Evaluation of the Residential Medication Management Review ... · RMMR Evaluation Appendix G –...

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Evaluation of the Residential Medication Management Review

Program

Appendix G

Questionnaires

Prepared for

Department of Health and Ageing

GPO Box 9848 Canberra ACT 2601

May 2010

RMMR Evaluation Appendix G – Questionnaires


CR&C 1074 1

TABLE OF CONTENTS

1. Accredited Pharmacists Survey........................................................................................ 2

14. GP Survey.......................................................................................................................... 14

20. Aged Care Home Survey.................................................................................................. 20



CR&C 1074 2

1. Accredited Pharmacists Survey

Instructions for completing this survey

Participation in the survey is voluntary and your responses will be kept confidential. The

evaluators will not be given any of your personal information. No names or personal details will

be released, nor used in any results of the survey. No individual responses will be identified in

the final report.

If you are a member of another organisation, it is possible you will receive a separate invitation

to complete this survey. Each person is to complete the survey only once. Please complete the

entire questionnaire. This will take you 10-15 minutes. If you are interested in taking part in this

evaluation, please complete and return this survey within two weeks of receipt of this email.

What if I have a question?

If you have any questions about this survey, please contact Anneliese Spiteri from Campbell

Research on their toll-free number 1300 368 113.

We thank you in advance for your contribution to this important project. Your participation in this

survey will be greatly valued.



CR&C 1074 3

2. Introduction

Q1. Are you currently accredited to do Residential Medication Management Reviews and Home Medicine Reviews?

� Yes CONTINUE � No TERMINATE

3. About your role in pharmacy These questions are about you, your role as an accredited pharmacist and the businesses for which you do medication reviews (including, if applicable, your own business).

Q2. How long have you been working in the pharmacy sector?

Write ‘1’ if you have been working as a pharmacist for less than 1 year

� ________________ Years

Q3. What year did you become accredited to do medication reviews?

� ____ ____ ____ ____ Year

Q4. In what state or territory is your main office or pharmacy?

This means the office or other building where you are primarily based, not necessarily where medication reviews take place.

� _____

Q5. Is this office or pharmacy located in a metropolitan, regional centre, rural or remote area?

� Metropolitan � Regional centre � Rural � Remote



CR&C 1074 4

4. Number and nature of RMMRs

Q6. Have you done any RMMRs in the last 12 months?

� Yes CONTINUE � No GO TO Q24

Q7. Do you conduct any RMMRs for a pharmacy which supplies medications to aged care homes (‘supply pharmacy’)?

� Yes, all of the RMMRs I conduct are on behalf of a supply pharmacy � Yes, some of the RMMRs I conduct are on behalf of a supply pharmacy � No, none of the RMMRs I conduct are on behalf of a supply pharmacy

Q8. What contracting and payment arrangements do you use when you conduct RMMRs? (Thinking of the last 12 months only).

Please choose more than one option if you conduct RMMRs under more than one arrangement.

� As part of your work at a pharmacy that you own � As part of your work for another type of company that you own: e.g., a company

specialising in reviews and quality management systems

� As a consultant pharmacist for a pharmacy owned by someone else � As a consultant pharmacist for another company: e.g., a company specialising

in reviews and quality management systems

� As a sole practitioner/small business: contracted directly to the aged care home

without the inclusion of another organisation such as a community pharmacy

� Other, please describe _______________________________________

Q9. What are the payment arrangements when you conduct RMMRs?

Please choose more than one option if you conduct RMMRs under more than one arrangement

� Paid a salary � Claim directly from Medicare � Paid by the RMMR Provider on a per RMMR basis

� Other arrangement _________________________________



CR&C 1074 5

Q10. In the last 12 months, approximately what proportion of those RMMRs were for residents in metro locations and what proportion for residents in non-metro locations?

An estimate is acceptable. The proportions need to add to 100%

� Metropolitan ______%

� Regional ______%

� Rural ______%

� Remote ______%

� Total ______% (automatically calculated)

Q11. In the last 12 months, how many aged care homes did you visit to conduct RMMRs?

An estimate is acceptable

� ______________________________

Q12. In the last 12 months, approximately how many RMMRs did you conduct?

An estimate is acceptable

� ______________________________

Q13. In the last 12 months, approximately what proportion of those RMMRs were for residents in metro locations and what proportion for residents in non-metro locations?

