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August 2015

Quick Pharmacy pick-up (QPUP) for stable ART patients. August 2015. Background. Increasing numbers of stable patients Don’t need to collect folder/see clinician every visit Currently we have the club model Clubs don’t suit all our stable patients

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August 2015

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  1. Quick Pharmacy pick-up (QPUP) for stable ART patients August 2015

  2. Background • Increasing numbers of stable patients • Don’t need to collect folder/see clinician every visit • Currently we have the club model • Clubs don’t suit all our stable patients • Our clinics can only manage certain number of clubs well • Exploring alternatives….…..give our patients options & diversify our approaches

  3. Combine +++ fromclub model & CDL pick-ups

  4. Summary of QPUP • Patient only collects folder & sees a clinician every 6 months • Other 2 visits: • Given a specified appointment time (2.5 hour slot on specific date for max 50 patients) • Straight to special pharmacy window to collect 2 months CDU packed ART • Can send a friend/family member if it is not a blood/clinical visit – only need green card!

  5. Staff roles • Facility manager: good oversight of QPUP • Clinicians: routine assessment of stable patient/informed choice and 6m clinical visits/scripting • Pharmacist: QPUP oversight management • Pharmacy assistants: CDU management/Run QPUPs • Registry/clerks: Capturing QPUP registers • Counsellors: Explain QPUP when doing options counselling and also clarify if any questions • Rest of clinic team: Good understanding & support

  6. Patient eligibility and choice • Clinicians will routinely assess whether patient is stable • 12m on ART with 2 x LDL VL • If stable: patient offered and counselled on options: Routine refill VS Facility or Community Club VS Quick PICK-UP (QPUP) • Complete assessment form

  7. Sister Linda 25/08/2015 Sister Linda

  8. If QPUP chosen • Clinician completes 2m clinic script (1m only if in October or November 2015) • Clinician completes CDU script • But does not insert 3 x TCB dates or QPUP number – these will be entered by pharmacy assistant (PA) • Sends to pharmacy with folder (assessment form and 2 scripts)

  9. On arrival at pharmacy • Patient joins normal pharmacy queue but 1 window will be designated for QPUP enrolment (marked clearly above window). • PA at this window will see next in the queue and all QPUPs in queue will go to this windo when they get to the front. • Only 50 patients can be allocated to any QPUP • the intention is to reduce waiting times!

  10. On arrival at pharmacy • Patient is offered choice of Monday or Wednesday late afternoon (16h30-19h00) • PA will have 2 QPUP registers (Mon and Wed) with them for particular week’s recruitment • PA will look at QPUP schedule to determine which QPUP to allocate the patient too – see next slide.

  11. How to allocate… • If patient is recruited in any of the weeks: • In red, they will be allocated to QPUP 1 or 2. • In blue, they will be allocated to QPUP 3 or 4

  12. Find QPUP 2 register • Place patient sticker and complete QPUP registration date

  13. After QPUP allocation • Supply according to clinician script to cover until next QPUP collection date • Place QPUP sticker with QPUP# on patient folder and green card • Place pre-printed sticker on green card with next 6 visits and complete first 3 TCB dates: 1. Collect at pharmacy: 23/11/15 2. Collect at pharmacy:18/1/16 3. Collect folder/see clinician/collect at pharmacy: 14/3/16 4. Collect at pharmacy: 5. Blood taken/collect at pharmacy: 6. Collect folder/see clinician/collect at pharmacy: • Staple patient folder stickers into green card (for blood visit later on)

  14. 1. Collect at pharmacy: 23/11/15 2. Collect at pharmacy:18/1/16 3. Collect folder/see clinician/collect at pharmacy: 14/3/16 4. Collect at pharmacy: 5. Blood taken/collect at pharmacy: 6. Collect folder/see clinician/collect at pharmacy: QPUP 2

  15. After QPUP allocation • PA collects CDU script from patient • Mark on script: • QPUP number (and place QPUP sticker) • 3 x TCB dates • Script should look the same as club script • Send/place: • Original submit to CDU • Copy in QPUP folder • Copy in patient folder

  16. QPUP – 1st refill date • Patient/buddy straight to QPUP window to collect CDU pack btw 16h30-18h45 • PA completes visit in QPUP register • Check patient understands TCB date and to come straight to window next time

  17. QPUP – 2nd refill date • Patient/buddy straight to QPUP window to collect CDU pack • PA completes visit in QPUP register • Check patient understands TCB date and next time must first get folder, see clinician for script, then come to pharmacy window with folder

  18. QPUP – 3rd refill date • Patient comes to clinic during the day • Collects folder at reception • Sees clinician for quick check-up and new script • Patient then queues in normal pharmacy queue and see PA at window designated for QPUP patients • PA collects new script, enters QPUP number, 3 TCB dates, replaces copied in patient folder and QPUP file and submits original

  19. 1. Collect at pharmacy: 23/11/15 2. Collect at pharmacy:18/1/16 3. Collect folder/see clinician/collect at pharmacy: 14/3/16 4. Collect at pharmacy: 12/5/16 5. Blood taken/collect at pharmacy: 10/7/16 6. Collect folder/see clinician/collect at pharmacy: 8/9/16 QPUP 2

  20. QPUP – 3rd refill date • PA distributes ART, completes next 3 TCB dates on green card • PA completes visit in QPUP register • Check patient understands TCB date and to come straight to window next time

  21. QPUP – 4th refill date • Patient/buddy straight to QPUP window to collect CDU pack • PA completes visit in QPUP register • Check patient understands TCB date and that the need to have blood drawn first at next visit and then to window.

