The VIVAIDS Pharmacotherapy Advocacy Mediation and Supportservice PAMS

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The VIVAIDS Pharmacotherapy Advocacy Mediation
and Support-service (PAMS)

• Presented By Sarah Lord, Coordinator of PAMS at
  VIVAIDS Inc.

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What is PAMS?

• A VIVAIDS Inc Project
• Telephone based advocacy, information, mediation,
  referral and support service for pharmacotherapy
  consumers, prescribers and pharmacists in
  relation to consumer issues and pharmacotherapy
  programs in Victoria

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Why have a PAMS Service?

• Representation
• Prescribers MPB, Div. GP, AMA
• Pharmacists PSA, PG, PB
• Consumers HSC (general), pharmacotherapy
  specific???
• Prescribers and Pharmacists limited time, large
  case load etc
• Nature of Drug Dependence prompt resolution of
  complaints, long term tment, many consumers
  marginalised (poverty, education,
  stigma/discrimination)
• State Guidelines differ greatly, varying degree
  of program control (increased difficulty for
  consumers who travel)
• Pharmacotherapy program run on, guidelines no
  body with investigatory powers to force
  legislation

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History of PAMS

• Formerly MACS, PACS now PAMS!
• Need to establish consumer information, advocacy,
  mediation, referral and support service
• MAG in 1998-1999
• Research into consumer complaints and grievances
  by VIVAIDS (Morgan, Thomson, 2000)
• MACS established 2000-2001

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PAMS Funding

• Funded from late 2000 until present
• First funded via TP NPP (12 months)
• 2001 present DHS, DPSB
• 2003 2006 3 year project funding
• 2006 - future re-negotiation of project funding

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How does PAMS Work?

• Operates Mon-Fri, 10AM-6PM, via telephone free
  call (1800 number)
• PAMS is peer-based (consumers)
• Consumers either self-refer or are referred via
  community, welfare and other service providers
• Pharmacists and prescribers are encouraged to
  phone PAMS regarding consumer related concerns
  (discrimination, dispensing fee debt etc)

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PAMS Findings 2004-2005

• Demographics of PAMS Callers
• 341 individual cases (average 31 per month)
• 56 male, 44 female
• Age of Callers - 46 years 9.9, 36-45 years
  26.3, under 21 years 2.8, 22-25 years 19.3,
  26-30 years 22.6, 31-35 years 19.3
• Caller Location Melb Metro 44.2, Outer
  Metro44.8, rural/regional 9.2, 1.7
  interstate
• Contact Type Consumers 85, Family/Sig Other
  4.3, Case Workers 9.4, Pharmacists 0.8, GPs
  0

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PAMS Findings 2004-2005

• Service Providers
• Pharmacists 69.9, GPs 21.7
• Type of Pharmacotherapy
• Methadone 62
• Buprenorphine 32.9
• Opioid Analgesics 4.2
• Program Type
• Community-based 91.7
• SMS 1.1

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PAMS Findings 2004-2005

• Reasons for Calling PAMS (up to 3 per case)
• Dispensing fees 36.1
• Discrimination 23.2
• Dosing Procedures 22.8
• Access to Services 12.9
• Prescriptions 12.9
• Difficulties Accessing Consumer Information
  10.1
• Access to Take-Away Doses 9.9
• Non-Collaborative Treatment Plan 8.4
• Program Terminated 8.4

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PAMS Findings 2004-2005

• Outcomes of Calling PAMS (up to 3 per case)
• Information Provision 74.9
• Debriefing 69.4
• Changed Service Provider 24
• Assist Consumer to Take Action 18.2
• Payment/Treatment Agreement 14.8
• VIVAIDS Financial Assistance 14.8
• Referral to official Complaints Body 5.4
• Referral to SMS 5.4

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PAMS Findings 2004-2005

• Caller Satisfaction Rate
• Satisfied with Service Provided by PAMS 98.5
• Not Satisfied with Service provided by PAMS 1.2
• Neither Satisfied/Dissatisfied/Not Asked 0.3

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PAMS Case Study 1

• Consumer Kathy
• Complaint 1 The way the pharmacy treats me I
  cant bring my children (3, under 5 years) or
  mobile phone into the pharmacy when I am dosed
  and I have nobody to mind them at home, I am not
  allowed to speak to other consumers in the
  pharmacy
• Complaint 2 When I was behind in payments and
  the owner (head pharmacist) was away I believe I
  was under-dosed and suffered opiate withdrawal
  symptoms, when he returned I nearly over-dosed on
  my usual dose
• Outcome Kathy was so scared of losing her
  place at the pharmacy and having to travel
  further with young children, she declined the
  offer of mediation and referral to the PB,
  despite being informed by PAMS of the serious
  nature of her complaint

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PAMS Case Study 2

• Consumer John
• Complaint 1 I owe (the pharmacy) a lot of
  money, but Im on a pension and they get it for
  free, plus get paid to run the program and now
  they are saying I have to pay up or they will
  kick me off, its just not fair
• Outcome PAMS worker explains that pharmacies
  dont pay for the methadone, but get no other
  money for dispensing, record keeping, increased
  overheads, they are small businesses and charge a
  modest fee. John says he didnt know this and
  offers to apologise to the pharmacist. PAMS
  contact the pharmacy (with Johns permission),
  negotiate a re-payment agreement on the basis
  that VIVAIDS provide 30 to assist with the total
  debt.

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PAMS Conclusions

• Complexity of cases not necessarily reflected in
  this data (limited by data collection system, 3
  issues per case)
• Most callers were male, 36-45YOs, on methadone,
  from metropolitan Melbourne, attending community
  pharmacies
• Dispensing Fees (problems with) was the most
  popular reason for consumers, then discrimination
  and dosing procedures
• Information, debriefing and support were common
  outcomes, lack of access to financial assistance
  and debt management continue to cause problems,
  mediation and negotiation with SPs and change of
  SPs were common outcomes
• PAMS callers are not necessarily a reflective
  sample of all Victorian pharmacotherapy consumers
• Knowledge of Program Guidelines Vs Capacity of
  PAMS to resolve concerns

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PAMS Recommendations

• Further develop and fully computerise data
  collection
• Increased promotion of PAMS amongst consumers and
  especially pharmacists and prescribers
• Prevent issues reaching crisis through the
  provision of peer based education for
  pharmacotherapy consumers
• Increased involvement with training of service
  providers to enhance understanding of consumer
  issues and perspectives

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Further Information

• Contact Sarah Lord, PAMS Coordinator at VIVAIDS
  Inc
• Address PO Box 12720, ABeckett Street,
  Melbourne, 8006
• Phone VIVAIDS [phone]
• Contact PAMS 1800 443 844 (free call, Victoria
  wide)

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And Last of All

• Thanks for Listening!!