An estimate is acceptable. The proportions need to add to 100%

� Metropolitan ______%

� Regional ______%

� Rural ______%

� Remote ______%

� Total ______% (automatically calculated)



CR&C 1074 6

5. Outputs of RMMRs

Q14. Of all the reviews that you have done in the last 12 months, in what proportion would you have recommended the following?

An estimate is acceptable.

None 1-5% 6-10% 11-20% 21-30% 31-40% 41%+

Don’t know/not applicable

Commencement of a new prescription medication � � � � � � � �

Commencement of a new non-prescription item (i.e. vitamins) � � � � � � � �

Cessation of a medicine � � � � � � � �

Increase of a medicine dose � � � � � � � �

Decrease of a medicine dose � � � � � � � �

Change in the mode of administration of a medicine � � � � � � � �

Q15. Thinking back over the last 12 months, please indicate how strongly you agree or disagree with the following statements:

.

Strongly

agree Agree

Neither agree nor disagree

Disagree Strongly disagree


Q16. a) Changes made to medication as a result of reviews, led to positive health outcomes for residents.

� � � � � �

Q17. b) Changes made to medication as a result of reviews, led to negative health outcomes for residents.

� � � � � �



CR&C 1074 7

Q18. Thinking back over the last 12 months, how often did you identify apparent adverse drug events for residents of aged care homes?

.

None 1-5 times 6-10 times 11-20 times 21-30 times 31 or more times Don’t Know

� � � � � � �

Q19. Thinking of the recommendations you have made in reviews you have done in the last 12 months, how often do you believe that GPs have acted on those recommendations?

� All of the time � Most of the time � Some of the time � Rarely � Never

� Don’t know

6. Payment and Costs The current claimable payment for an RMMR is $130 per resident reviewed.

Q20. In general, how much do you receive per RMMR conducted?

For example, the RMMR provider may pay you $100 of total RMMR payment.

� I am always paid a salary � $_______________________

Q21. What are the costs you incur when involved with RMMRs?

Please tick all that apply

� Travel long distances to aged care homes � Costs associated with software and IT � Administrative overheads � Pharmacist salaries � Contract management costs � Time taken to liaise with GPs � Time taken to pursue dispensing histories � Inefficient records at aged care homes � Other, please describe ____________________________



CR&C 1074 8

7. Collaborative RMMRs RMMRs can be done either as ‘Pharmacist-Only’ or as ‘Collaborative Reviews’ where the GP is also entitled to claim. For these questions, ‘Collaborative Reviews’ refers only to reviews done where GPs claim a payment for their services. GPs claim under Medicare Item 903.

Q22. In the last 12 months, what proportion of the RMMRs you have conducted have been Collaborative Reviews with a GP?

� None CONTINUE � 1-5% CONTINUE � 6-10% CONTINUE � 11-30% CONTINUE � 31-50% CONTINUE � 51-70% GO TO Q24 � 71-90% GO TO Q24 � 91%+ GO TO Q24 � Don’t Know GO TO Q24

Q23. Why are the majority of the RMMRs you conduct done as ‘pharmacist-only’ reviews?


� I do not seek GP involvement because GPs in my area do not value RMMRs � GPs are too busy to take part in a Collaborative Review � I do not seek GP involvement because little value is gained through involving

them � GPs do not respond to my invitations to become part of Collaborative Reviews

� Other, please describe _________________________________

GO TO Q25 IF Q22 = NONE

Q24. Thinking of the GPs with whom you conduct Collaborative Reviews, would you agree or disagree with the following statements?

Strongly agree

Agree Neutral Disagree Strongly disagree

Not applicable

The GP adds value to the review process � � � � � �

The involvement of the GP makes changing medication regimes easier � � � � � �

Without the GP’s involvement, there is little point in conducting a review � � � � � �



CR&C 1074 9

Q25. How would you describe the level of cooperation you currently receive from GPs in relation to RMMRs?

� Cooperative � Neither cooperative nor un-cooperative � Un-cooperative � Don’t know

Q26. In the future, would you like to…

� Do more Collaborative Reviews with GPs (Reviews where the GP can claim

as well as the Accredited Pharmacist) � Do the same number of Collaborative Reviews � Do fewer Collaborative Reviews

� Don’t know

8. Accreditation

Q27. Were you aware that a financial incentive is available for pharmacists who attain accreditation?

