharmacy, University of Tasmania Juanita Westbury (Lecturer)

St Vincent’s Fiona Quigley

Sydney West Area Health Service Shivon Singh

Think Clinical Services Kevin O’Connor (Clinical Pharmacist)

University of Melbourne, Royal Freemasons’ Home of Victoria (respectively)

Sam Scherer (Clinical Associate Professsor, General Manager Medical services).

Wesley Gardens Aged Care Tracy Dickerson (DON)

Yass District Aged Care Services Penny Temple (Director at ACH)

n/a Adrian Sheen

n/a Alan Freedman (Consultant Pharmacist)

n/a Carlene Smith (AACPA)

Kununurra Aged Care Facility Gaye Collins (CN)

n/a Keli Symons (Pharm)

n/a Martine Light (community pharmacist)

n/a Robert DiSipio (AP)

n/a Stephen Carbonara (CP- AACPA)

n/a Wanda Amos (Consultant Pharmacist)

n/a Christine Wise (AP)

n/a Marcus Weidinger



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n/a Lina Mascaro, Anastasia Peripetsakis, Neil Petrie

n/a Phillip Elliot

n/a Chris Bonner

PK Reviews Penny Kraemer (Consultant Accredited Pharmacist)

** Two submissions requested they not be identified

1.5 Qualitative Research with Health Professionals

The aim of this stage of the project was to capture a range of views from health professionals on

the RMMR program. The primary target groups were those professionals most directly involved

in the RMMR program, which included GPs, Directors of Nursing (DONs) at Aged Care Homes,

and Accredited Pharmacists as well as pharmacists from a number of ACH supply pharmacies

and RMMR Provider companies.

Campbell Research recruited health professionals with a range of experience with the RMMR

Program including those who did not participate in the RMMR Program at all, those who had

participated in the program and had since discontinued their involvement; those with a little

experience, those who were very familiar with and experienced with the RMMR Program and

health professionals who were wanting to participate in the RMMR Program but were currently

unable to do so.

Over June and July 2009, 53 in-depth interviews were conducted by the senior members of

Campbell Research with health professionals from a range of organisations and disciplines

including:

• GPs (11)

• Accredited Pharmacists who were conducting RMMRs (19)

• Other pharmacists – either supply pharmacy and/or RMMR Provider

companies (5)

• Directors of Nursing or equivalent at ACHs (18).

These interviews explored the perceptions of the RMMR Program, the relationships between

Aged Care Homes, pharmacists and GPs, the potential barriers to the success of this program

as well as the benefits.

Consultations were conducted over six locations across Australia with Aged Care Home

Directors of Nursing or their authorised representative; aged care home staff; RMMR service

providers; Accredited Pharmacists conducting RMMRs; and GPs who may or may not be

participating in collaborative RMMRs. Interviews were conducted face-to-face where possible.

Interviews were approximately 45 minutes in length. Stakeholders were asked for permission for

recording of the interview and were reassured about confidentiality of the interview.



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A small number of consultations were conducted via telephone for budgetary and time-saving

reasons, including providing adequate opportunity for participation of all relevant parties.

The recruitment achieved a broad range of views and experiences across the range of PhARIA1

regions, states and types of Residential Aged Care Homes. Including:

• 6 states

• Metropolitan, rural and remote regions

• Not-for-profit and private sector aged care homes

• High and low care facilities

• Regions characterised by high and low socio-economic status.

Nursing homes and GPs were sent a primary approach letter, introducing the qualitative

research project and advising them that the person in the organisation most knowledgeable

about the current implementation and/ or practice of conducting RMMRs would be invited to

participate in an interview. Follow up calls were made by Campbell Research staff to secure

interviews with appropriate stakeholders.

Analysis of the qualitative data from consultations with health professionals followed a

systematic process. Notes and recordings from all interviews were reviewed, summarised and

collated. A thematic analysis approach was applied.

Locations chosen for interviews with health professionals

Locations were considered in light of a wide range of factors such as higher and lower

populations of people over 85, presence of larger and smaller numbers of residential aged care

homes and other relevant factors.

It is important to note that not all of the locations selected for fieldwork are home to that state’s

highest proportions of older people. This is because Campbell Research understands that

access to timely provision of RMMRs may be more difficult in those areas with smaller

proportions of older people and fewer aged care homes.

Locations where fieldwork was conducted are listed in Table 3 along with a reference to a small

number of the factors which relate to their selection. One of the considerations was the need to

cover a range of PhARIA locations as accessibility and remoteness can be barriers to provision

of timely Medication Review services. A separate tabulation, Table 4, of the numbers of health

professionals located in each area is also included.

Note: The number in brackets beside each town name is to indicate the PhARIA region (1-6) in

order to confirm a range of accessibility issues are covered (Table 2).

1 (Source: http://www.gisca.adelaide.edu.au/projects/pharia_0809/PhARIA_info.html)



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Table 2: PhARIA regions

Category 1 Highly Accessible

Category 2 Accessible (Group A)

Category 3 Accessible (Group B)

Category 4 Moderately Accessible

Category 5 Remote

Category 6 Very Remote

Table 3: Field visit locations

Location State PhARIA

Region

Reasons for selection

Bundaberg –

Maryborough

QLD 1 In Queensland, the Statistical Districts with the highest proportions

of their population in the 85 years and over age group were

Sunshine Coast (with 1.8%), followed by Wide Bay-Burnett and

Darling Downs (each with 1.7%), and Gold Coast (1.6%).

This area falls within the region of the Wide Bay Division of GPs.

