Home Medicines Review (HMR) is a service to patients living at home in the community. The goal of HMR is to maximise an individual patient's benefit from their medication regimen, and prevent medication-related problems through a team approach. HMR involves the patient, their general practitioner (GP), an accredited pharmacist and regular community pharmacy. In some cases other relevant members of the healthcare team, such as nurses in community practice, or carers, are included.
The HMR process utilises the specific knowledge and expertise of each of the health care professionals involved. In collaboration with the GP, a pharmacist comprehensively reviews the patient's medication regimen in a home visit. After discussion of the visit findings and report with the accredited pharmacist, the GP and patient agree on a medication management plan. The patient is central in the development and implementation of this plan with their GP.
The objectives of HMR are to:
- achieve safe, effective and appropriate use of medicines by detecting and addressing medicine-related problems that interfere with the patient's desired outcomes
- improve the patient's quality of life and health by using a best practice approach, that involves cooperation between the GP, pharmacist, other relevant health professionals and the patient (and where appropriate, their carer)
- improve the patient's and health professional's knowledge and understanding about the patient's medicines
- build cooperative working relationships between members of the healthcare team in the interests of patient health and wellbeing.
Why refer for a HMR?
If medicines aren't used properly, including over the counter and complementary products, the results can be serious. Each year more than 140,000 Australians have to go to hospital with problems caused by their medication. It has been shown that, in up to 69% of these cases, the problem can be avoided. Older people are particularly at risk.
Example of risk factors:
- currently taking five or more regular medicines
- taking more than 12 doses of medicine per day
- significant changes to medicine regimen in the last three months
- recent discharge from hospital
- taking medicine with a narrow therapeutic index or that requires therapeutic monitoring
- symptoms suggestive of an adverse medicine reaction
- patient having difficulty managing their own medicines because of literacy or language difficulties, or impaired sight
- patient attending a number of different doctors, both general practitioners and specialists.
How does it work?
- Identification of person requiring HMR service;
- Assessment by GP of clinical need for an HMR from a quality use of medicines perspective with the patient as the focus;
- Formal initiation of HMR;
- Patient is informed and gives their consent;
- Referral by GP to approved HMR service provider;
- Approved HMR service provider coordinates the HMR service and notifies the GP of the details of the accredited pharmacist who will conduct the service;
- The preferred address and time for HMR are arranged with the patient;
- Pharmacist conducts HMR;
- Review of information by accredited pharmacist and development of suggested management strategies;
- Preparation of report by accredited pharmacist;
- Report provided to and discussed with GP;
- Medication management plan agreed between patient and GP;
- Implementation of agreed actions with appropriate follow-up and monitoring.
Payment
On conclusion of the preparation of a medicine management plan with a patient, resulting from a HMR, MBS Item 900 can be claimed. A benefit of $146 is payable not more than once in each 12 month period, except where there has been a significant change in the patient's condition or medication regimen requiring a new HMR.
The HMR service is not available to in-patients of a hospital, day hospital facility or care recipients in residential aged care facilities. For individuals living in Australian Government funded residential aged care facilities, see the Residential Medication Management Review (RMMR) web page.
Confidentiality
All information relating to the HMR is confidential. Information from the patient's record can only be given to the pharmacist conducting the review, with the patient's consent. Input from each person involved in the review process is documented in the review report, as well as the recommendations and management plan.
The GP and HMR service provider will keep a full record of all documents for auditing purposes.
Changes to the HMR program from 1 October 2011
From 1 October 2011, GPs can provide an HMR referral directly to an accredited pharmacist who has been approved as an HMR service provider, as well as to a patient's usual community pharmacy.
Accreditation
An accredited pharmacist is a pharmacist who has undertaken specified education programs or examinations and has received accreditation to conduct medication reviews from the Australian Association of Consultant Pharmacy (AACP) or the Society of Hospital Pharmacists of Australia (SHPA).
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