� Yes � No � Not sure

Q28. Were you aware that a financial incentive is available for pharmacists who renew their accreditation each year?

� Yes � No � Not sure

These questions are about the incentive payment that is made to pharmacists when they become accredited, and the yearly payment that is made for ongoing accreditation. The incentive is known as the Medication Reviews Accreditation Incentive, or MRAI.

Pharmacists who achieve accreditation receive a one-off initial payment of $1,500. The pharmacist also receives an annual payment of $750 for each year they remain accredited.



CR&C 1074 10

8.1 Initial payment

Q29. Did you claim the initial payment when you became accredited (or when the payment came in for those who were already accredited at that time)?

� Yes GO TO Q28 � No CONTINUE � Don’t know GO TO Q30

Q30. Why did you not claim the initial payment?

� I was not aware that the incentive was available � I did not get around to claiming the incentive � My claim was rejected

� Other, please describe __________________

ALL RESPONDENTS TO Q30

Q31. How much did the initial payment influence your decision to become accredited?

� A lot � A little

� Did not influence my decision

Q32. Would you have become accredited without the initial payment?

� Yes � No

� Don’t know

8.2 Yearly payment

A yearly payment is available to pharmacists who maintain their accreditation under MRAI.

Q33. Have you ever claimed the yearly payment that is available through MRAI to accredited pharmacists?

� Yes GO TO Q32 � No CONTINUE � Don’t know GO TO Q36



CR&C 1074 11

Q34. Why have you not claimed the yearly payment?

� I have not been accredited for a full year � My accreditation has lapsed � I was not aware that an annual incentive was available � I did not get around to claiming the yearly payment � Other, please describe __________________

ALL RESPONDENTS TO Q36

Q35. How much did the yearly payment influence your decision to remain accredited?

� A lot � A little

� Did not influence my decision

Q36. Would you maintain your accreditation without the yearly payment?

� Yes � No

� Don’t know

Q37. Do you intend to renew your accreditation in the next 12 months?

� Yes GO TO Q36 � No CONTINUE � Don’t know CONTINUE

Q38. What are the main reasons why you would not renew your accreditation?

Please choose all that apply.

� I do not have time to do the necessary study / exams � I do not have the time to conduct reviews � Renewing accreditation is too expensive � Lack of opportunity to provide RMMRs � Lack of demand for HMRs � Accreditation will not lead to increased revenue for me/my business � I see little value in medication reviews � The accreditation incentive is not sufficient � Other __________________



CR&C 1074 12

9. Conducting RMMRs ONLY FOR RESPONDENTS WHO ANSWERED ‘NO’ AT Q6. OTHERS SKIP TO Q39

Q39. What are the main reasons that you have not conducted a RMMR in the last 12 months?


� Lack of time � Other pharmacists hold the contracts as RMMR Providers � I am unable to get another pharmacist to replace me while I am doing RMMRs � RMMRs are not profitable for me/ my business � My accreditation has lapsed � There are no aged care homes in my area � I am not interested in doing RMMRs � Other________

Q40. Given the opportunity, would you like to conduct RMMRs in the next 12 months?

� Yes � No � Don’t know

Q41. What would have to change in order for you to start conducting RMMRs?


� I would need to become accredited � A contract would need to become available for me to become a RMMR provider � The RMMR payment would have to increase � I would need to be able to source another pharmacist to replace me while I do

RMMRs � I would need more time � I would need to become interested in doing RMMRs � There would need to be aged care homes established in my area � Don’t know � Other________



CR&C 1074 13

10. QUM Quality Use of Medicines (QUM) is part of the RMMR Program. QUM encompasses learning and education sessions for aged care home staff provided by the pharmacist.

Q42. In the last 12 months, how often have you provided the following services to staff at aged care homes?