Southern Adelaide -

Victor Harbor

SA 1 In June 2006, South Australia had the highest proportion of its

population aged 85 years and over among all states and territories

at 2.0% or 30,600 people. Between June 2001 and June 2006,

the number of people in this age group rose by 5,200 people

(21%).

The Local Government Areas of Holdfast Bay (4.1%), Unley,

Victor Harbor and Walkerville (all 3.7%) had the highest proportion

of their population aged 85 years and over in June 2006. Holdfast

Bay includes Glenelg, Brighton and surrounds.

This area falls within the region of the General Practice Network

South.

Mornington

Peninsula

VIC 1 This area falls within the region of the Peninsula GP Network.

Mornington Peninsula Division of General Practice has the highest

number of aged care beds in Victoria (close to 3,000 in 2004) and

some 44 residential aged care homes.

Hobart – Southern

Tasmania

TAS 1 and 5 Regionally, 1.8% of the Greater Hobart SD and Northern

populations were aged 85 years and over, while 1.7% of the

Mersey-Lyell population and 1.1% of the Southern Statistical

Division population were aged 85 years and over.



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Table 3: Field visit locations

Location State PhARIA

Region

Reasons for selection

LGAs (excluding those with population less than 2,000) with the

highest proportion of their population aged 85 years or more

included Hobart (C) (2.2%).

Tasmania is also identified as one of the states/territories with an

under-supply of aged care homes. This area falls within the region

of General Practice South. The Division has approximately 35

Residential Aged Care Facilities.

Dubbo and Western

Plains

NSW 2,4 and 6 The region has a number of smaller towns with aged care homes

with very few residents, scattered across considerable distances.

This area falls within the region of Dubbo/Plains Division of

General Practice.

The Divisional area has a total of 26 Residential Aged Care

Facilities, comprising 955 beds.

Southern WA WA 1,2,4 and 5

WA is one of the states/territories, along with Tasmania and the

Northern Territory, which is known to suffer from a shortage of

aged care homes.

1.7% of the Busselton LGA was aged over 85 at the time of the

2006 census. 1.4% of the Augusta-Margaret River Local

Government Area was aged over 85.

This area falls within the region of GP Down South WA (also

known as the Peel South West Division)

The region has a number of towns with small aged care homes,

scattered across considerable distances.

Throughout the region there is a shortage of health professionals

including General Practitioners. The inland towns of Pinjarra,

Waroona, Harvey, Collie, Bridgetown, Manjimup, Pemberton are

most deficient.



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Table 4: Health Professionals interviewed by PhARIA Region

PhARIA 1 PhARIA 2-4 PhARIA 5-6

Directors of Nursing 11 4 3

GPs 6 3 2

Non-Accredited Pharmacists 10 3 2

Accredited Pharmacists 13 3 1

* Health professionals may have serviced more than one PhARIA region.

1.6 Quantitative component—Accredited Pharmacist Case Studies

Campbell Research designed the quantitative component of the diary-based case studies to

assess the cost efficiency of the RMMR Program. This component was developed after

extensive qualitative research with health professionals. The quantitative component measured

the total dollar amount claimed from Medicare Australia with expenses incurred by pharmacists

in the conduct of RMMRs. From this comparison, cost efficiency was assessed by determining

the profit, loss or breakeven of pharmacists as they conducted RMMRs under a range of

different scenarios.

Campbell Research recruited 172 Accredited Pharmacists from around Australia to conduct

case studies. This involved conducting interviews with participants, as well as Aged Care Home

staff and GPs they may work with, in order to form a richer understanding of how the RMMR

service is provided. For the period of a month, Accredited Pharmacists were required to fill out a

diary to document the details involved in preparing, conducting and finalising a visit to an Aged

Care Home.

Diary development and content

The diary system was developed in conjunction with health economist associates Professor Jim

Butler and Mr Ian McRae of the Australian National University. Their input to the design,

analysis and reporting of the case studies provided the necessary financial expertise and rigour

to this stage of the evaluation.

Cognitive testing was conducted with an Accredited Pharmacist to inform the final diary. Some

adjustments were made to the diary as a result of the testing, so that the diary was written in the

language understood by pharmacists, to ensure the highest quality results.

The diaries contained sections that asked pharmacists to record:

2 Nineteen Accredited Pharmacists were recruited but two withdrew from the project, leaving 17. One case study was not able to claim payments for RMMRs but provided information on

an alternative arrangement in an indigenous facility.



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• Basic demographic information for the pharmacist and pharmacy/ business

including state, regionality, years’ experience in the pharmacy sector and

business type (community pharmacy, sole contractor, employee of a company

that specialises in the conduct of Reviews)

• Information for each visit to an Aged Care Home to conduct RMMRs,

including information relating to the home:

o The location of the home

o Number of beds, including a count of both high and low care beds

o Number of Reviews conducted

o Number and nature of recommendations made

o Number and nature of QUM activities conducted

• Information for each visit to an aged care home, including information relating

to the expenses incurred by pharmacists in the conduct of the visit:

o Time costs for the pharmacist, administrative staff and other staff in the

period leading up to the visit including activities such as phoning GPs

and Aged Care Homes to schedule the visit, and arranging for travel and

accommodation

o Travel costs to and from the Aged Care Home, including car costs and in

a small number of cases airline costs

o Time costs for pharmacists and other staff during the visit as the RMMRs

were estimated

o Time costs for pharmacists and other staff after the visit spent on

activities such as preparing reports and claiming payment from Medicare

Australia.

