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 Switchover of Schedule II to Schedule V card in case of Diabetic patients

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Diabetes is a Chronic Disease listed under the Social Security Act and affected patients are entitled to free medicines as listed on the Government Formulary. However, in contrast to other chronic diseases, in the past, diabetic patients were also given the option to have both the Yellow (Schedule V) card or the Pink (Schedule2) card even if not means tested....

 

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DH Circular 8/2017

DH 3036/2016

30th January 2017

To All Health Care workers

 

Switchover of Schedule II to Schedule V card in case of Diabetic patients

 

Diabetes is a Chronic Disease listed under the Social Security Act and affected patients are entitled to free medicines as listed on the Government Formulary. However, in contrast to other chronic diseases, in the past, diabetic patients were also given the option to have both the Yellow (Schedule V) card or the Pink (Schedule2) card even if not means tested.

 

In 2012, an initiative was undertaken to address this anomaly and entice diabetic patients to relinquish the Pink Card (when NOT means tested) in favour of the Yellow Card in line with the Social Security Act. Patients with yellow card for diabetes have been entitled to better entitlements as regards diabetes, which includes entitlement to new diabetic treatments. Since 2012 newly diagnosed patients were only issued with Yellow Schedule V cards.

Following the publication of the National Diabetic Strategy in 2015, new diabetes initiatives have been and are still being launched.

 

In 2016, Repaglanide and Gliptins were introduced for the first time on the Government Formulary and the entitlement of up to 120 Blood sugar monitoring strips for Type 1 diabetics was increased from a maximum of 18 years of age to include all ages.

In January 2017, an initiative was launched to further address the anomaly mentioned above.

 

The following corrective actions have been launched and as a result diabetic patients with a valid Yellow Schedule V card will NOW also be entitled to:

 

  • New medicines introduced for the management of diabetes. These include Repaglanide and Gliptins (introduced in 2016), as well as, the new analogue insulin to be introduced later in 2017 for patients who are uncontrolled, whether they are Type 1 or Type 2.
  • Blood sugar monitoring sticks
    • Since last year (2016) the entitlement of up to 120/month blood sugar monitoring strips for Type 1 diabetics was increased from a capping of 18 years of age to include all ages.
    • Later in 2017, Insulin-requiring Type 2 diabetic patients who have a Schedule V card will also be given blood sugar monitoring strips so that they can better monitor and control their glycaemic profile at home.
  • Subsidy onspectacles - To encourage better ophthalmic care in diabetics, the subsidy on spectacles will now be extended to diabetic patients with a valid Schedule V (yellow) card Prescription has to be made on forms issued specifically by the Department of Health. The date when this measure will becpome effective will be announced later
  • Free dental treatment which includes dental check up, fillings and dentures carried out at Mater Dei Hospital
  • Antibiotics – up to three courses per year according to set protocols which would require prescriptions from doctors in the community both public and private or consultants, the latter required in case of chronic diabetic related wound infections. List of antibiotics listed in Annex 1 below.
  • Insulin syringes
    • currently irrespective if they use more or less, diabetic patients with
      • Schedule II (pink) card are entitled to 10 syringes per month
      • Schedule V (yellow) card are entitled to 30 syringes a month . 
    • Now patients with a Schedule V (yellow) card will be entitled to 60 syringes per month.
  • Rebates on Telecare services like holders of Schedule II
  • Aqueous cream

 

Diabetic patients with a valid Pink (Schedule 11) card can opt to retain and renew this card.   and will retain same rights they currently have. They will still be entitled to medicines prescribed for acute non chronic conditions, listed in Annex 2 below but will not benefit from the new measures being introduced for yellow (Schedule V) card holders

 

As a matter of procedure, diabetic patients who opt to switch over to the Yellow Schedule V card to benefit from the new initiatives are to present to the regional office of the Department of Social Security (DSS) when their current pink card expires to sign their intent. A valid SLH 145 form is to be presented. The DSS officer will scan the signed document to the Pharmacy of Your Choice This email address is being protected from spambots. You need JavaScript enabled to view it.. A new Schedule V card will then be sent by post to the patient. This will avoid patients having to run from one office to another. 

 

To facilitate matters, if the SLH 145 form has expired, this may now be renewed by the Diabetic Specialists either in the local Health Centres or at Mater Dei Hospital.

 

Patients who are diabetic who never had a Schedule V (yellow) card or have never utilised the public services and would like to start doing so, will have to be referred to the Diabetic Clinic at MDH as new cases for an initial visit and in order to apply for a Schedule V card.

 

It is important to note that diabetic patients with Pink Card (Schedule II) because they are means tested will not be affected by the changes being proposed. In order to benefit from the new treatment and initiatives they will still need to apply for a Schedule V card but will NOT lose their pink card.

 

New DH Circulars will be issued to inform all when the new initiatives planned for 2017 will be launched

Annex 2 below attempts to summarise the difference in entitlement for diabetic patients with Schedule V (yellow) and Schedule  II (pink) card, before and after the launch of this initiative.