Never 1-10 times 11-20 times

21-30 times

31+ times Don’t know

Medication advisory activities

Drug usage evaluations (DUE) � � � � � �

Advise members of the health care team on medication issues � � � � � �

Participated in Medication Advisory Committee (MACs) � � � � � �

Assist in the development of nurse-initiated medication lists � � � � � �

Participate in policy and procedure development activities � � � � � �

Education

Provide in-service sessions for disease state management � � � � � �

Provide drug information for medical practitioners and/or ACH staff � � � � � �

Continuous improvement

Assist the facility to maintain medication management accreditation standards

� � � � � �

Assess competency of residents to self-administer medications � � � � � �

Assessed the practical requirements of medication management � � � � � �

Conduct medication administration audits and/ or surveys � � � � � �

Assist with the development of quality indicators � � � � � �

11. END

Thank you for completing this survey. Your time is greatly appreciated.



CR&C 1074 14

12. GP Survey

13. About your role in general practice These questions are about you and your general practice.

Q1. How long have you been practising as a GP (at this and other practices in Australia and overseas)?

Write ‘1’ if you have been practising as a GP for less than 1 year.

� ________________ Years

Q2. Is this practice (the practice where you received this letter) a:

Please select only one option. � Sole general practitioner � Group practice, a practice owned by the GPs who work in the practice � Corporate practice, a practice owned by an individual or group other than the

GPs who work at the practice � Other, please specify __________________________

Q3. Is this practice located in a metropolitan, regional centre, rural or remote area? � Metropolitan � Regional centre � Rural � Remote

Q4. In what state/ territory is this practice? � NSW � VIC � QLD � WA � SA � TAS � ACT � NT



CR&C 1074 15

14. Participation in Residential Medication Management Reviews

A Residential Medication Management Review (RMMR/ review) is a service provided to a

permanent resident of an Australian Government funded aged care home. RMMRs can be done

either as ‘Pharmacist Only’ or as ‘Collaborative Reviews’ where the GP is also entitled to claim.

For these questions, ‘Collaborative Review’ means only those reviews done where GPs claim a

benefit for their services. GPs claim under Medicare Item 903.

Q5. Approximately how many Collaborative Reviews have you participated in during the past 12 months?

� _________________ Reviews � Don’t know � None

Q6. Of all the reviews conducted for your patients in aged care homes, what proportion are done as Collaborative Reviews?

� _____% (Please include a ‘0’ if none have been conducted as Collaborative Reviews)

� Don’t know

Q7. a) Of all the reviews conducted for your patients in aged care homes, would you like to… � Have more done as Collaborative Reviews � Have about the same number done as Collaborative Reviews � Have fewer done as Collaborative Reviews � Don’t know/ no opinion

b) Can you please specify the proportion of reviews you would like to have done as Collaborative Reviews for your patients in aged care homes? � _____% � Don’t know

Q8. In your experience, how valuable are RMMRs to your patients in aged care homes?

Very valuable

Somewhat valuable

Not valuable

Don’t know

� � � �

Q9. In your experience, how valuable are RMMRs to you as a GP?

Very valuable Somewhat valuable Not valuable Don’t know

� � � �



CR&C 1074 16

14.1 Co-operation

Q10. Would you agree or disagree with the following statement?

Strongly agree

Agree Neutral Disagree Strongly disagree

No opinion/ Don’t know

It is essential for the GP to be involved in the review process � � � � � �

Q11. How would you describe the level of cooperation you currently have from the pharmacists conducting Collaborative Reviews for you?

� Cooperative � Neither cooperative nor un-cooperative � Un-cooperative � Don’t know/ no opinion � Not Applicable

Q12. What factors limit the proportion of Collaborative Reviews conducted for your patients in aged care homes?


� Pharmacists often do not advise me that the reviews are scheduled � The pharmacists in my area do not see the value of the GP’s role � I am too busy to take part in Collaborative Reviews � Little value is gained through involving GPs in the reviews � I do not find the reviews to be helpful � Pharmacists do not respond to my invitations to become part of Collaborative

Reviews � There is insufficient payment for me to become involved in reviews � I do not believe the GP needs to receive payment for their role in the review

� Other, please specify _________________________________



CR&C 1074 17

15. Outputs of RMMRs

Q13. Do you receive copies of medication review reports for your aged care home patients (both Collaborative and Pharmacist Only reports)?

� Most of the time � Some of the time � Not at all � Don’t know

Q14. How useful are medication review (RMMR) reports in assisting with the following decisions about your aged care home patients?

