[Revised 19 May 2020]
When you have identified a potential LTC patient you can start the assessment phase. Go to LTC Manager > LTC Assessment Tool in the patient info screen to
Once you have identified a patient as potentially LTC, go into the Patient. From the top of the screen, go to LTC Manager, LTC Assessment Tool and do a new assessment.
(You can also access this via the daily dispensing log screen under Patient Care).
How do I use the RxOne LTC Assessment Tool?
The RxOne Assessment Tool is based on the paper Assessment form. Fill in this as you would normally fill in the paper assessment form. The paper based LTC Assessment Tool, upon which the RxOne Assessment Tool is based, may take you 30-45 minutes. This can be completed in RxOne as you dispense.
If a box is greyed out it means that you have not entered enough criteria. As you complete questions the boxes will become editable. There is an indicator at the bottom of the screen that will change colour between red, yellow and green. This tells you the progress of the assessment and whether your patient has become eligible. |
Enter your staff ID.
Fill in the first three sections (Q1,2 &3) on page one before you can go further. If there is no score on page one, then it is not possible to proceed to next page (i.e. The patient does not fulfil initial screening criteria).
After filling in Q1 and Q2, you may see some scores next to the page numbers as RxOne has automatically populated as much information as it can.
You can see the RxOne estimated % compliance under Section 3 (Q3)
If the RxOne estimated compliance is less than 80%, a score of 10 will automatically applied.
If the computer estimated compliance is greater than 80%, but you have evidence that the patient is non-compliant or have identified factors that negatively affects the patients compliance and self management of medicines, then under Pharmacy Assessed click on the down arrow on the selection box to select score and reason.
Under Other info source/comments , add in as much information as you can to support your assessment.
Once a score of 10 has been achieved on this initial screening page, you can move to the next page.
The top of page 2 and 3 displays a list of the patient’s medicines (regular and non regular) dispensed in the past 6 months and their corresponding therapeutic groups, providing a quick reference for you to check and answer the questions about LTC conditions and Polypharmacy etc.
RxOne will populate the LTC Condition field with the most likely Long Term Condition associated with the therapeutic group, eg. Oral Hypoglycaemic Agents are linked to the LTC of Diabetes, Beclomethasone to Asthma or COPD etc.
This is only a guide. Since some drugs can be used for more than one condition. It's your reponsibility to check the conditions that have been automatically populated is correct for the patient and change if necessarily. Also, you will need to manually add other LTCs if required.
The auto-populated LTC is displayed in orange colour the first time it auto-populates. To accept these, select Update LTC Conditions on Patient Record. When you next go back into the Assessment Form they will appear in black.
If you don’t want to accept these auto-populated conditions, then highlight the one you don’t want and select Delete LTC Condition
To manually add a condition, use Add LTC Condition. Clicking on this button will bring up the official list of LTC conditions for you to select from. After adding the conditions, you can click on Update LTC Conditions on Patient Record so next time the conditions will be completed for you.
RxOne will automatically fill this in for you if the patient has medicines in this category. Please check this information. Only score once for each drug and only if for long term use. Use the remove button to remove from the list if necessary.
Check each section carefully.
If you have received Patient consent tick the appropriate box. Note: If you havent got consent yet, you can still save and send the assessment to the portal. But the patient cannot be registered as LTC until consent has been obtained.
Once you have finished the assessment, click on Save Complete & Send to EAR Portal.
This will save a copy of the form in the Patient forms and file for review or audit. It will also record in the patient Event Audit that an LTC Assessment has been done.
If you have ticked Patient’s consent obtained in Q11, then RxOne will automatically change the patient type from Core to LTC when you click on Save Complete form & send to EAR Portal
If you still need to get patient consent, leave the consent obtained box unticked. Say Yes to the question "Do you want to automatically tick the consent required box and add a comment into the patient comment". (This will tick the ‘Eligible, Consent Required’ box and add the note "Please get the Patients Consent to register for the LTC service!" in the Patient Comment Box to alert you to get consent when the patient comes in next).
Once you have obtained patient consent, on the Patient Screen, change Core to LTC and untick the ‘Eligible, Consent Required’ box. Manually remove the patient comment about getting consent.
The information will be sent to the Community Pharmacy Portal (EAR) which is managed by the company Whanau Tahi (Simpl).
After registering the patient as an LTC patient, you will need to do the Management Plan. You may need to work through the management plan with the patient.
All LTC patients need to be reassessed each year to ensure they are still eligible for the service.
The reassessment looks at whether the factors which led them to be registered for the service still apply. As LTC patients have received adherence support over the last year one can expect most of them will now be collecting and taking their medicines as they should be. When reassessing their adherence the pharmacist has to ask themselves 2 questions:
whether the factors (e.g poor health literacy) which led the person to be poorly adherent are still applicable, and
what, in the pharmacists clinical judgement, would happen if the LTC service support the patient receives was stopped — would the patient remain adherent or would they slip back into poor adherence?
At the end of the reassessment:
If the patients conditions and other risk factors (e.g high risk medicines and polypharmacy status) remain the same and the pharmacist concludes the patient would slip back into poor adherence if support was withdrawn, then the patient is still eligible and remains in the service.
If the pharmacist concludes the support and work done during the year has changed the ability of the patient to manage their medicines so that support could be withdrawn without the patient slipping back into poor adherence, then the patient is no longer eligible and is exited from the service.
The process for established patients relies more heavily on clinical judgement than the initial assessment, as it does with the management of long-term conditions in general. Given the sort of patients receiving the LTC service it seems likely many will continue in the service until they either move into aged care or die, but some will be able to leave the service because they are now able to manage their medicines adequately.
Do the factors which led the patient to be registered for LTC still apply?
Would the patient slip back to poor adherence if this service was discontinued?
If the answer to either of these questions is ‘No’ then the patient can be exited from the service. If the answer to both is ‘Yes’ then the patient should remain ‘LTC’.
Reassessment process is essentially the same as a new assessment. Either do a new assessment or load the last assessment (See below for limitation of this option).
If the Compliance Score is over 80% (which is most likely as the patient has been managed under the LTC service), it will not contribute to any points. You will need to make a decision that without your intervention and support the patient will not be adherent. Under Pharmacy Assessed, select the reason the patient still needs to be in the LTC service. In this case you are stating that your support is required and this will contribute 10 points.
Select the information source. Under Other info source/comments , add in as much information as you can to support your assessment.
Complete the rest of the assessment as normal , then select ‘Save Complete Form and send to EAR Portal’. An event will then be added into the Event Audit tab in RxOne and this will also update the assessment date on the EAR portal ensuring continued payment.
Load Last Assessment
When doing a reassessment, if you choose to load the last assessment instead of doing a new assessment, then be aware of the limitation of this option. Load Last Assessment, does exactly that. It will load the last comments, adherence factors, conditions etc. BUT it will not check the most recent 6 months medications to suggest any changes or additions of LTC conditions, Mental Health Conditions, Polypharmacy etc. If there has been medication changes, you will need to manually add or delete the conditions, change the polyphamacy score etc. Make sure you check every section carefully to see if the information on the old assessment still applies and change if necessary.
How to identify who needs reassessment?
Use the LTC last Contact Report. In Dispensary, go to Patient Care Menu, LTC Manager, LTC Reports, LTC Last Contact Report. Select LTC Patients) to identify which patients are due for a re-assessment.