QUMAX Program Specific Guidelines - The Guild

QUMAXProgram Specific GuidelinesQuality Use of MedicinesMaximised for Aboriginal andTorres Strait Islander People(QUMAX)The QUMAX Program is funded by the Australian Government Department of Health and Ageing as part of the Fifth Community Pharmacy Agreement betweenthe Commonwealth and the Pharmacy Guild of Australia.

ContentsDefinitions..........................................................................................................................................3Introduction........................................................................................................................................5Background........................................................................................................................................5QUMAX Program Definition.............................................................................................................5Who is eligible?......................................................................................................................5QUM Support Categories......................................................................................................5Aboriginal Community Controlled Health Service (ACCHS) Participation...................................7Eligibility..................................................................................................................................7Participation............................................................................................................................7Payment Schedule..................................................................................................................8Reporting.................................................................................................................................9Community Pharmacy Participation.............................................................................................. 10Eligibility................................................................................................................................ 10Participation.......................................................................................................................... 10Payment Schedule................................................................................................................ 11Reporting............................................................................................................................... 11Program Support.............................................................................................................................12QUMAX Reference Group...................................................................................................12QUM Support Pharmacists (QUMSP).................................................................................12NACCHO State Affiliates......................................................................................................12IT System Arrangements.................................................................................................................13QUMAX IT System (Pharmacy Programs System)...........................................................13NACCHO Communication Network (NCN).........................................................................13Resources and Information.............................................................................................................13APPENDIX A – QUMAX Funding Algorithm..................................................................................14QUMAX PROGRAM SPECIFIC GUIDELINES • JUNE 2011 • 2

DefinitionsIn this document, unless the contrary intention appears the following definitions apply:5CPAACCHS or ACCHSsDeedDepartmentDAAForm AForm BGuildMOUNACCHONACCHO State AffiliateOATSIHProgramPSAFifth Community Pharmacy Agreement between the Australian Governmentand The Pharmacy Guild of Australia signed on 3 May 2010Aboriginal Community Controlled Health Service(s) (ACCHS) which is fundedby the OATSIH for the provision of primary health care services to Aboriginaland Torres Strait Islander peoples, and that employs general practitioners ableto prescribe medicines to clients of that organisationMulti Scheduled Funding Agreement signed between the Department andthe Guild on 24 January 2011The Australian Government Department of Health and AgeingDose Administration Aid is a tamper evident, adherence device which dividespatient medications into individual doses and arranges them according to thedosage schedule throughout the dayQUMAX DAA Agreement form which formalises negotiated arrangementsbetween the ACCHSs and pharmacies for the provision of DAAs and otherQUM services if requiredBanking details and RCTI agreement for community pharmacies participatingin DAA arrangementsThe Pharmacy Guild of AustraliaMemorandum of UnderstandingNational Aboriginal Community Controlled Health Organisation (NACCHO)who are the national peak Aboriginal health body representing AboriginalCommunity Controlled Health Services throughout AustraliaPeak bodies representing the Aboriginal community controlled health sectorat the State/Territory level for the relevant State/Territory and which arerepresented as such on the NACCHO boardThe Australian Government Department of Health and Ageing through theOffice for Aboriginal and Torres Strait Islander Health (OATSIH) is committedto supporting sustained action coordinated across all governments toachieve health improvements over timeThe QUMAX ProgramPharmaceutical Society of AustraliaQUMAX PROGRAM SPECIFIC GUIDELINES • JUNE 2011 • 3