  22. QPUP – 5th refill date • Patient had choice for blood draw: • Either on 5th ART refill date goes with green card to blood room btw 15h00-16h15 for blood draw, no folder. • Comes to clinic any other day between 08h00-15h30 4-8 weeks before 6th refill date for blood draw, no folder • Nurse uses patient id stickers from green card for lab form and blood tube • Sticks bar code from lab form on green card as proof blood drawn • Patient then goes straight to QPUP window to collect CDU pack • Check patient understands TCB date and next time must first get folder, see clinician for script, then come to pharmacy window with folder

  23. QPUP – 5th refill date • PA completes visit in QPUP register • Check patient understands TCB date and next time must first get folder, see clinician for script + clinical visit, then come to pharmacy window with folder • If patient sends buddy on blood visit, provide CDU pack - ask buddy to tell patient to come for blood taking in next 2 weeks otherwise will be removed from QPUP at next visit

  24. QPUP – 6th refill date • Patient attends clinic during the day • Collects folder at reception • Sees clinician for annual clinical visit (check VL) and only rescript with CDU script if VL is LDL • Patient joins normal pharmacy queue but when gets to the front goes to QPUP designated PA window to collect last CDU pack • PA collects new script, enters QPUP number, 3 TCB dates, replaces copied in patient folder and QPUP file and submits original

  25. QPUP – 6th refill date • PA distributes last CDU pack, completes next 3 TCB dates on green card • PA completes visit in QPUP register • Check patient understands TCB date and to come straight to window next time

  26. 1. Collect at pharmacy: 23/11/15 2. Collect at pharmacy:18/1/16 3. Collect folder/see clinician/collect at pharmacy: 14/3/16 4. Collect at pharmacy: 12/5/16 5. Blood taken/collect at pharmacy: 10/7/16 6. Collect folder/see clinician/collect at pharmacy: 8/9/16 1. Collect at pharmacy: 2/11/16 2. Collect at pharmacy:18/1/17 3. Collect folder/see clinician/collect at pharmacy: 10/3/17 4. Collect at pharmacy: 5. Blood taken/collect at pharmacy: 6. Collect folder/see clinician/collect at pharmacy:

  27. QPUP – 6th refill dateIf high VL or unwell • If high VL or clinically unwell inform patient require more regular clinical/adherence support, first need to regain wellness/resuppress before back into QPUP • Complete patient assessment form to note exit form QPUP and cross out QPUP label on patient folder and patient green card • If high VL, patient first goes to ROTF/enhanced adherence • Then to pharmacy queue and designated QPUP PA for last collection • PA will confirm that patient understands will no longer come to the QPUP window next time

  28. Sister Linda 25/08/2015 Sister Linda Dr Hewittson 20/02/2016

  29. QPUP – 6th refill date • Enters collection and exit in QPUP register • PA checks QPUP number cancelled on green card, patient folder and removes CDU script from QPUP folder

  30. Late/missed appointmentsArrive after 2.5hrs or within 5 days • PA informs that patient has to come within time slot or if they cannot come - send a buddy to collect. • If late again, will be removed from QPUP • Complete collection + LATE in QPUP • On clinical visit (3 & 6) can come anytime on day as joins normal pharmacy queue

  31. Late/missed appointmentsAfter 5 days or 2nd late visit • PA informs patient nicely that unfortunately patient cannot use the QPUP going forward and needs to collect their folder, see clinician and them come to pharmacy. • PA cancels QPUP on green card, patient folder and marks exit on assessment form. • Removes CDU script from QPUP folder • Come to usual pharmacy queue – can provide CDU pack or pre-pack

  32. Festive season cover • Different approach to clubs as difficult to manage within scripting cycle • Clinic pharmacy provides 1m additional supply to CDU pack if TCB btw 16/12-13/1 (clinic scripts will need to be written for entire QPUP and place in QPUP folder) • Provide TCB date – 3 months later and then continue as usual • CDU pack will arrive 1m early but will be corrected at next script date

  33. RECAP

  34. 1 year (visit 5) 3 x year (visit 1,2&4) 2 x year (visit 3&6) 6 individual visits a year: 4 very quick (30min-1hr) 1 slightly longer to take blood (1hr) (or keep short and add 1 visit for blood draw) 2 normal clinic visits – folder/clinician and pharmacy (3-4 hours)

  35. Pharmacy planning MSF to provide • QPUP files for CDU scripts • QPUP registers • QPUP stickers and TCB stickers • QPUP boxes where CDU packs unpacked in preparation, QPUP files and registers kept • MSF will support set up if pharmacy – need to sit with pharmacy team to determine what they need.

  36. LETS GET RID OF OUR QUEUES AND KEEP OUR PATIENTS ON ART BY MAKING IT EASIER!

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