A brief summary of advice from leading pharmacists on the telehealth changes that have recently occurred
Due to changes passed this month in the wake of the COVID-19 pandemic, eligible patients are now able to access medication reviews from a pharmacist via video or teleconference.
Accredited pharmacists are also allowed to provide two additional follow-ups for Home Medicines Reviews (HMRs) and Residential Medication Management Reviews (RMMRs) with patients within nine months of the initial review.
On Wednesday, the PSA conducted a webinar on telehealth hosted by national president Chris Freeman, lead 7CPA negotiator Shane Jackson and pharmacist Nicolette Ellis. You can listen to the full webinar here.
Here are five top pieces of advice from the broadcast:
1. Discuss the appropriateness of a telehealth consult.
It’s really important to have contact with the patient beforehand to discuss and establish the appropriateness of a telehealth consult, said Ms Ellis.
“There is an eligibility criteria for medications reviews and MedsChecks that is outlined for those most at risk,” she reminded pharmacists.
For a HMR, RMMR, MedsCheck or Diabetes MedsCheck to be conducted via telehealth the patient must meet the following eligibility criteria (in addition to the eligibility criteria for the relevant program):
- Meets the current national triage protocol criteria for suspected COVID-19 infection after consultation with either the national COVID-19 hotline, state COVID-19 hotlines, a registered medical or nursing practitioner or COVID-19 trained health clinic triage staff;
- people aged over 70;
- identify as Aboriginal and Torres Strait Islander people aged over 50;
- people with chronic health conditions or who are immunocompromised; or
- parents with new babies and people who are pregnant.
Ms Ellis also gave the example of a patient with significant cardiovascular health risks.
“You notice multiple medications that prolong the QT interval [so] you might think it’s more appropriate to do a face-to-face HMR in that regard,” she said.
“Sometimes [telehealth] is not appropriate.”
Dr Jackson agreed. “Telehealth shouldn’t be the default. Patients need to know this is an option,” he said. “Patients need to consent to that process and be adequately informed around the process.”
Professional indemnity insurance provider PDL told AJP: “Each opportunity to undertake a telehealth service needs to have a risk-benefit assessment to ensure that the means of consultation is suitable for the client and pharmacy and the risk of oversight, omission or miscommunication is minimised.
“Documentation supporting the decision to undertake the service via telehealth should be saved. If there is an inability to communicate clearly and professionally with a client then the telehealth option should not be used and the reasons for this decision documented.”
2. Remember to gain and document informed consent.
“This is a thing where I’ve noticed my GP colleagues and other specialists becoming unstuck, because they’ve been maybe audited by Medicare and they’ve found that they haven’t actually documented consent [of the patient],” said Ms Ellis.
“Unfortunately if they haven’t documented consent then that funding, they have to pay it back,” she said.
“That could be a scenario that we find for pharmacists as we go forward with the great improvements to our services for medication reviews. I always email my patients with the consent form as well so I have it in writing.”
Associate Professor Chris Freeman reminds pharmacists that there is an up-to-date consent form on the PPA website which can be read out to the patient.
“If you are providing these services via telehealth, please ensure you have the correct consent form to move forward with,” he said.
3. Familiarise yourself with the program rules, and the professional guidelines for service delivery.
“If I can make a call out to people – familiarise yourself with two documents,” said Dr Jackson.
“One being the program rules, which are around claiming and eligibility – so you don’t fall foul of doing the wrong thing from a claiming and delivery point of view, so you’re not delivering the service to somebody you shouldn’t have, you’re not delivering the service outside of the payment rules,” he said.
“Second thing is from a professional perspective, familiarise yourself with the professional guidelines for service delivery. We used to have the HMR and RMMR guidelines, they’ve now been brought together to have one document around comprehensive medication review, released in April 2020. I encourage people to look at that as well because that’s the ‘how’ – the step-by-step guideline around how you do a medication review from a professional practice point of view,” said Dr Jackson.
4. Be aware of privacy considerations.
“Privacy is really important especially to health consumers,” said Ms Ellis. “I generally discuss with them that none of the consultation will be recorded without their consent. I would err on the side of caution and make sure that you are not recording any of your consultations on telehealth and on the same side, the patient should not be recording the consultation on telehealth, because you’re not sure what would happen with the recording as well – so just to protect you.”
She also pointed out the importance of using encrypted software for consultations.
“There’s really good benefits for [telehealth] but it needs to be used correctly. Now that we’ve been given a bit of a treat, we need to respect it and also do really well, it’s a really great opportunity for our profession to continue doing these sort of services,” said Ms Ellis.
Associate Professor Freeman agreed: “We should respect that and ensure we are following the guidelines, especially around privacy and informed consent.”
PDL told AJP: “The means of telehealth communication must be considered to ensure it is undertaken in a secure and private manner to minimise the risk of a breach of privacy or confidentiality.
“PDL reminds pharmacists to review the security standards of any platform and preferably use secure platforms utilising high levels of protection such as encryption and invitation-only formats where control of access is visible and suitably managed.”
5. Check your indemnity insurance covers telehealth consultations.
Ms Ellis reminds pharmacists that it’s important to check your professional indemnity insurance covers telehealth and teleconferencing, as there is potential for some providers not to cover them.
“The take home message from an indemnity point of view is to double check,” said Associate Professor Freeman. “If you’re going to get that advice, please get it in writing … in the event that you might need to draw upon that.”
PDL informed AJP that its Non-Proprietor Pharmacists Liabilities Insurance Master Policy provides cover for HMRs, RMMRs, MedsCheck and Diabetes MedsCheck when the service is provided in accordance with the Program Rules, as set out by the Pharmacy Programs Administrator.
This policy cover extends to include telehealth HMRs, RMMRs, MedsCheck and Diabetes MedsCheck services, as defined in the April 2020 Program Rules without any requirement for the member’s cover to be specifically endorsed or noted.
PDL reiterates that program rules and practice standards need to be followed at all times, with particular reference to the criteria to qualify for a telehealth service.