The cost of pharmacist and administrative time was based on rates reported by experts in the

sector. This information was gathered during the qualitative fieldwork phase of the project. $50

an hour has been allowed for pharmacist time and on-costs, and $30 an hour was allowed for

administrative time and on-costs. Travel costs were calculated at 60 cents per kilometre, or the

cost of air-fares as reported by pharmacists. Other expenses such as parking, accommodation

etc were included as recorded by pharmacists.

Recruitment and fieldwork

At the conclusion of the diary-keeping period, Campbell Research conducted telephone follow

ups with each pharmacist to discuss:

• The initial findings of the diaries in terms of the financial and administrative

requirements of conducting RMMRs; and

• The pharmacist’s perception of these administrative requirements and how

they relate to the successful operation (or otherwise) of their business.

In order to understand the diversity of situations faced by Accredited Pharmacists in providing

RMMRs, Accredited Pharmacists from various backgrounds were selected as participants in the



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case studies, differing by geographical location, size of business, contracting arrangements,

size and number of Aged Care Homes visited, and remoteness of access.

From the stakeholder consultations, it was clear that individual Accredited Pharmacists often

have more than one contracting arrangement within the RMMR Program. For example, some

Accredited Pharmacists contract directly to Aged Care Homes as independent reviewers, whilst

also providing RMMR services through a Community Pharmacy. The Accredited Pharmacists

selected for the case studies cover the range of scenarios explored during consultations to

reflect the diversity of RMMR processes.

Accredited Pharmacists also differ in the number of visits they make to Aged Care Homes.

Some, working for large businesses, may conduct nearly two thousand RMMRs a year, whilst

those working purely as independents, contracting directly to Aged Care Homes may only

conduct two visits a month. Information from both types of businesses will inform an

understanding of the issues, efficiency of processes and achievements of both smaller

businesses and larger ones.

Campbell Research ensured that selection of Accredited Pharmacists covered all six PhARIA

regions (Table 5), to identify differences of servicing busy metropolitan areas compared to

remote, difficult to access regions.

Accredited Pharmacists, whilst having their office located in one PhARIA region, often provided

services across a number of PhARIA regions. To accurately reflect the scope of PhARIAs

covered by these pharmacists, Campbell Research included the number of PhARIA regions the

Accredited Pharmacists serviced, in addition to the PhARIA region their office was based in

(Table 5).

Table 5: PhARIA Regions Covered

PhARIA 1 PhARIA 2-4 PhARIA 5-6

Number of Accredited Pharmacists 11 11 5

* Please note that there is no total column as health professionals may service more than one PhARIA region.

An Accredited Pharmacist who services an un-accredited Aboriginal Aged Care Home was also

included. The Accredited Pharmacist therefore cannot claim for the RMMRs conducted at this

Aged Care Home. The story provided a valuable addition to the information provided by the

Accredited Pharmacists who meet the full criteria for the case studies.

Conduct of fieldwork

Campbell Research briefed the pharmacists on the correct use of the diary system. Campbell

Research also followed up and monitored participating pharmacists to encourage them to keep

their diaries up-to-date and fill in the required fields correctly.



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The diaries were provided to pharmacists in electronic form. Some pharmacists completed hard

copy print-outs of the diary by hand; others completed the form electronically in Microsoft Word.

The data provided by pharmacists was entered into a single Excel file for analysis.

Nineteen pharmacists were recruited to complete the diaries; however, two pharmacists

withdrew from the study. The fieldwork period commenced in September 2009 and concluded

in November 2009. Pharmacists provided information about the RMMRs they conducted over a

four week period, though not always the same four week period, as different pharmacists

commenced their diary at different times.

Analysis and reporting

The collated data was analysed for each pharmacist on a per-visit basis. The number of visits

made by pharmacists varied greatly during the period with a minimum of one and a maximum of

14. Costs and outputs reported by pharmacists were averaged across all visits to provide the

key measures of:

• The pharmacists financial return or loss from the conduct of RMMRs over the

period

• The distribution of expenses incurred across staff time, travel expenses and

other expenses

• Average time spent and expenses incurred by pharmacists before, during and

after the RMMR visit, including a comparison for the average for all case

studies.

The above three analyses are presented for each case study alongside the qualitative findings

for each case, see Appendix C.

Caveats and cautions

The reader should note the following caveats and limitations inherent to the quantitative

component of the case studies:

• The cost per hour of pharmacists and administrative staff may not be all-

inclusive of all costs incurred by pharmacists. In particular, costs associated

with software and IT, for example may not be truly reflected in the dollar per

hour estimate. It is therefore possible that the financial return reported for

some Accredited Pharmacists in this report may be inflated.

• The sample of Accredited Pharmacists used for the analysis (n=16) was

small. The quantitative component of the case studies should not be

considered a survey that is representative of the population of pharmacists

who conduct RMMRs. The reader is encouraged to focus on the data

reported for individual Accredited Pharmacists in each case study, and not to

assume that the averages reported for all case studies are representative of

all pharmacists who conduct RMMRs in Australia.

• The data collected and collated for the case studies was self-reported by

pharmacists. No audit or observation of pharmacists was made to verify the

accuracy of the data.



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1.7 Qualitative component of the Case Studies

The quantitative component of the case studies that focussed on financial expenditure and

return was complemented by qualitative interviews. This component further explored

approaches to and attitudes towards RMMR. Each of the pharmacists recruited for the case

studies was extensively interviewed. In many cases additional interviews were conducted with

representatives of the Aged Care Homes serviced by the pharmacists, and GPs who may (or

may not) have collaborated with the pharmacist in the delivery of RMMR.

