DDA and Good Practice

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DDA and Good Practice
By Dr Diane Harris, Community Pharmacy Advisor,
across all PCTs in Southern Derbyshire, based at
Amber Valley PCT.
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DDA (my personal interpretation)

• A person has disability, if has
• physical (e.g. arthritis, poor vision) OR
• mental impairment (e.g. dementia, learning
  disability)
• has substantial and long term adverse effect on
  ability to carry out normal day to day activities
  (mobility, manual dexterity, eyesight, memory,
  physical co-ordination, understanding etc.)
• long term lasted / likely to last 12 months

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DDA contractor obligations

• Contractor discriminates against disabled person
  if fails to comply with section 21 duty
  (unless failure to comply is justified)
• Section 21 duty arises where contractor has
  practice or procedures which make it impossible
  or unreasonably difficult for the disabled person
  to make use of a service (e.g. medicines)
  which contractor provides

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DDA contractor obligations

• Contractor is under duty to take reasonable
  steps, in the circumstances of case, to change
  practice so that it no longer has that effect
• Act suggests auxiliary aids should be considered
  if likely to help (e.g. reminder / tick charts,
  large print labels or compliance aids).
• Should not presume patients should always be
  given MDS (take reasonable steps to help).

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DDA contractor obligations

• If contractors refuse to support a patient under
  DDA, they must make this decision on a sound
  basis. 
• They must comply with their duties under the Act
  if the person has a disability.  
• Keep records of assessment procedure and record
  decision made, reasons why, and what assistance
  was provided

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DDA tests to apply

• Is the patient disabled within meaning of Act?
• e.g. - Severe arthritis, - memory loss from
  dementia, - a person who cannot walk unaided
• Do the services provided make it impossible or
  unreasonably difficult to use the medicines?
• Then determine the type of adjustment that might
  assist  
• Assessment tool guides
• - PSNC workbook (includes compliance
  self-assessment) -
  NPA guidance

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Compliance Support and DDA

• Patients should have problems taking their
  medicines caused by
• Physical problems (e.g arthritis, vision) OR
  
• Mental impairment (dementia or learning
  disability)
• which has lasted / likely to last 12 months or
  longer
• Should have a substantial adverse effect on
  ability to carry out normal day to day activities
  (memory, vision etc)
• Is it making it impossible or unreasonably
  difficult to use the medicines?

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Questions to Ask

• 1) Is the patient able to visit the pharmacy for
  assessment to see if they can help them with
  their compliance problem?
• If YES may be suitable for assessment under the
  DDA
• If unable to visit pharmacy, then other
  arrangements are needed

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Questions to Ask

• 2) Does the patient have physical problems which
  is causing them problems taking medicines, for
  example, manual dexterity problems or eye sight
  problems?
• If YES may be suitable for assessment under the
  DDA

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Questions to Ask

• 3) Does the patient have mental impairment and
  problems with taking medicines, for example,
  dementia or learning disability?
• If YES may be suitable for assessment under the
  DDA

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Questions to Ask

• If questions 2 and/or 3 YES patient may be
  suitable for assessment under the DDA.
• Carer/ Patient should contact their regular
  pharmacy to ask for advice and assessment
• What to do - if patient does not fit into
  categories above?

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Assessment form for support

• All medicines
• Can you read the instructions on the medicine
  labels ? Comments
• Do you understand the instructions on the
  medicines labels? Comments
  
• Do you sometimes forget to take or use your
  medicines? Comments
• Do you ever get muddled about what medicines you
  need to take or use? Comments
  
• Do you have help in organising your medicines?
  Comments
• Have you found a routine that helps you to cope
  with taking/using your medicines?
  Comments
• Do you have a carer?
• If yes, do they help you to take your medicines?
  Comments

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Record of Assessment

• Record of assessment for possible support under
  DDA
• Date Patients Name Patients Address
• Summary of problem
• Is the patient eligible for support under DDA?
  Yes/No
• Reasons for decision
• Summary of action taken

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Other support from PCTs

• PCT summarised guidance on DDA support (incl.
  assessment form record form)
• Letter of explanation and who to contact for
  advice
• NPA and PSNC guidance
• Pharmacy Development Group meetings
• Multi-disciplinary Forum (GPs, nurses, practice
  and community pharmacists) -
  presentation and discussion

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Other support

• Letter of explanation and guidance for health
  care professionals
• (GPs, district nurses, CPNs etc.)
• How DDA works
• Not to promise MDS to patients
• Other options will be explored
• Pharmacist will make assessment and decide what
  support is needed
• Liaison with LPC
• Simple Referral form for health care
  professionals to send to regular community
  pharmacist