LTC2 - Service Approach to Evaluation

Patients who do not live in ARRC facilities, registered community residential care facilities or prisons, and have at least one long term condition become eligible for this service when they score 20 or more points at evaluation.

Key points of the Evaluation are:

1. Adherence
2. Long Term Care conditions
3. High Risk medicines
4. Polypharmacy, Palliative Care, Hospital Admissions

1. Adherence LTC PF:

Adherence is based on pharmacy information OR existing referred Needs assessment/MUR’s.

Patient history may show that the patient is already adherent but the pharmacist may have evidence that the patient is not taking their meds OR that there are known patient factors that make it hard for a patient to self-medicate.

The list of approved adherence factors are prefixed with LTC PF: 

At least one adherence factor MUST exist for a patient to be eligible for the LTC Service.

2. Long Term Care conditions LTC:

There are 21 core long term conditions, prefixed with LTC:, that qualify for eligibility. 

At least one of these conditions must exist (in addition to at least 1 adherence factor)  for a patient to be eligible for the LTC Service,

Additional conditions relate to mental health and/or infectious disease. 

Prefixed LTCMH and LTCID respectively they are NOT acceptable as a qualifying conditions in the absence a core LTC’s.

Add conditions to patients as soon as a patient is known to be diagnosed with them. 

This makes assessments faster since Toniq uses them to autopopulate and autoscore most of the eligibility evaluation form.

LTC factors and conditions can be added to a patient record at any time using the F3 LTC/Services - C Conditions from Rx entry screen.

How the conditions are scored:

LTC: Long Term Care service qualifying conditions	Prefix	List of ?	Score	To a Max
Adherence scoring Patient Factors (minimum of 1)	LTCPF	10	10	10
Long Term conditions  (minimum of 1)	LTC	21	2 each	10
Mental Health disorders (not required for eligibility)	LTCMH	1	10 any	10
Infectious Diseases (not required for eligibility)	LTCID	5	10 any	10

3. High Risk Medicines – split into 6 groups

These medicines are automatically identified in the patient history and can be identified by short code at the bottom of the patient history grid.

This patient is getting both Clopine – a monitored therapy (MT) medicine and an anti coagulant (AC) medicine. 

Since these high risk meds belong to different high risk groups this patient is given 10 points towards LTC eligibility.

So long as at least one Long Term Condition or adherence factor is saved on the patient record, the high risk score will show on the Patient entry screen.

High Risk Group	Medicine Dispensing Note	Code	Score
Oral Anticoagulants warfarin or dabigatran	LTC - High Risk 1: Anticoagulant	AC	5
Antidiabetics including insulins	LTC - High Risk 2: Antidiabetic	AD	5
Opioids: fentanyl, morphine, oxycodone & tramadol	LTC - High Risk 3: Opioid	O	5
Drugs with narrow therapeutic index – digoxin, lithium, phenytoin, theophylline	LTC - High Risk 4: Narrow Therapeutic Index	NT	5
Monitored Therapy clozapine, methotrexate	LTC - High Risk 5: Monitored Therapy	MT	5
Combined therapy with NSAID, ACE inhibitor and diuretic	Note identifies either LTC: NSAID, LTC: ACE Inhibitor or LTC: diuretic	CTa CTd CTn	5

4. Polypharmacy LTCPP

Patients are given some points towards eligibility dependant on the number of REGULAR medicines that they are receiving – referred to as polypharmacy.

Look at the patient history and make a judgement on how many regular medicines are being taken and load one or other of the LTC polypharmacy options (prefixed LTCPP) against the patient.

5 to 8 meds score 5 and more than 9 score 10.

Palliative Care LTCPC

Similarly if a patient is in palliative care, this is listed as an LTCPC item and can be onto the patient record. Palliative care scores 10.

Hospital Admissions
Lastly the dispensary program cannot help much with identification of how many hospital admissions a patient has had. Canterbury pharmacies submitting data to the HealthOne data repository can do online enquiries by NHI to see this information.
Consider suggesting to dispensary staff members that they add a very basic note to patient history if they become aware that a patient has come out of hospital. This may be of use to refer back to at LTC evaluation or re-evaluation OR it may take a patient from ineligibility to eligibility. A hospital visit (relevant to an LTC) scores 5 points and can make the difference between qualifying for the service and not.