PRACTICE POLICIES
PLEASE READ AND CONSENT TO THE INFORMATION AND APPOINTMENT REQUIREMENTS BELOW
STEP 1: ASSESSMENT PROCESS, MEDICATION AND PRESCRIPTIONS
Please Note: Dr Manuel works with the Shared care with GP’s model to improve efficiency and optimization of medication management by providing ADHD medication prescribing education and advise to the GP’s on any query regarding ADHD or medication.
The stimulant medications for ADHD treatment such as Vvyanse, Dexamphetamine, Ritalin and Concerta are schedule-8 and have prescribing regulations and restrictions and require a permit to prescribe.
The shared care GP-liaison model to improve efficiency and optimization of medication management for the patient such as dose changes. Initially Frequent medication review weekly to two weekly is recommended for medication titration. Dr Manuel has limited availability for the required frequency of medication reviews and is available for stimulant medication management support and advise the authorised prescribing Gp by phone call and or Email.
Mental Wellness First Practice- GP shared care Model for ADHD medication management:
In order to meet the increasing need for assessment and diagnostic clarity for patients with ADHD:
Aim and Purpose: 1) To provide assessment and Diagnostic clarification service for patients especially patients with ADHD who are often long undiagnosed, and desperate for diagnostic clarity.
2) Step 2: After the diagnostic assessment to assist with medication initiation and management through the GP shared care stimulant management system.
3) Education and Information to Gp’s and allied Health on ADHD/ ASD also known as Executive function dysregulation and co-morbidities and management including medications and other modalities
To provide an efficient service to each patient, given the huge need, given the paucity of psychiatrists diagnosing and treating ADHD.
The whole assessment for an ADHD diagnosis involves the following steps Screening for diagnoses of any other psychiatric disorders and a whole routine normal initial psychiatric assessment, plus score ADHD questionnaires, and explain treatments, treatment alternatives, and potential adverse effects, medication dosing and medication SFX, and take comprehensive notes and write letter of assessment and management recommendations to the GP.
Shared care - co-opting with skilled GPs the backbone of our health systems for stimulant medication management and monitoring to ensure Patient medication management is optimised as explained below:
Prescribing stimulant medication: The ways in which the stimulant medication The 1) Psychiatrist prescribes, 2)The GP prescribes with a letter from the psychiatrist. 3)The Psychiatrist initiates and the GP continues prescribing when the patient has stabilised.
Prior to taking the stimulant medication the patient needs a physical examination of the cardiovascular system from his GP, and an ECG, BP, weight and HR check.
To get baseline blood tests to rule out possible causes of symptoms. Such as Iron deficiency and electrolyte imbalances, hyper or hypo thyroidism.
Pharmacies required to confirm script validity with direct phone call with the prescribing doctor.
Safe-Script checks for abuse / mis use/ trafficking potential of medications.
Benefits the Patient - as follows
1) The cost benefit for the patient and reduced waiting times to see a general practitioner for a prescription. I have limited capacity and availability in my practice ADHD, to write the regulated scripts for every patient and to review and monitor the patient every one to two weeks, However, in a multi practitioner clinic, if the authorised GP is unavailable another Gp in the same practice can prescribe by law and regulation/ see VIC health regulation info below: to review and help minimise the disruption from running out of scripts and from not having timely access to prescriptions.
Vic Health Department of Drugs and Poisons information for Schedule 8 stimulant prescribing: Multi-practitioner clinics:
At multi-practitioner clinics, more than one medical practitioner might be involved in the management of some patients. For this reason, each practitioner is not required to obtain a permit, provided a valid permit is held by one practitioner at the clinic and the prescribing is consistent with and does not exceed the permit limits or conditions.
Note: To ensure compliance, details of permits, including maximum dosage plus expiry or cancellation dates, should be prominently displayed within patient records.
Permit applications by general practitioners
Attention Deficit Hyperactivity Disorder
The department’s policy is that specialist involvement is necessary for the diagnosis and ongoing management of all ADHD patients.
• General practitioners will generally only be issued with permits to prescribe dexamphetamine, lisdexamfetamine or methylphenidate where there is evidence of a specialist diagnosis and that a specialist review has taken place within a specified period.