QUMAXQRGQUMQUMSPsQUMAX Work PlanQUM Work Plan templateRCTIQuality Use of Medicines Maximised for Aboriginal and Torres Strait IslanderPeople (QUMAX) Program developed as part of the Fifth CommunityPharmacy AgreementQUMAX Program Reference Group established to advise the Minister and theACC on policy dimension of the program when such advice is requestedQuality Use of Medicines as outlined by the Australian National MedicinesPolicy (December 1999) involves:− selecting management options wisely− choosing suitable medicines if a medicine is considered necessary− using medicines safely and effectivelyQuality Use of Medicine Support Pharmacists (QUMSPs) are pharmacistsemployed by the State and Territory branches of the Guild to provide QUMsupport services to staff of participating ACCHSs and community pharmaciesLocalised QUMAX Program objectives developed annually by ACCHS. Theobjectives are formulated using the approved QUMAX Work Plan template.The approved template to be used as the basis for developing localisedQUMAX Program objectivesThe Recipient Created Tax Invoice is an agreement allowing the Guild to issuea tax invoice on behalf of community pharmacy. This allows the Guild to makeDAA payments to community pharmacy based on QUMAX DAA Agreement.The QUMAX Program Specific Guidelines are intended to provide consistency and certainty in respect to theadministration of the Program. The Guild, NACCHO and Department may depart from these Guidelines inindividual situations when circumstances warrant and will receive written approval from the Department beforemaking a decisions to depart from the rules.Without limiting its right at law or otherwise, the Guild reserves the right at any time to suspend, amend or varythe Guidelines, in consultation with NACCHO and with the approval of the Department.QUMAX PROGRAM SPECIFIC GUIDELINES • JUNE 2011 • 4

IntroductionThis document outlines the Program Specific Guidelines governing the provision of Quality Use of MedicinesMaximised in Aboriginal and Torres Strait Islander Peoples (QUMAX) Program.Funding of up to $11 million is provided under the Fifth Community Pharmacy Agreement (5CPA) for theQUMAX Program that will commence from 1 July 2011.BackgroundAs part of the Fourth Community Pharmacy Agreement (4CPA) the Guild and NACCHO jointly developed theQUMAX Program in consultation with the QUMAX Reference Group (QRG).The QUMAX Program was originally funded as a two year pilot to 30 June 2010. Due to success of the Programit was later approved for a transition year outside the 4CPA and for a further four years under the 5CPA QUMFramework to Support Rural and Urban Aboriginal and Torres Strait Islander Peoples. This Program is to becontinued and to be referred to as QUMAX under the 5CPA.Under the 5CPA, management of the QUMAX Program has been assigned to the Guild who will undertake thisin conjunction with NACCHO.QUMAX Program DefinitionThe QUMAX Program is a QUM support initiative that aims to improve health outcomes for Aboriginal and TorresStrait Islander people. The focus of the QUMAX Program is to improve QUM through a range of support servicesprovided by participating ACCHS and community pharmacies in rural and urban Australia. The QUMAX Programwill be supported by the Guild, NACCHO, QUM Support Pharmacists (QUMSPs) and NACCHO State Affiliates.Who is eligible?The QUMAX Program is intended to benefit Aboriginal or Torres Strait Islander people of any age who presentto participating ACCHS and are assessed by prescribers to be at risk of adverse health outcomes from a failureto comply with their medicine regime without assistance.QUM Support CategoriesTo achieve the aim of the QUMAX Program, funding is allocated amongst participating ACCHSs on a yearlybasis. Once funding is allocated, each ACCHS will complete an annual QUMAX Work Plan, outlining local QUMobjectives for each QUM support category.The QUMAX Work Plan includes seven QUM support categories detailed below:1.Dose Administration Aid (DAA) arrangementsAim: Reduce the financial barriers to access a comprehensive DAA service provided by communitypharmacy to improve medication adherence and medication management for ACCHS clients.QUM pharmacy support2. **Aim: To facilitate additional community pharmacy involvement and support in areas such as QUM planning,policies, protocol development, medicine quality assurance and appropriate Safety Net utilisation.QUMAX PROGRAM SPECIFIC GUIDELINES • JUNE 2011 • 5

