Note: This is a message specifically for pharmacies providing services to residents of long-term care homes. This initiative does not apply to claims for residents of retirement homes)
Pharmacists working in the LTC sector will recall that the Long-Term Care Medication Management Initiative was launched in early September 2016, with the goals of improving medication management in long-term care homes (LTCHs) and supporting the quality of care delivered to residents through the increased use of safe, effective, and lower-cost medications within the same therapeutic categories. A critical component of any study, including demonstration projects, is measurement and evaluation, and as such, it is important that we track the outcomes of the various interventions and decisions being made in order to confirm if the project has been appropriately structured. To assist in the evaluation of prescribing behaviours, the Ministry of Health and Long-Term Care has agreed to enable LTC pharmacy providers to track and capture outcomes through the use of four PINs.
Successful conversions of therapy from high cost molecules to lower cost but equally efficacious ones are an obvious way to measure system savings from this initiative. However, it is equally important to measure, track and understand unsuccessful therapy conversions. Your recommendations toward driving such conversions in therapy can be rejected for a number of reasons, particularly from prescriber or resident/POA rejections or from the fact that the project has been deemed voluntary. Because these rejections may vary in their rationale, the use of PINs will be integral in understanding them.
In a process similar to that used with the pharmaceutical opinion and smoking cessation programs, these PINs will capture the outcomes of your recommendations in as close to real time as possible. They are defined as follows:
As with other professional service PINs, the pharmacist becomes the prescriber of record for the submission of these PINs.
- When a recommendation has been made solely for the purpose of the demonstration project and there are otherwise no clinical issues or therapeutic problems that require a resolution to improve the resident’s clinical response, then these PINs are to be used to capture the outcomes of the prescriptive intervention request and there will be no payment associated with the use of these PINs.
- If the pharmacist identifies a clinical issue or therapeutic problem with the “targeted” (higher cost) drug product and the pharmacist recommends a switch to the lower cost therapeutic agent as a possible solution to the problem, then the Pharmaceutical Opinion Program would apply and the pharmacist would submit the appropriate “POP” PIN upon receiving a response from the prescriber. In this circumstance, the POP-specific PIN would be compensated. Full documentation would of course be required to support this claim for remuneration.
- Submit the “POP” PIN as per normal protocol with the Pharmaceutical Opinion Program, and then
- Submit the appropriate LTC Medication Management PIN to indicate the resolution of the pharmacist’s recommendation.
Representatives from Neighbourhood Pharmacy Association of Canada and the Ontario Pharmacists Association will be meeting regularly with the Ministry to track PIN utilization and will incorporate this information into the project measurement and evaluation process for overall analysis. For any questions or comments as they relate to the application of these PINs for the demonstration project, please email us.