At the conclusion of the diary-keeping period, Campbell Research conducted telephone follow

ups with each Accredited Pharmacist to discuss:

• The initial findings of the diaries in terms of the financial and administrative

requirements of conducting RMMRs; and

• The pharmacist’s perception of these requirements and how they relate to the

successful operation (or otherwise) of their business.

Specifically, the interview component provided a qualitative assessment of the following

elements:

• Accredited Pharmacist background, including scale of RMMR experience,

geographic setting, contract or salary arrangements

• Proportion of Reviews done as Collaborative Reviews

• The approach to seeking the involvement of the GPs

• The processes by which Reviews were scheduled, conducted and reported

• The approach to the provision of QUM services within the Aged Care Home

• Other relevant matters such as travel.

The quantitative findings of the diaries were combined with the qualitative findings of the

interviews to form the 16 case studies.

1.8 Quantitative Research with Health Professionals

Campbell Research surveyed Accredited Pharmacists, interested GPs and Aged Care Home

Directors of Nursing (DONs). The surveys were administered on-line to Accredited Pharmacists

(section 0), and were posted to GPs (section 0) and Aged Care Homes (section 0). The unit of

analysis for this component will be the individual practitioner/professional, although aspects

which relate to the RMMR Provider links were taken into account.

The survey allowed for two important inputs to the evaluation:

• A ‘quantification’ of the findings from the qualitative research to assess how

issues and opinions raised by individual stakeholders hold across the sector;

and

• An opportunity for broad and inclusive input from all health professionals.

Based on these considerations, the survey was designed to ultimately provide a firm evidence-

base for conclusions.



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The survey contained the following key sections, the contents of which were based on the

discussion areas from the qualitative research. Key sections included:

• A demographic section containing details such as the nature of the health

professional’s organisation (pharmacy, GP, Aged Care Home etc) location

and size of the organisation

• Information about the rebate claims system including consideration of

administrative processes and the impact on health professionals

• The impact of administrative arrangements more generally on collaborative

efforts and partnership building, particularly in relation to:

o collaboration with relevant GPs and aged care service providers

o collaborative Reviews, including barriers and other issues associated

with promoting participation

• Assessment of QUM activities including:

o The nature and quantity of QUM activities;

o The impact of these activities on aged care home staff and residents;

o The administrative requirements of QUM activities;

• How well the RMMR Program is currently reaching those likely to benefit most

from an RMMR (such as new residents; residents who have just transferred

homes; residents who have recently been hospitalised, or other categories of

residents as identified in the qualitative research) including any access gaps;

and

• Factors driving health professional participation or non-participation in the

RMMR Program.

The survey was designed using a modular structure with some common questions for all

respondents, and sets of specific questions for specific stakeholder groups.

Campbell Research sought the Department’s approval of the draft questionnaire before testing,

and the final questionnaire before the implementation of the fieldwork. The questionnaire was

also submitted to and received clearance from the Statistical Clearing House of the Australian

Bureau of Statistics.

Accredited Pharmacists online survey

An online survey was administered to Accredited Pharmacists, using Campbell Research’s in-

house online survey tool. Emails were sent to pharmacists via the Australian Association of

Consultant Pharmacy (AACP). Each address contact on the AACP database received an email

link and an invitation to complete the online survey. A reminder email was sent out by the

AACP a week after the initial invitation.

The online self completion method was chosen for the convenience for the respondent of

completing the survey at a time that suits them, and for the greatest efficiency given the large

sample size.



CR&C 1074 17

The survey was conducted between 21 October 2009 and 10 November 2009. A total of 338

Accredited Pharmacists completed the survey.

Table 6: Accredited Pharmacists Survey Field report

Accredited Pharmacists

Number sent to 1814

Date initial email sent 21 October 2009

Date reminder email sent 28 October 2009

Date survey withdrawn from field 10 November 2009

Number of responses received 338

Response rate 19%

GP survey

The GP survey was originally intended to also be administered using an email link. However,

revisions were made to the methodology in light of new information and designed to maximise

the effectiveness in distributing surveys to GPs for this project.

The Department advised Campbell Research that email addresses of GPs who had claimed for

RMMRs in the past 12 months were difficult to obtain. In order to distribute surveys to these

GPs, Campbell Research chose a hardcopy print survey approach, given that interest in the

survey would primarily be limited to those GPs who have claimed. Distribution through other

means would have necessitated sending the survey to all GPs, placing an unnecessary burden

on the time of those GPs who have little interest in the subject. Campbell Research ascertained

that a wide cross-section of GPs would be reached, as there would be GPs who have claimed

only once or twice in the past 12 months.

Campbell Research posted surveys to 50% of GPs in the database provided by the Department

in response to Statistical Clearing House recommendations. The GPs were selected randomly.

A reminder letter was sent two weeks after initial posting to maximise the response rate.

Surveys were posted to a total of 2,540 GPs.

The survey was conducted between 28 October 2009 and 20 November 2009. A total of 386

completed surveys were received.



CR&C1074 18

Table 7: GP Survey Field report

GPs

Number sent to 2,540

Returned to sender 30

Qualifying GPs 2,510

Date initial survey sent 28 October 2009

Date reminder letter sent 10 November 2009

Date survey withdrawn from field 20 November


Response rate 15%

Aged Care Home survey

The Aged Care Home survey was originally intended to also be administered using an email

link. However, revisions were made to the methodology following consultation with Aged Care

Associations, to maximise the effectiveness in distributing surveys to Directors of Nursing and

other senior staff in Aged Care Homes.