Very useful Useful Neutral

Not very useful

Not at all useful

Don’t know/ Not applicable

Commencement of a new prescription medication � � � � � �

Commencement of a new non-prescription item (ie vitamins) � � � � � �

Cessation of a medicine � � � � � �

Increase of a medicine dose � � � � � �

Decrease of a medicine dose � � � � � �

Change in the mode of administration of a medicine � � � � � �

Q15. Overall, what proportion of the time would you follow the pharmacist’s recommendation for each of the following?

Please provide an estimate for each type of medication change below.

Never 1-5% 6-10% 11-20% 21-30% 31-40% 41%+



Commencement of a new non-prescription medication item (ie vitamins)

� � � � � � � �







CR&C 1074 18


.

Strongly

agree Agree




a) Changes made to medication as a result of reviews, led to positive health outcomes for residents.

� � � � � �

b) Changes made to medication as a result of reviews, led to negative health outcomes for residents.

� � � � � �

Q17. Thinking back over the last 12 months, how often did the pharmacist identify apparent adverse drug events for your patients in aged care homes?

.

None 1-5 times 6-10 times 11-20 times 21-30 times 31 or more times Don’t know

� � � � � � �



CR&C 1074 19

16. Payment

The current Medicare benefit for a Collaborative Review (item 903) is $96.00 per resident

reviewed.

Q18. In general, would you describe the Medicare benefit as …

� More than enough to cover the costs of your involvement in RMMRs � Enough to cover the costs of your involvement with RMMRs � Not enough to cover the costs of your involvement with RMMRs � Nowhere near enough to cover the costs of your involvement with RMMRs

� Don’t know

17. END

Thank you for taking the time to complete this survey. Could you please check that you have

completed all questions that apply to you.

When you have finished, please put the completed survey into the

enclosed self-addressed envelope.

If you cannot find the envelope, please post to (no stamp needed):

Campbell Research and Consulting

Reply Paid 441

CLIFTON HILL VIC 3068

Your answers to this survey will be treated in confidence and with respect.



CR&C 1074 20

18. Aged Care Home Survey

19. About your role in aged care These questions are about you, your role in aged care, and the aged care home where you work.

Q1. What is your position at this aged care home? � Director of Nursing � Clinical Care Co-ordinator � Quality Manager � Registered nurse, please specify designation __________________ � Other type of manager � Other, please describe _______________________

Q2. How long have you worked in aged care (all experience in aged care, not just your current role)? Write ‘1’ if you have been working in aged care for less than 1 year � ________________ Years

Q3. How many high care beds and low care beds does this facility have? � ________________ High care beds � ________________ Low care beds

Q4. In what state/ territory is this aged care home? � NSW � VIC � QLD � WA � SA � TAS � ACT � NT

Q5. Is this home located in a metropolitan, regional centre, rural or remote area? � Metropolitan � Regional centre � Rural � Remote



CR&C 1074 21

20. Number of RMMRs A Residential Medication Management Review (RMMR/ medication review) is a service provided to a permanent resident of an Australian Government funded aged care home. RMMRs can be done either as ‘Pharmacist-Only’ or as ‘Collaborative Reviews’ where the GP is also entitled to claim.

Q6. How many times has an accredited pharmacist come to this aged care home to do medication reviews in the last 12 months?

Please provide your best estimate � _____

� None � Don’t know

Q7. Is the accredited pharmacist who visits your aged care home …If more than one type of pharmacist, please select all that apply � Contracted directly to the home as an individual � Contracted to the home through your supply pharmacy � Contracted to the home through another pharmacy � Contracted to do reviews through another organisation � Don’t know � Not applicable

Q8. In a single visit, how many medication reviews does the accredited pharmacist do, on average? � ____________________ Reviews � Don’t know � Not applicable

Q9. On average, how long does a single visit take for the accredited pharmacist?

Please round to the nearest hour. � ____________________ Hours � Don’t know � Not applicable

Q10. For each visit by the accredited pharmacist, how many hours of work are required of aged care home staff to …

Less than 1 hour

1-2 hours 2-3 hours More than 3

hours Not

applicable

Prepare for the pharmacist’s visit � � � � �

Accommodate the pharmacist during the visit (getting set up, conducting the reviews etc)

� � � � �

Follow up on the accredited pharmacist’s visit (reviewing reports, contacting GPs etc)

� � � � �



CR&C 1074 22

21. Outputs of RMMRs

Q11. Do you receive reports from pharmacists that contain the findings of medication reviews? � Yes � No � Don’t know � Not applicable

Q12. How useful are these reports for informing medication management for your residents? � Very useful � Useful � Neutral � Not useful � Not at all useful � Don’t know � Not applicable

Q13. Thinking back over the last 12 months, what proportion of the time has an accredited pharmacist made the following recommendations for residents of this aged care home?