Follow-Up Interval
Only specified if patients are being co-managed with the GP, and in this case, the GP must ask for a specialist review at least every 2 years
Co-Prescribing Details
Strictly speaking, Victoria does not allow the specialist and GP to both have permits to prescribe at the same time but will allow co-managing which means that the permit to prescribe is transferred from the specialist to the
GP, and the GP can keep prescribing stimulants (after the permit has been approved) for up to 2 years before a specialist review is required to allow this to continue.
More Information
For more information on SafeScript visit the SafeScript website here. For more information including the required forms to manage routine stimulant prescribing and dispensing of Schedule 8 medications, visit the Stimulant Prescribing section of the medicines and poisons website.
Not all GP’s prescribe stimulants:
Prior to the appointment Patient to enquire if their GP prescribes stimulants for ADHD treatment. Following the appointment a letter of authority to prescribe is sent to the nominated Gp.
Please Note: Please visit health.vic.gov.au to obtain more information on the schedule 8 stimulant prescribing regulations and restrictions for ADHD medications/ Vyvanse, Dexamphetamine, Ritalin and Concerta.
Vic Stimulant Prescribing Regulations
STEP 2: SUPPORT PERSON
Reasoning: Having a support person who knows you well to attend the session with you can help Dr. Caroline Manuel understand your history and provide assessment and diagnosis. understand that I must attend the initial appointment with a support person.
Please have a support person/close contact (Family/Friend) available for contact on phone/video at the time of consultation for the completion of assessment.
For new clients, it is preferable to have someone who has known you prior to the age of 18 as this may affect your ability to receive prescription at lower cost / PBS subsidy
*Please Note: The stimulant medications for ADHD treatment such as Vyvanse, Dexamphetamine, Ritalin and Concerta are schedule-8 and have prescribing regulations and restrictions.
Please have a support person/close contact (Family/Friend) available for contact on phone/video at the time of consultation for the completion of assessment.
For new clients, it is preferable to have someone who has known you prior to the age of 18 as this may affect your ability to receive prescription at lower cost / PBS subsidy.
STEP 3: GENERAL INFORMATION
Reminding you to attend:
We will send you a SMS reminder prior to your appointment. We may not be able to reach you and it is your own responsibility to attend.
Getting ready for your appointment
PLEASE NOTE: DR MANUEL MAY BE ATTENDING TO A CRISIS WITH A CLIENT OR ON TELEPHONE CALL WITH THE GP HENCE YOU MAY HAVE WAITING TIME PRIOR TO BEING SEEN BY THE DOCTOR
How to attend the online tele-health appointment
To attend your secure appointment go to our website by entering www.mentalwellnessfirst.com on google search using web-browser Google chrome or safari.
Once you are on the website www.mentalwellnessfirst.com
• Click on the home page tab Enter Waiting Room
• The link will ask you to enter you first name and last name and a snap shot which will be deleted after completion of your consultation with the doctor.
• You will then be guided to the tele-health waiting room.
• When your session is ready to begin the doctor will take you into the tele-health consulting room.
Referrals: it is the client’s responsibility to obtain a referral and to ensure it is kept up to date. Referrals from a General Practitioner are valid for 12 months unless specified with “indefinite”, which means that your referral will last as long as your GP’s provider number is valid. Those from other Specialists will last for 3 months. Once your referral has reached expiry, you will need to obtain a new referral prior to any further appointments you may have. Medicare rebate is only available with a current referral.
FOR URGENT MATTERS/ Crisis
Please contact your GP or the nearest hospital’s Emergency Department for advice. There is also a Mental Health Triage Number available in the area that you reside. Our doctors are not available for emergencies after hours and please contact your local Mental health triage or attend your local emergency department.
Dr Caroline Manuel works on a primary care model with your GP. Please see your GP or another GP for ADHD Stimulant scripts and for any other ADHD queries unless otherwise discussed.
I understand that no appointment can be provided without a direct referral addressed to Dr. Caroline Manuel *
DISCLAIMER
All psychiatry appointment will require a direct GP referral prior to your booking. Please request your GP to direct the referral to Dr Caroline Manuel
Dr. Caroline Manuel or Mental Wellness First are not an emergency service and do not provide crisis services.
If you are in crisis or in need of immediate assistance, please call 000 or visit your nearest emergency department.
Fax: 038-732-0321
Email: askmentalwellnessfirst@gmail.com