A Home Medicines Review (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 pharmacist visits the patient at their home, reviews their medicine routine and provides their GP with a report. The GP and patient then agree on a medicine management plan.
The objectives of an 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
Who conducts a HMR
The GP refers the patient to an approved HMR service provider, who completes the pharmacist component of the HMR service or employs an accredited pharmacist to conduct the service on their behalf.
If there is no access to an accredited pharmacist in a timeframe suitable to the patient, a registered pharmacist may conduct the interview and give the information to an accredited pharmacist who completes the clinical assessment and writes the report.
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).
Patient eligibility
A general practitioner must determine that a review of a patient living at home is clinically necessary to ensure the quality use if medicines or to address a patient's needs.
Example of risk factors may include patients:
- currently taking five or more regular medicines
- taking more than 12 doses of medicine per day
- with significant changes to their medicine regiment in the last three months, including
- recent discharge from hospital
- taking medicine with a narrow therapeutic index or that requires therapeutic monitoring
- with symptoms suggestive of an adverse medicine reaction
- having difficulty managing their own medicines because of literacy or language difficulties, or impaired sight
- attending a number of different doctors, both general practitioners and specialists.
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. Pharmacists should keep all records necessary to show that they have complied with HMR terms and conditions, for seven years.
How to become an HMR service provider
Owners of a community pharmacy approved to supply pharmaceutical benefits under Section 90 of the National Health Act 1953 can become approved HMR service providers. In order to be eligible, owners of a community pharmacy must have access to an accredited pharmacist and complete the MMR Program Service Provider application form.
From 1 October 2011, independent accredited pharmacists will also be eligible to become approved HMR service providers. In order to be eligible, independent accredited pharmacists need to complete the MMR program service provider application form [PDF, 186Kb] and agree to the terms and conditions.
All applicants must receive written approval to be an HMR service provider from Medicare Australia before providing services.
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.
From 30 September 2011, Medicare Australia will stop payments for the HMR Rural Loading. From 1 October 2011, the incentive will be replaced by the HMR Rural Allowance, administered by the Pharmacy Guild of Australia (the Guild). From that date, any claims for travel should be sent to the Guild, regardless of whether the service was provided before or after 1 October 2011. More information on how to claim for the HMR Rural Allowance will be provided closer to 1 October 2011.
Current HMR service providers must provide Medicare Australia with the details of all accredited pharmacists conducting HMR services on their behalf using the HMR S90 pharmacy notification of accredited pharmacist's form that was mailed out in June. Service providers must return this information to Medicare Australia by 31 August 2011 in order to continue to be able to provide, and claim for, HMR services from 1 October.
Medicare Australia will require all accredited pharmacist details in order to process any claims received by Medicare Australia after 15 September 2011.
Receiving payments
Medicare Australia must approve your application to provide HMR services before you can provide HMR services or receive payment.
Medicare Australia will pay $197.76 (indexed annually from 1 July 2012) to the approved service provider for each HMR undertaken after a referral by a GP.
Claims are to be submitted monthly by completing the claim and confirmation form.
More information, including FAQ is available at www.medicareaustralia.gov.au/provider/pbs/fifth-agreement/home-medicines-review.jsp
Forms
Terms and Conditions for Medication Management Review (MMR) programs
Home Medicines Review Section 90 pharmacy notification of accredited pharmacists form
MMR programs service provider application form
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