Following consultation with Aged Care Associations, Campbell Research understood that there

were a number of potential issues with using an on-line methodology:

• ACH’s typically have limited computer and internet access.

• In addition, working via computer is not the preferred method for some DONs.

Campbell Research therefore chose a hard copy survey approach. A single methodology

approach was also the most cost-effective.

Campbell Research posted surveys to 50% of Aged Care Homes in the publicly available

government managed database, in response to Statistical Clearing House recommendations.

The Aged Care Homes were selected randomly. A reminder letter was sent to 2,500 Aged Care

Homes.

The survey was conducted between 28 October and 20 November 2009. A total of 332 surveys

were received.



CR&C 1074 19

Table 8: Aged Care Home Survey Field report

Aged Care Homes

Number sent to 2,500

Returned to sender 16

Qualifying ACHs 2,484

Date initial survey sent 28 October 2009

Date reminder letter sent 10 November 2009

Date survey withdrawn from field 20 November 2009


Response rate 13%



CR&C1074 20

2. Qualitative Research Discussion Guides

2.1 Accredited Pharmacists Discussion Guide

Qualitative Research Discussion Guide:

Accredited Pharmacists – RMMR providers

Topic Points to cover

INTRODUCTION Introduction about the nature of the interview. Confidentiality, privacy, recording, note-taking, non-identifiable. No right or wrong answers. Just after your opinion.

RMMR Provider Do you provide RMMR services through:

o A Community (Section 90) Pharmacy

+ If so, is that as a salaried employee of that

pharmacy or as a consultant?

o Your own consultancy business?

+ If so, is that as a sole operator? Or do you

work in partnership with a number of others?

o A larger company where you are an employee?

Would the majority of the RMMRs you provide be ‘standard’ RMMRs or collaborative RMMRs in conjunction with GPs?

Are you also providing HMR services?

ACH and service

provider background

How long have you been providing Medication Review services in aged care? And to this ACH (where an interview has occurred/is occurring with the DON/relevant GP)?

(Note the range of facilities where RMMR services provide: High/low care/combined? Other? NFP/ Private sector/Govt run? ACH owned by a private company with a number of ACHs?

In total, over the course of the last 12 months, how many RMMRs would you have conducted approximately? Over what geographic area?

(If covering a range of more distant locations, note this as well)

Thinking of the contract with ACHs under which you conduct RMMRs - is this the same provider who supplies Medication to the ACH?

Who makes the decisions in regards to the agreements with ACHs for RMMRs? What is your role in this?

Standard RMMR Process Can you tell me how you feel about the RMMR service and how well it works in general and in this facility (the home where other related interviews have been conducted/are being conducted)? (Positive/neutral/negative) Why? (PROBE



CR&C 1074 21




FULLY)

At the ACH who is involved in the standard/routine RMMR and what tasks do they carry out to support the Review?

In the ACHs where you provide services, do all residents have an annual RMMR? If not, what proportion?

Do all residents need an RMMR? Do all residents that need one get one? Why/ why not?

Do residents receive that RMMR in the optimum time frame? If not, what are some of the barriers you encounter in seeking to provide a timely RMMR?

Can you talk me through the standard RMMR process according to how you conduct them?

What does the facility need to do/provide - Before, during and after the Review? How easy / difficult is it to do this? (PROBE FULLY)

How easy is it to get another Review if one is needed? Is the resident’s GP then involved?

How does the process differ for new residents? How satisfactory is the process for identifying residents who may require a priority RMMR?

In your view, how effective is the standard Review process? How useful is it? How could it be improved?

Are you always able to conduct RMMRs in person? Or does a non-Accredited Pharmacist do the ACH visit and then liaise electronically with the Accredited Pharmacist in some cases, for example where distance may be a barrier? If this is the approach, how well does this work?

Collaborative RMMR

How often would you be involved in collaborative RMMRs?

In your experience, how is a collaborative RMMR initiated? Do you sometimes approach the GP to seek an additional RMMR?

Under what circumstances? How effective is this approach in triggering an RMMR for a resident in urgent need?

How do you feel about collaborative RMMRs and how well they work in general?

Can you talk me through the collaborative RMMR Process as it usually takes place? Who is involved and what are their individual roles?

How long does it usually take?

How effective has the collaborative RMMR been in:

• Increasing the involvement of the GP in the

Medication management for residents?



CR&C1074 22




• Cementing/improving relationships between the

various health providers? Eg pharmacy and nursing

staff/ GPs and pharmacists etc

• Providing higher level of resident access to

appropriate medical care?

• Providing better outcomes for residents?

What examples are you able to cite of specific positive outcomes for residents arising from RMMRs you have conducted? Have their been unintended negative consequences?

Impact of RMMR with

other programs

• How well do RMMRs dovetail with other Reviews and

regular medical assessment conducted for residents?

Do they enhance or detract from these?

• What about Comprehensive Medical Assessments

undertaken by GPs?

Aged Care Funding

Instrument

Have you seen any change in demand for RMMRs in ACHs as a result of the introduction of the new Aged Care Funding Instrument introduced in March 2008? If so, what changes have you observed?

(There are a number of aspects of the Funding Instrument’s requirements which may have generated a higher demand)

Value of RMMR Perceived benefits of RMMR to:

• Resident

• ACH

• Health care professionals – eg greater participation of

GPs; development of partnerships

Perceived drawbacks of the RMMR as it is currently provided, for:

• Resident

• ACH

• Health care professionals, including pharmacists and

GPs

Could anything be done to improve the value of the RMMR?