3.4.5.6.7.Home Medicines Review (HMR) models of supportAim: Reduce the cultural and logistical barriers to access HMRs by ACCHS clients.QUM devicesAim: Reduce the financial barriers of access to QUM devices to improve overall delivery of medicines andmanagement of chronic diseases i.e. asthma and diabetes.QUM educationAim: Reduce financial barriers of access to QUM education and health promotion for ACCHS employees andtheir clients. This category may also help ACCHS to access current medicine resources, promoting suitable,safe and effective medication management for ACCHS clientsCultural awarenessAim: Improve access and delivery of cultural awareness resources and training for community pharmacy topromote a culturally aware pharmacy environment.TransportAim: Reduce barriers of access to medicines and community pharmacy services by providingtransport support.The work plan categories enable ACCHS to develop local QUM objectives and negotiate with preferredcommunity pharmacy (or pharmacies) to establish bulk local QUMAX DAA Agreements and any other supportas requested.** In exceptional circumstances where a community pharmacy (or pharmacies) confirms they are unable to provide thissupport, the ACCHS may recommend alternative arrangements via the work plan to the Guild and NACCHO, who will jointlyprovide a recommendation to the Department for consideration.QUMAX PROGRAM SPECIFIC GUIDELINES • JUNE 2011 • 6

Aboriginal Community Controlled HealthService (ACCHS) ParticipationEligibilityTo be eligible ACCHSs need to meet the following criteria:• Employ a General Practitioner(s);• RRMA classification of 1-5 (i.e. a non-remote location) (1991 Census Edition);• Not currently eligible for the Section 100 Pharmacy Support Allowance Program; and• Agree to the QUMAX Program Specific Guidelines.ParticipationREGISTRATIONANNUALBUDGETQUMAXWORK PLANFORM AQUMAX DAAAGREEMENTCONTRACTWITH GUILDRegistrationTo participate ACCHS are required to complete an annual registration form. The registration form requiresauthorisation by the ACCHS Chief Executive Officer (CEO). ACCHS will be advised of the annual registrationperiod and registration will only be accepted during this time.ACCHS registration form is available from the QUMAX Module on the NACCHO Communication Network (NCN): http://ncn.naccho.org.au/ncn/ncn_admin.plAnnual BudgetOnce registration is complete an annual QUMAX Budget will be allocated to each participating ACCHS based ona budget algorithm (see Appendix A).The budget allocated for each ACCHS will be embedded in the online work plan and is available from theQUMAX Module on the NCN: http://ncn.naccho.org.au/ncn/ncn_admin.plTo address limited budgets ACCHS may develop local policies to determine client prioritisation for specificservices funded under the QUMAX Program.QUMAX Work PlanUpon allocation of a budget, ACCHS will be required to develop an annual QUMAX Work Plan which involvesdistributing the annual budget and defining local objectives / activities for each of the QUM support categories:1. DAA arrangements2. QUM pharmacy support3. HMR models of support4. QUM devices5. QUM education6. Cultural awareness7. TransportQUMAX PROGRAM SPECIFIC GUIDELINES • JUNE 2011 • 7

Funding can be allocated by ACCHS to any or all of these categories.The QUMAX Work Plan will define the following information:• who is responsible for providing services under each QUM support categories• what activities are planned for each QUM support category• what the funding amount is for each negotiated category.Once completed ACCHS will submit the work plan via the NACCHO Communication Network (NCN) forapproval by the NACCHO and Guild. The NCN will also include the status of the work plan (including theQUMAX DAA), assessment and contract negotiation.The NCN is available at: http://ncn.naccho.org.au/ncn/ncn_admin.plForm A (QUMAX DAA Agreement)ACCHS will negotiate with their preferred community pharmacy (pharmacies) for the provision of a localDAA service for eligible clients. This arrangement will be documented by both parties on Form A (QUMAXDAA Agreement).To maximise service provision ACCHS may also choose to take advantage of a bulk agreement with communitypharmacy incorporating other QUM support categories. The negotiation of other QUM services will take placeon a local level between the community pharmacy and the ACCHS and details will be documented in theQUMAX Work Plan.FORM A (QUMAX DAA Agreement) is available from: www.5cpa.com.au and http://ncn.naccho.org.au/ncn/ncn_admin.plContractsIn order to participate in the QUMAX program, ACCHS will be required to enter into a contract with the Guild.A standard contract has been developed in consultation with NACCHO and approved by the Department.Following approval of the QUMAX Work Plan the Guild will provide two original copies of the contract toACCHS for signature.The contracts will be renewed annually in line with registration and work plan updates. The ACCHS CEO andExecutive Director of the Guild will be required to sign both copies of the contracts and each party will beforwarded a copy for their records.Payment SchedulePayments will be made to ACCHS on a six (6) monthly basis in line with the work plan.Initial paymentThe Guild will make an initial payment upfront for half of the yearly allocation for all non-DAA QUM categorieson receipt of approved work plan and two signed complete copies of the original contracts.Subsequent paymentsThe subsequent payments will be made at six months by the Guild within 30 days only upon receipt of theadequate feedback.QUMAX PROGRAM SPECIFIC GUIDELINES • JUNE 2011 • 8

