Key points
1. The Disability Discrimination Act 1995 requires service providers
to make reasonable adjustments to their service so that people
with disabilities are able to use it
2. Providing people with disabilities support to manage and take
their medicines is an essential service
3. Pharmacy staff will determine whether a patient needs the service
using an assessment form that is designed for use nationally
4. The service consists of two levels. Level 1 includes making adjustments
to labelling and packaging, and providing reminder charts. Level
2 is providing medicines in a compliance aid
5. Only nationally approved multi-compartment compliance aids should
be used in this essential service |
Some people need help in managing and taking their medicines. Providing
people with disabilities with this support is an essential service in the
new community pharmacy contract. In other words, it is something that all
community pharmacists will have to provide.
(Other medicines support services, which could be provided for patients
who do not have disabilities, fall within the enhanced tier of the contract.)
Anyone who provides any type of
service is required, under the Disability Discrimination Act 1995, to make
reasonable adjustments to the service so that it can be used by people
with disabilities. This requirement applies to community pharmacists. Most
are aware that the Act requires them to make adjustments to their premises,
such as providing a ramp for wheelchair access, but the Act is about much
more than physical surroundings. It also requires people to provide auxiliary
aids and, for pharmacy, this could include compliance aids. Furthermore,
service providers cannot charge people with disabilities for these auxiliary
aids.
Provision of compliance aids and other support to people with disabilities
is not new for pharmacists. However, in the past, it has tended to happen
in a less than uniform way. By making support for people with disabilities
an essential service, it should now be provided in a systematic manner.
Service aims
The aim of the service is to support people with disabilities to manage
their prescribed medicines so that they can use them safely and appropriately.
Interpreting the requirements of the Disability Discrimination Act creates
two main difficulties. The first is defining “disability”.
The Act defines a disabled person as someone with “a physical or
mental impairment which has a substantial and long-term adverse effect
on his ability to carry out
normal day-to-day activities”. It is clear that this definition includes
a large number of people with a wide variety of disabilities; any long-term
condition that has an impact on a person’s day-to-day life is included.
The second difficulty is defining “reasonable adjustment”.
Although providing large-print labels on medicines could be classified
as “reasonable” it seems unlikely that requiring all pharmacies
to have the facility to print labels in Braille would be. How the service works
Case study: a similar service
A comparable service, although not specifically for
people with disabilities, is a concordance/compliance service for
older people that has been running in Norfolk
for nearly a year.
Ian Charles, co-ordinator of the Norfolk Medicines Support Service,
explains that patients are assessed by a pharmacist or pharmacy technician. “They
come up with an appropriate intervention from something simple like
putting ordinary caps on bottles, popping tablets out of blister
packs or providing medication reminder charts through to clinical
interventions,” he says.
Many people are given monitored dosage systems or referred for assisted
administration by a care worker. “There are differences between
the MDS systems so it is important to ensure that patients get one
that they can use,” Mr Charles explains. With all interventions,
he says that pharmacists should make a choice with the patient rather
than imposing a decision. |
It is envisaged that the service will be initiated when a person who
has a disability asks the pharmacist for assistance with managing and
taking medicines. Pharmacy staff
will determine the patient’s needs using an assessment form designed
for use nationally. This form is currently being developed by the National
Primary and Care Trust Development Programme (NatPaCT).
If requested, staff should help a patient to complete the form.
Pharmacy staff will then use a scoring method to determine whether or not
the
patient is eligible for support. They will also have to decide how much
support the patient needs: the service includes two levels of support or,
if a patient needs more extensive help, the patient should be referred
to the local primary care trust for further assessment.
Completed assessment forms should be sent to the PCT. The PCT has the
right to
review the pharmacy’s forms and may decide that a service is inappropriate
for a particular patient. If this happens, the PCT will have to tell
the patient of its decision before
instructing the pharmacy to stop providing the service.
The two levels of support that pharmacists can provide are: · Level 1 which includes making adjustments to labelling and packaging,
and
providing reminder charts
· Level 2 is providing medicines in a compliance aid
The type of level 1 support provided will vary from patient to patient.
For example, a visually impaired person might need medicines to be labelled
in a more legible way, such as placing additional flagged labels on the
package that use large lettering. People who have difficulty getting tablets
out of blister packs, such as patients with rheumatoid arthritis, might
need their medicines removed from blister packs and placed into a tablet
container instead (subject to the stability of the product).
Another level 1 support is writing reminder charts to help people to remember
to take their medicines. Medicines administration records could also be
prepared to help people keep track of whether they have taken their medicines.
It is only if these methods fail that the use of a multi-compartment compliance
aid should be considered. Patients who are eligible for a compliance aid
will receive four weeks’ supply in a compliance aid at once. A nationally
approved list of compliance aids is currently being drawn up and pharmacists
will only be allowed to use the approved aids for this service.
Pharmacists should continue to provide the service, unless instructed by
the PCT otherwise, until a review is conducted. It has not yet been decided
how often reviews should take place.
There is an opportunity within the enhanced tier of the new contract — services
that are commissioned locally by PCTs — to offer further medicines
support services. This would allow pharmacists additionally to
provide such support to people who do not have disabilities and to provide
a more extensive service than is included within the essential service
to anyone who requires it. |
The
Pharmaceutical Journal