The role of the RMMR is to ensure that information about residents’ medication is collated and comprehensively assessed in order to “identify, resolve and



CR&C 1074 23




prevent medication problems”

How well does the RMMR program reflect these aims? PROBE FULLY

Are there any issues specific to this region/ area or location, which make RMMRs more difficult and which should be addressed? EXPLORE

Quality Use of Medicines

in the ACH

Are you happy with the QUM approach at the ACHs where you provide Medication Review services? Why? Why not? What factors contribute to the QUM approach there?

What range of support on QUM have you provided in the ACHs where you provide services? What types of activities have occurred and who has initiated and been involved in these?

What about the local community pharmacy supplier (if different from the Accredited Pharmacist) – are they also involved in providing QUM support to the ACHs where you work? If so, in what way?

What are some of the benefits of the QUM activities conducted here?

o Residents

o Staff

What do you think of the process for reporting on QUM activities to DOHA (as part of your RMMR service provision arrangements)? Do you have any suggestions for improvement?

Overall comment Is there anything that could enhance the program? Is there anything you would like to add about what we have discussed today?

CONCLUSION Thank you for your time. I would like to repeat that your details will remain confidential and we will not report any information which is identifiable.



CR&C1074 24

2.2 Non-RMMR Community Pharmacies Discussion Guide


Community pharmacies (Non-RMMR provider)



Demographics of

clientele

Could you please tell me something about the clientele of your pharmacy, including age ranges, backgrounds, locations?

Other characteristics of the pharmacy? Size? Ownership/franchise?

Services for aged care

homes

How many ACHs would you service as a supply pharmacy? What are the characteristics of those homes? High/low care? Private operator? Govt? NFP?

Is your supply relationship directly with the ACH or do you tend to work through the GP who attends the ACH?

Does your pharmacy provide Medication Review services (RMMRs) to ACHs? If not, what are the reasons for this?

Does your pharmacy provide HMR services?

ACH and service

provider background

How long have you been a supply pharmacy for aged care homes?

Given that your pharmacy supplies to this ACH (where an interview has occurred/is occurring) what are the reasons that you do not provide RMMR services?

How does it work with your pharmacy being the supply pharmacy and another pharmacist elsewhere providing the RMMR? Has that caused any confusion? Any serious consequences as far as you are aware?

Standard RMMR Process

(ONLY RELEVANT IF

THEY CONDUCT

RMMRs)

When an Accredited Pharmacist (from another company) is providing RMMRs for residents of the ACHs where you are the supply pharmacy, what, if anything, are you required to do?

In general, what follow-on actions do you see arising from the RMMRs? i.e. Are you occasionally asked to make certain changes?

In the ACHs where you provide services, as far as you’re aware, do all residents have an annual RMMR? If not, what proportion?

Are there any barriers to provision of RMMRs in the ACHs where you are the supply pharmacy?

How satisfied are you with the Medication Review services provided to the residents at the ACH where you are the supply pharmacy?



CR&C 1074 25




Do you see any areas requiring improvement?

Collaborative RMMR

GPs are involved in the initiation of collaborative RMMRs.

Are you ever asked to be involved in collaborative RMMRs?

Do you sometimes approach the GP on behalf of your ACH customers, to suggest the need for an RMMR even though you do not provide these? What would prompt you to do that?

How effective is this approach in triggering an RMMR for a resident you consider to be in urgent need? i.e. Is the GP usually responsive? And the ACH?

Impact of RMMR with

other programs

To the best of your knowledge, how well do RMMRs dovetail with other Reviews conducted for residents such as Comprehensive Medical Assessments undertaken by GPs?

Value of RMMR

The role of the RMMR is to ensure that information about ACH residents’ medication is collated and comprehensively assessed in order to “identify, resolve and prevent medication problems”

Do you have any comments on this?

Are there any issues specific to this region/ area or location, which make Medication Review more difficult?


in the ACH

Are you happy with the QUM approach at the ACHs where you provide Medication Review services? Why? Why not?

For ACHs where you supply medications, are you involved at all in providing QUM support? If so, in what way?

If you are the supply pharmacy but NOT the RMMR provider to an ACH, does this present any issues for QUM in your view?

Overall comment Is there anything that could enhance the RMMR program? Particularly when the supply pharmacy is not the RMMR provider?

Is there anything you would like to add about what we have discussed today?




CR&C1074 26

2.3 Non-RMMR Community Pharmacist Discussion Guide

Discussion Guide for Interviews with Non-RMMR Community Pharmacies

1074 RMMR Evaluation





Demographics of

clientele

Could you please tell me something about the clientele of your pharmacy, including age ranges, backgrounds, locations?

Other characteristics of the pharmacy? Size? Ownership/franchise?

Services for aged care

homes

How many ACHs would you service as a supply pharmacy? What are the characteristics of those homes? High/low care? Private operator? Govt? NFP?

Is your supply relationship directly with the ACH or do you tend to work through the GP who attends the ACH?

Does your pharmacy provide Medication Review services (RMMRs) to ACHs? If not, what are the reasons for this?

Does your pharmacy provide HMR services?

ACH and service

provider background

How long have you been a supply pharmacy for aged care homes?

Given that your pharmacy supplies to this ACH (where an interview has occurred/is occurring) what are the reasons that you do not provide RMMR services?

How does it work with your pharmacy being the supply pharmacy and another pharmacist elsewhere providing the RMMR? Has that caused any confusion? Any serious consequences as far as you are aware?