ReportingParticipating ACCHS will be required to provide the Guild and NACCHO with six monthly feedback reports,including progress and financial reporting against QUM Support categories as outlined on the approvedQUMAX Work Plan. A reporting mechanism for ACCHS is available through the NCN and will involve the ACCHSspecifying for each QUM support category:• the amount spent versus allocated budget;• how the funding was spent (ie. what was purchased); and• the number of patients that have benefited.Reporting mechanism will be available from: http://ncn.naccho.org.au/ncn/ncn_admin.plQUMAX PROGRAM SPECIFIC GUIDELINES • JUNE 2011 • 9

Community Pharmacy ParticipationEligibilityTo be eligible a community pharmacy must agree to the QUMAX Program Specific Guidelines and be aSection 90 approved pharmacy.ParticipationACCHS INITIATECONTACTFORM AQUMAX DAAAGREEMENTFORM BBANKINGAND RCTISEND TOGUILDACCHS Initiate ContactTo participate, a community pharmacy will need to liaise with the ACCHS regarding the potential to supplyDAAs and any other QUM support categories as requested.Form A (QUMAX DAA Agreement)ACCHS will negotiate with their preferred community pharmacy for the provision of a local level comprehensiveDAA service for eligible clients. The DAA arrangement will be documented on Form A and agreed to and signedby a representative of both parties (QUMAX DAA Agreement).FORM A (QUMAX DAA Agreement) is available from: www.5cpa.com.au and http://ncn.naccho.org.au/ncn/ncn_admin.plThe negotiation of any other QUM services will take place on a local level between the community pharmacyand the ACCHS and details will be documented in the QUMAX Work Plan.Form B (Banking details and RCTI Agreement)In order for payments to be made a community pharmacy will also be required to complete Form B (Bankingdetails and RCTI Agreement).FORM B – Banking details and RCTI form is available from: www.5cpa.com.auSend to GuildFORM A and FORM B must be forwarded to the Guild in order to receive payments.QUMAX PROGRAM SPECIFIC GUIDELINES • JUNE 2011 • 10

Payment ScheduleThe Guild will make advance payments for DAA arrangements to community pharmacy on a four (4) monthlybasis in line with the negotiated QUMAX DAA Agreement (Form A).Initial paymentThe Guild will make the initial DAA payment upfront to community pharmacy on receipt of the signed QUMAXDAA Agreement (Form A) and the Banking Details and RCTI Agreement (Form B).Subsequent paymentsAll subsequent DAA payments will be made on a four monthly basis within 30 days only upon receipt of anadequate report (see below).ReportingParticipating community pharmacies will be required to provide the Guild with evidence of the number of DAAsand/or patients (dependant on negotiated arrangement with ACCHS) who have accessed the DAA service. Thiswill need to be forwarded to the Guild in line with the following reporting dates.First Report Due: 15 Nov 2011 (Reporting period 1 Jul 2011 to 30 Oct 2011)Second Report Due: 15 Mar 2012 (Reporting period 1 Nov 2011 to 28 Feb 2012)Third Report Due: 15 July 2012 (Reporting period 1 Mar 2012 to 30 Jun 2012)Community pharmacy is also required to provide reports to the relevant ACCHS on DAA utilisation andexpenditure of any QUM categories in the format agreed with the local ACCHS and specified on the QUMAXDAA Agreement.QUMAX PROGRAM SPECIFIC GUIDELINES • JUNE 2011 • 11