 

In case of doubts, customer care officials with in our Ministry will be available to clarify matters

 

Dr. Denis Vella Baldacchino

Chief Medical Officer

 

 

 

Annex I

 

  1. Antibiotics – As of 1st January 2017 ALL diabetic patients, regardless of whether they are  Type 1 or Type 2 diabetics, with a valid Yellow Schedule V card for diabetes or Schedule II card are entitled to the following antibiotics that will be classified into two groups: Those that can be prescribed by doctors in the community (public or private), which prescriptions cannot exceed ten (10) days duration and the number of episodes should not exceed three per calendar year. If longer courses are believed to be required, advice from respective caring physician should be sought. The antibiotics include:
    1. Amoxicillin capsules 250mg, Syrup 125mg/5ml
    2. Cefalexin capsules 250mg, Syrup 125mg/5ml
    3. Doxycycline capsules 100mg
    4. Erythromycin capsules/tablets 250mg, syrup 125mg/5ml
    5. Flucloxacillin capsules 250mg, syrup 125mg/5ml
    6. Metronidazole tablets 200mg, suspension 200mg/5ml
    7. Nitrofurantoin tablets 50mg, syrup 25mg/5ml
    8. Amoxicillin + Clavulanic Acid Tablets 250mg + 125mg

 

  1. Antibiotics that can be prescribed by Consultants for chronic wound infections related to diabetes. These include all of the above, as well as:
    1. Ciprofloxacin capsules 250mg
    2. Clindamycin capsules 150mg
    3. Co-trimoxazole 400mg + 80mg
    4. Fusidic Acid

 

These antibiotics will be available only from the pharmacies at Floriana and Paola Health Centres, as well as, the pharmacy at Gozo General Hospital and after office hours from the in-patient pharmacy at Mater Dei Hospital.

 

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Highlights

  • Postgrad course on exercise as medicine is being proposed

    Dear prospective applicant,

    A proposal for a postgrad course on physical activity (PA) as a therapy for non-communicable diseases is currently being evaluated. Hereunder, a two-question survey is being forwarded for your attention in order to assess whether the idea sounds appealable or not.

    Proposed award

    M.Sc in Therapeutic Physical Activity (TPA), with postgrad certificate (PgC) and postgrad diploma (PgD) exit routes

    Proposed specialisation titles[1]

    Holders of PgC, TPA can claim the title of: ‘Clinical exercise prescriber’.

    Holders of PgD, TPA can claim the titles of: ‘Advanced exercise prescriber’ or ‘Clinical and public health exercise prescriber’.

    Holders of M.Sc, TPA can claim the title of: ‘Physical activity - health specialist’.

    Are you sure you know why physical activity is so important?

    Everyone is aware that physical inactivity is a major health concern but, do you know that through the right type of exercise you can prevent or treat at least 35 chronic conditions? In 2007 the American College of Sports Medicine officially declared an important statement: ‘Exercise is medicine’. Moreover, health-enhancing physical activity (HEPA) is important in today’s world not only in view of improving health and wellbeing but also for its economic values. For example, a lifestyle intervention involving 150 minutes of weekly PA was scientifically shown to be significantly more effective than the administration of metformin.

    Possibilities of further career development in exercise prescription

    Exercise prescription, that is, being qualified to professionally recommend the right type of exercise for health does not stop on a one-to-one basis. Do you think you are qualified to: (a) conduct research on PA interventions, and (b) develop, implement and evaluate community or population programmes involving PA strategies? Unfortunately, many wide-scale programmes that are implemented undergo no evaluation to determine how they have worked or what their effects may be. Have you ever imagined the possibility of attending a tertiary course which would be designed to: (a) give you the ability to design a project for the generation of new knowledge and be able to publish it internationally, or (b) train you on how to evaluate wide-scale interventions and how to apply strategies to sustain their continuities?


    A glimpse of the proposed programme of studies

    Intended for:

    The programme of studies is aimed at a wide and diverse cohort of students wishing to pursue any careers in HEPA sectors mainly: exercise prescription; health promotion (policies and practice); general health and fitness industry; and to further their studies (e.g. PhD). It can also serve as an adjunct to enrich one’s knowledge of his / her established profession or career. Examples include: medical practitioners; pharmacists; nurses; physiotherapists; nutritionists; public health specialists; sport medicine specialists; sport psychologists; teachers of physical education (PE); coaches; gym instructors; and personal trainers. Fitness and sport enthusiasts are also encouraged to apply.

    Duration:

    Three years part-time leading to an M.Sc in PA as an effective therapy, with postgrad certificate and postgrad diploma exit routes after the first and second years respectively.

    Mode of delivery:

    Seventy per cent will be delivered online and the rest of the thought units will be offered on a once weekly two-hour evening basis starting at 18.00hrs.

    Admission criteria:

    You should provide evidence of higher educational qualification(s) - normally, a diploma or a degree related to health and / or PA / sport. An award in PE is also ideal. Mature students without these basic qualifications would be required to present evidence of experience related to PA and health.

    Mode of assessment:

    Units will be assessed through the submission of coursework. These will vary from short assessments to long essays. If you would like to progress at Masters’ level, a traditional dissertation or paper in the format for journal publication and a final presentation (in the form of slides or poster) of your research findings will have to be undertaken.

    Round-up

    Unlike other under- and postgrad courses which only cover a fraction from the whole science of HEPA, this comprehensive programme of studies would lead to a specialization specifically on TPA. For careers in promotion, prescription and research of PA, the proposed programme of studies is a must.

    Important notice

    All the above information is subject to change and would eventually have to be approved by the Programme Validation Committee of the University of Malta. Needless to say, your feedback in the next two questions is extremely important.

    Yours in health & exercise,

    Charles Micallef B.Pharm (Hons), M.Sc PAPH (Staff)                                                8th August 2017

    The two questions hereunder.

    1. In view of the above information, would you be interested in applying for this particular postgrad course leading to a specialisation in physical activity with respect to health, that is, a qualification that gives you the right to prescribe exercise for health, even at population levels?

    Yes or No: 

    1. What would you change from or suggest to what is being proposed?

    Please state your name & surname:

    Your current job / profession:

    Please save your changes and forward your reply to Charles Micallef on: This email address is being protected from spambots. You need JavaScript enabled to view it.

    Your cooperation is greatly appreciated.


    [1] In order to professionally recommend exercise for health, you may need to be registered in the appropriate regulatory board and be in possession of a warrant to operate with the respective titles.

    University of Malta

    Written on August 19, 2017
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