(ONLY RELEVANT IF

THEY CONDUCT

RMMRs)

When an Accredited Pharmacist (from another company) is providing RMMRs for residents of the ACHs where you are the supply pharmacy, what, if anything, are you required to do?

In general, what follow-on actions do you see arising from the RMMRs? i.e. Are you occasionally asked to make certain changes?

In the ACHs where you provide services, as far as you’re aware, do all residents have an annual RMMR? If not, what proportion?

Are there any barriers to provision of RMMRs in the ACHs where you are the



CR&C 1074 27




supply pharmacy?

How satisfied are you with the Medication Review services provided to the residents at the ACH where you are the supply pharmacy?

Do you see any areas requiring improvement?

Collaborative RMMR

GPs are involved in the initiation of collaborative RMMRs.

Are you ever asked to be involved in collaborative RMMRs?

Do you sometimes approach the GP on behalf of your ACH customers, to suggest the need for an RMMR even though you do not provide these? What would prompt you to do that?

How effective is this approach in triggering an RMMR for a resident you consider to be in urgent need? i.e. Is the GP usually responsive? And the ACH?

Impact of RMMR with

other programs

To the best of your knowledge, how well do RMMRs dovetail with other Reviews conducted for residents such as Comprehensive Medical Assessments undertaken by GPs?

Value of RMMR

The role of the RMMR is to ensure that information about ACH residents’ medication is collated and comprehensively assessed in order to “identify, resolve and prevent medication problems”

Do you have any comments on this?

Are there any issues specific to this region/ area or location, which make Medication Review more difficult?


in the ACH

Are you happy with the QUM approach at the ACHs where you provide Medication Review services? Why? Why not?

For ACHs where you supply medications, are you involved at all in providing QUM support? If so, in what way?

If you are the supply pharmacy but NOT the RMMR provider to an ACH, does this present any issues for QUM in your view?

Overall comment Is there anything that could enhance the RMMR program? Particularly when the supply pharmacy is not the RMMR provider?

Is there anything you would like to add about what we have discussed today?




CR&C1074 28

2.4 Director of Nursing Discussion Guide

Discussion Guide for Interviews with Directors of Nursing

1074 RMMR Evaluation

Qualitative Research Discussion Guide - DONs



ACH and service

provider background

How long have you been involved with aged care? How long in the role of DON? / How long have you been in this role at this particular ACH?

What type of facility is this - High/low care/combined? Other?

Is it NFP/ Private sector/Govt run?

Is this ACH owned by a private company with a number of ACHs?

How many residents at this facility – high care/low care?

Thinking of your home’s contract with service providers to conduct RMMRs - is this the same provider who dispenses medication to this facility? Why/ Why not?

Who makes the decisions in regards to the agreements with service providers for RMMRs? What is your role in this?

As far as you are aware, Is the RMMR provider for this facility a sole operator/employed by a community pharmacy or employed by a larger company?


Can you tell me how you feel about the RMMR service and how well it works in general and in this facility? (Positive/ neutral/negative) Why? (PROBE FULLY)

Who is involved in the standard/routine RMMR and what are their roles?

Is this an annual occurrence for every resident or on an as needs basis?/ Do all residents have an annual RMMR? If not, what proportion?

Do all residents need an RMMR? Do all residents that need one get one? Why/ why not?

Do residents receive that RMMR in the optimum time frame?

Can you talk me through the most common standard/ routine RMMR process as it usually takes place here?

What does the facility need to do/provide - Before, during and after the Review? How easy / difficult is it to do this? (PROBE FULLY)

What impact does this have on the ACH and staff? How long do the Reviews



CR&C 1074 29



usually take? (PROBE FULLY)

In your view, how effective is the standard Review process? How useful is it? How could it be improved?

How does this Review and the process differ for new residents?

Are RMMRs for your residents always conducted by an Accredited Pharmacist in person? Or does a non-Accredited Pharmacist sometimes do the ACH visit and then liaise electronically with the Accredited Pharmacist? Perhaps because distance is a barrier? If this is the approach, how well does this work?

Collaborative RMMR

How often would collaborative RMMRs take place in this facility? (If necessary – these are Reviews initiated in collaboration with the GP).

How do you feel about collaborative RMMRs and how well they work in general for the residents here?

In your experience, how is a collaborative RMMR initiated? Do you sometimes approach the GP to seek an additional RMMR?

How often do collaborative RMMRs take place in this ACH?

Can you talk me through the collaborative RMMR Process as it usually takes place here?

Who is involved in the standard/routine RMMR and what are their individual roles?

What do you need to do/provide - Before, during and after the Review? What impact does this have on the ACH and staff? How long does it usually take?


• Increasing the involvement of the GP in the daily care

of residents?

• Cementing/improving relationships between the

various health providers? e.g. pharmacy and nursing

staff/ GPs and pharmacists etc

• Providing higher level of resident access to


Providing better outcomes for residents?

Impact of RMMR with

other programs





• Resident – eg higher access or residents to medical

care



CR&C1074 30



• ACH – eg. Confidence in resident’s medication

eg. better total care?

• Health care professionals – eg greater participation of

GPs; development of partnerships

Perceived drawbacks of the RMMR at it is currently provided, for:

• Resident

• ACH – e.g. time, cost, administration, disruption etc

• Health care professionals


The role of the RMMR is to ensure that information about residents’ medication is collated and comprehensively assessed in order to “identify, resolve and prevent medication problems”


Are there any issues specific to this region/ area or location, which make RMMRs more difficult and which should be addressed? How?


in the ACH

Are you happy with the QUM approach at this ACH? Why? Why not? What factors contribute to the QUM approach here?

