Malaysia

RMTAC

Protocol & Tools

involved

Pharmacist

Outline of presentation Protocol of RMTAC

What you should know?

Workflow of RMTAC

Documentation

Statistics

Tools need to prepare Questionnaires- ACT, CAT

Inhalers-placebo

Test- spirometry, peak flow meter

Flipchart of Inhaler/Handbook

Flipchart of the Disease

Respiratory diary (asthma diary)

PROTOCOL BOOK

http://www.pharmacy.gov.my/v2/sites/default/files/document-

upload/book.-protocol-respiratory-2.6-fa.pdf

2010 2015

What you should know? Malaysia RMTAC- introduced in 2004.

started by Hospital Melaka by former KPF, Tn Hj Malek.

RMTAC- work in a team

◦ Chest physician/Family Med specialist

◦ Nurse

◦ Lab technician

◦ Pharmacist : 1-4 person/team

Working hours- usually on respi clinic day

Place to counsel patient- room at the clinic

Before start the MTAC program, inform JKNS

What you should know? Main Objectives of RMTAC

◦ To help patients in managing their Asthma &COPD.

• Other objectives:

◦ To maximize the benefits of medication therapy in Asthma/COPD

patients.

◦ To increase patient’s adherence towards Asthma/COPD medications.

◦ To educate and encourage patients/caregivers on the appropriate use

of Asthma/COPD medications and self-care inhalers/devices.

◦ To minimize adverse effects or complications resulting from the

Asthma/COPD medications and/or multiple drug regimens.

◦ To reduce the frequency of emergency room visits and thus, reduce

the total health care costs in treating Asthma/COPD.

◦ To collaborate with consultative services physicians and other health

care professionals on Asthma/COPD medication related issues.

Scope of service

Operate in the clinic area, during clinic days

Pharmacist role :-

◦ Assessing patients for pharmaceutical care

issues,

◦ providing appropriate education to patients and

caregivers,

◦ completing follow-up sessions and

◦ documenting actions and plans in relevant

RMTAC forms

Appointment for RMTAC All appointments shall be scheduled by the pharmacist

using the Respiratory MTAC Appointment Book

(Appendix 1).

All recruited patients need to complete a minimum of three (3)

follow-up sessions (Pre: Post = 1: 3). More follow-up sessions

will be scheduled, depending on individual patient’s requirement.

*Pre – First visit with the consent of enrollment into RMTAC.

*Post – Subsequent RMTAC follow-up sessions i.e. visit 2, 3, 4 and

so on. It is compulsory for patients to undergo a minimum of three

(3) follow-up sessions.

Patients diagnosed with Asthma/COPD, who fulfill at least ONE of the following criteria, should be offered to be recruited into the RMTAC:

Patients with Childhood Asthma Control Test (C-ACT)

or Asthma Control Test (ACT) score of ≤ 19.

Patients with uncontrolled Asthma according to latest

GINA Guidelines.

Patients with frequent Asthma/COPD exacerbation

according to latest GINA/GOLD Guidelines.

Patients with poor inhaler technique.

Patients with low adherence to medications (Morisky

Medication Adherence Scale score < 6).

Who shall be recruited?

Enrolment

Getting

Consent for

recruitment

*Green –COPD

* Pink – Asthma

Phone Number!

RMTAC Workflow The initial visit entails the following:

a) Inform the objectives of RMTAC.

b) Educate overview of the disease (using Module

RMTAC Asthma/COPD flipchart).

c) Conduct a baseline assessment using the

RMTAC Pharmacy Assessment Form (Adult)

(Appendix 5a) or RMTAC Pharmacy

Assessment Form (Paediatric) (Appendix

5b), which consists of:

◦ - Past medical history;

◦ - Exacerbation history;

◦ - Peak expiratory flow rate (PEFR);

◦ - Spirometry measurement (if applicable);

◦ - Asthma symptoms: using C-ACT, ACT or

Asthma Symptom Control (GINA);

◦ - COPD symptoms: using COPD Assessment

Test (CAT) or Modified Medical Research

Council (mMRC) Dyspnea Scale ;

◦ - Past medication history and medication

adherence; and

◦ - Inhaler/device technique.

2.1.3 Medication counselling and patient education

shall be undertaken whenever appropriate.

Documentation (Patient Database)

Documentation

•Max 25 marks-

the higher the

better control –

interpret!

•Have commercial

bilingual sheets

•Question No 4

always causes

confusion.(!!)

•CAT score max 40 marks-

bigger scores indicates higher

impact.

•Need to print 2 languages

from web (who can help?)

Documentation

Follow up Patient

Or Filling up form?

(to print/use own)

Missed appoinment

Discharge Patient

Documentation

PEFR predicted value

•PEF meter technique may

affect the reading.

•Best to refer best patient’s

value

•Do 3 times and take the

highest value.

How to write in Case

Note?

•Forms or Case Note

writing

•Dilemma? Is Dr

reading?

Documentation-Database

TOOLS

Questionnaires- ACT, C-CAT & COPD test

Inhalers-placebo

Test device- spirometry, peak flow meter

Inhaler flipchart

Disease flipchart

Inhaler handbook

Respiratory diary (asthma diary)

QUESTIONNAIRES FROM PROTOCOL BOOK

PLACEB0

FLIP CHART

25

FLIP CHART TEKNIK PENGGUNAAN

UBAT SEDUT

26

BUKU TEKNIK INHALER

27

ACTIVITIES Baseline Knowledge

◦ Pre Test –MCQ (1 hour)

◦ Assessment on Inhalers technique

Introductory Lectures

A) General

◦ Activities in the clinic and ward

◦ Objectives of Respiratory MTAC(RMTAC)

◦ Protocol and documentation (refer to Respiratory MTAC Protocol: Asthma/COPD (Adult & Paediatric) 2nd Edition 2015 & use of CP1, CP2, CP3, CP4 & counselling form)

◦ Inhaler technique (refer to Respiratory MTAC Protocol: Asthma/COPD (Adult & Paediatric) 2nd Edition 2015 or any other updated relevant references)

◦ **Science behind inhalation (additional)

◦ ** Study discussion

B) Asthma

◦ Pathophysiology (disease, risk & trigger factors)

◦ Management and pharmacotherapy (GINA etc)

◦ Assessment tools (ACT, Level of Asthma Symptom Control, PEFR, laboratory investigation)

C) COPD

◦ Pathophysiology (disease, risk factors)

◦ Management and pharmacotherapy (GOLD etc)

◦ Assessment tools (CAT, mMRC, FEV1, laboratory investigation)

Ward Attachment : ◦ Rounds with physicians (at least 6 rounds)

◦ Clerk case (6 cases)

MTAC Attachment : ◦ Observation 2 cases (1 Asthma & 1 COPD)

◦ Hands-on and case clerking - 4 cases (2 enrolment / new case) -1 Asthma & 1 COPD; 2 follow-up (1 Asthma & 1 COPD)] Entry in case note/ form

ACT/CAT

◦ Medication history taking, patient interview and education

◦ Medication compliance assessment

◦ Medication counselling – technique

◦ Peakflow

◦ Adverse Drug Reaction (ADR) or Allergic Reaction reporting (if any)

◦ Prepare , dispense Medication, and set next TCA

Case Presentation:

◦ 2 cases (1 from RMTAC and 1 from Ward clerking)

Bedside Presentation:

◦ 6 cases (3 COPD; 3 Asthma)

◦ With CP2 and counseling forms

Post Test and Discussion

Case simulations (as needed)