Please provide an estimate for each type of recommendation. It will help you to answer by thinking about the number of residents you’ve had in the past 12 months.

Never 1-5% 6-10% 11-20% 21-30% 31-40% 41%+



Commencement of a new non-prescription item (ie vitamins)

� � � � � � � �







CR&C 1074 23


.

Strongly

agree Agree



Don’t know/ not

applicable

a) Changes made to medication as a result of reviews, led to positive health outcomes for residents.

� � � � � �

b) Changes made to medication as a result of reviews, led to negative health outcomes for residents.

� � � � � �

Q15. Thinking back over the last 12 months, how often do you believe that an accredited pharmacist has identified apparent adverse drug events for residents of this aged care home?

None of the time 1-5 times 6-10 times 11-20 times 21-30 times 31 or more times Don’t know

� � � � � � �



CR&C 1074 24

22. Reach of RMMRs

Q16. Thinking of residents in your aged care home, would you say that … � Medication reviews are always conducted when required � Medication reviews are sometimes conducted when required � Medication reviews are seldom conducted when required � Medication reviews are never conducted when required � You do not know whether reviews are conducted when required

Q17. Are there any types of residents whom you think are particularly poorly provided for by medication reviews? Please tick all that apply � Residents who have recently entered residential aged care � Residents who have been transferred between homes � Residents who have recently been discharged from hospital � High care residents � Low care residents � Residents with very complex medication needs � Other type of resident, please describe

_____________________________________ � Don’t know � No – all residents receive reviews when they are needed



CR&C 1074 25

23. QUM Quality Use of Medicine (QUM) is part of the RMMR Program. QUM encompasses learning and education sessions for aged care home staff provided by the pharmacist.

Q18. In the last 12 months, how often has an accredited pharmacist provided the following services to your aged care home?

Never 1-10 times 11-20 times

21-30 times

31+ times Don’t know

Medication advisory activities

Drug usage evaluations (DUE) � � � � � �

Advise members of the health care team on medication issues

1 � � � � � �

Participated in Medication Advisory Committee (MACs) � � � � � �

Assist in the development of nurse-initiated medication lists � � � � � �

Participate in policy and procedure development activities � � � � � �

Education

Provide in-service sessions for disease state management � � � � � �

Provide drug information for medical practitioners and/or ACH staff � � � � � �

Continuous improvement

Assist the facility to maintain medication management accreditation standards

� � � � � �

Assess competency of residents to self-administer medications � � � � � �

Assessed the practical requirements of medication management

2 � � � � � �

Conduct medication administration audits and/ or surveys � � � � � �

Assist with the development of quality indicators � � � � � �

1 I

ssues including storage, administration, dose forms, compatibilities, therapeutic and adverse effects and compliance

2

Medication storage requirements, monitoring and standards, including storage and labelling, expired stock, security of medication storage areas and safe

disposal of unwanted medications; on medication errors, altered dosage forms



CR&C 1074 26

�IF YOU ANSWERED NEVER TO ALL OF THESE STATEMENTS PLEASE GO TO THE END OF THE SURVEY

Q19. Overall, how useful are these QUM activities for the following staff members?

Very useful

Useful Neither Not very useful

Not at all useful

Not applicable

Don’t know

Aged care staff overall � � � � � � �

Director of Nursing � � � � � � �

Clinical Care Co-ordinator � � � � � � �

Registered nurses (senior positions) � � � � � � �

Registered nurses (other positions) � � � � � � �

Personal Care Assistants � � � � � � �

Other, specify _____________

� � � � � � �

24. END

When you have finished, please put the completed survey into the

enclosed self-addressed envelope and return it.

If you cannot find the envelope, please post to (no stamp needed):

Campbell Research and Consulting

Reply Paid 441

CLIFTON HILL VIC 3068

Your answers to this survey will be treated in confidence and with respect.

Evaluation of the Residential Medication Management Review ... · RMMR Evaluation Appendix G –...

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