Program SupportThe Guild and NACCHO are responsible for overall QUMAX Program support. QUMSPs and NACCHO StateAffiliates will assist with this on a local level to disseminate information, provide advice and support for the5CPA QUMAX Program.QUMAX Reference GroupThe QRG will provide advice on program development, implementation and issues of the QUMAX programwhen required. Membership of the QRG will include:• the Pharmacy Guild of Australia• the National Aboriginal Community Controlled Health Organisation• the Australian Government (OATSIH and Community Pharmacy Branch of Department of Health and Ageing)• the Pharmaceutical Society of Australia.QUM Support Pharmacists (QUMSP)QUMSP will work with each ACCHS and local participating pharmacies to:• Provide advice and support to assist with strengthening relationships between ACCHS andcommunity pharmacy;• Assist in the development of QUMAX Work Plan objectives and QUMAX DAA Agreements betweenACCHS and community pharmacies;• Provide QUM education to ACCHS staff and their clients;• Work with ACCHS to develop strategies to maximise QUM such as access to QUM education, HomeMedicine Reviews, relevant diabetes and asthma programs and uptake of the Medicare Safety Net byall family members;• Provide a copy of the Cultural Awareness booklet to community pharmacy (produced by PSA); and• Assist ACCHS and their clients in accessing other community pharmacy services.NACCHO State Affiliates• Provide information to QUMAX Pharmacists (QUMSPs) regarding working within the ACCHS sector inthe relevant jurisdiction.• Assist NACCHO in the review of registration data from each state to facilitate budget allocations.• Communicate with QUMSP and NACCHO (via the QUMAX NCN forum) regarding state based priorities orissues (if identified).• Incorporate QUMAX sessions (where appropriate) in relevant state based meetings (NACCHO NPM will beavailable to attend and it is encouraged that relevant QUMPs are invited to participate where appropriate).• Nominate a QUMAX contact person for ACCHS and QUMSPs.• Enter information describing recommended Cultural Training and Resources to the NACCHO CST Inventory.In the event that a state affiliate chooses not to participate in state coordination NACCHO will make alternativesupport arrangements.QUMAX PROGRAM SPECIFIC GUIDELINES • JUNE 2011 • 12

IT System ArrangementsQUMAX IT System (Pharmacy Programs System)The use of the Pharmacy Programs System (online prescribe and claim MAAPS system) will cease on the30 June 2011.To enable smooth transition to the new QUMAX Program the Pharmacy Programs System will continue to15 November 2011 to enable community pharmacies to claim for DAA prescriptions that have been issuedprior to 30 June 2011.Under the 5CPA all payments will be made directly upfront to ACCHS and pharmacies for locally negotiatedagreements, therefore the Pharmacy Programs System will no longer be required for the 5CPA QUMAXProgram.NACCHO Communication Network (NCN)The online NCN will provide:• ACCHS online registration, QUMAX Work Plan development;• ACCHS QUMAX Work Plan feedback mechanisms;• Forum for discussion between ACCHSs, QUMSPs, State Affiliates and Program Managers;• Library of relevant QUMAX Program documents; and• Cultural Inventory TrainingNCN website and access details are available from: http://ncn.naccho.org.au/ncn/ncn_admin.pl?rm=mainResources and InformationFor general QUMAX Program information please access:• 5CPA website: www.5cpa.com.auFor information on community pharmacy participation and the Pharmacy Program System please access:• QUMAX Hotline: 1300 764 088• Email: qumax@guild.org.auFor information on ACCHS participation and the NACCHO Communication Network (NCN) please access:• NCN website: http://ncn.naccho.org.au/ncn/ncn_admin.pl?rm=main• Email : QUMAXmanager@naccho.org.au• NACCHO Phone: 026-248-0644QUMAX PROGRAM SPECIFIC GUIDELINES • JUNE 2011 • 13

APPENDIX A – QUMAX Funding AlgorithmQUMAX Budget per ACCHS = $10,000 + [a/b x ($d – c10,000)]Where:a = number of current QUMAX registered clients attending ACCHS (i.e. total number QUMAXclients in previous 12 months)b = total number of QUMAX registered clients across all participating ACCHSsc = number of ACCHSs registered to participate in the QUMAX Programd = total annual QUMAX budget allocated to QUMAX Work Plan supportQUMAX PROGRAM SPECIFIC GUIDELINES • JUNE 2011 • 14