What range of support on QUM has been provided in this ACH by an Accredited Pharmacist - your RMMR provider? What types of activities have occurred and who has initiated these? (Explore the role of the RMMR provider in this.

What about your local community pharmacy supplier (if different from the Accredited Pharmacist) – are they also involved in providing QUM support here? If so, in what way?

What are some of the benefits of the QUM activities conducted here?

o Residents

o Staff

(If they do not seem to be aware of this, say ‘QUM is required to be among the services provided to an ACH by RMMR provider? Were you aware of this?’)

Overall comment What have your peers been saying about the RMMR?

Is there anything that could enhance the program? Is there anything you would like to add about what we have discussed today?




CR&C 1074 31

2.5 GP Discussion Guide

Qualitative Research Discussion Guide - GPs



ACH patients Explore extent of interaction with aged care home residents.

How long have you been involved with aged care? How long providing medical services at the ACH? Do you attend a number of ACHs? If so, where are those homes?

How many ACH residents would you attend to overall? High care/low care? Dementia? Other specific health conditions?

What level of interaction do you have with the pharmacies which supply medications to those ACHs?

In the ACHs where you attend, are you familiar with the providers of RMMRs to those homes’ residents?

Who makes the decisions about when your ACH patients have a RMMR? What is your role in this?


Can you tell me how you feel about the RMMR service and how well it works in general and for the patients you attend in ACHs? (Positive/ neutral/ negative) Why? (PROBE FULLY)

When you have not initiated an RMMR, what involvement, if any, do you have in that process?

o For example, do you receive copies of the

information?

o Do you receive a follow-up call from the

Accredited Pharmacist?

o Have you ever been asked to consider issues

arising from such Reviews?

As far as you’re aware, who is involved in the standard/routine RMMR and what are their roles?

How satisfactory is this process from your perspective? How satisfactory do you believe it is for the patient – ACH resident?

Are you aware whether your ACH patients receive an annual Medication Review? In the optimum time frame?

How effective is the standard RMMR process? How could it be improved?

How does this Review and the process differ for new residents?



CR&C1074 32



Collaborative RMMR

You will no doubt be aware that there is also the option for residents to have a collaborative RMMR, where you as their treating medical practitioner, would be involved. This is subject to a Medicare rebate Item 903.

How often would collaborative RMMRs take place for your ACH patients? Do you typically request these or is it more likely that the DON or a pharmacist contacts you and requests such a Review?

How do you feel about collaborative RMMRs and how well they work in general for your patients?

Can you talk me through the collaborative RMMR Process as it usually takes place when you are involved?

What do you need to do/provide - Before, during and after the Review? What impact does this have on your time and that of your practice staff? How long does it usually take?


o Enabling your involvement in the daily care of

residents?

o Cementing/improving relationships between the

various health providers? e.g. pharmacy and

nursing staff/ GPs and pharmacists etc

o Providing higher level of resident access to


o Providing better outcomes for residents?

Impact of RMMR with

other programs





o Patient

o ACH

o GP

Perceived drawbacks of the RMMR as it is currently provided, for:

o Patient

o ACH

o GP

The role of the RMMR is to ensure that information about residents’ medication is collated and comprehensively assessed in order to “identify, resolve and prevent medication problems”



CR&C 1074 33





How important do you think RMMRs are for the clinical care of the patient? Do you see any benefits in terms of preventing hospitalisation or major deterioration

Benefits and drawbacks

of RMMRs

Thinking now of the benefits and drawbacks of the RMMR:

Who would you expect to specifically benefit from a TIMELY RMMR? New residents? Existing residents with medication profile? Both?

And from a collaborative RMMR?

How effective is the RMMR program in reaching those residents most likely to benefit from them?

o Standard RMMR/Collaborative RMMR?

How useful are they for your patients?

How well do they meet the needs of residents?

Are there any types of patients who you believe are not adequately covered through the current approach to RMMRs? How could this be addressed?

Aspects requiring

improvement

Are there any areas in this process that you find particularly difficult? Any areas that could be improved?

• Identification of need for collaborative RMMR

• Consultation with resident/carer

• Collaboration between GP and pharmacist

• Post Review discussion GP and Pharmacist

• Consultation with resident/carer

• Preparation of written medication management Plan

• Discussion with aged care staff if necessary

• Billing

Are there any issues specific to the ACHs in this area, which make RMMRs more difficult and which should be addressed? How?

In an ideal world, how should the Collaborative/Standard RMMR program work?

GP participation

What are the factors driving the participation of GPs in RMMR?

And why you think some GPs do not initiate RMMRs?



CR&C1074 34




in the ACH

Thinking now about the Aged Care Homes where you attend:

Are you happy with the QUM approach at the ACHs you are familiar with? Why? Why not? What factors contribute to the QUM approach in those ACHs?

Minimum or higher standards to be attained?

QUM is required to be among the services provided to an ACH by the Accredited Pharmacist contracted to that facility? Were you aware of this? What evidence have you seen that such support has been provided in the ACHs you attend?

How do you promote the Quality Use of Medicines as part of an RMMR, if at all? What role, if any, do you have with the following in this respect?:

• Pharmacists

• Aged care providers

• Residents

• ACH staff

Overall comment Is there anything you would like add about what we have discussed today?


`

Documents

Department of Health | Welcome to the Department …...RMMR Evaluation Appendix A - Methodology Department of Health and Ageing CR&C 1074 Please note that, in accordance with our Company’s