One of the realities of getting older is that we generally take more medicines to manage conditions and treat ailments. However, we need to manage how the medicines are taken and ensure as patients we, or those we care for, are taking appropriate medicines, that the medicines we take don’t interact with others, and that we understand our medicines and are compliant in taking them.
Unfortunately, each year more than 190,000 Australians have to go to hospital with problems caused by their medicine. This puts a financial burden of some additional $600 million onto the already stretched health budget. However, it has been shown that in up to 69 per cent of these cases the problem can be avoided.
All of these factors fall under what is referred to broadly as the Quality Use of Medicines (QUM), which is one of the central objectives of Australia’s National Medicines Policy. This policy is a cooperative endeavour to bring about better health outcomes for all Australians.
According to the Pharmaceutical Society of Australia, one of the principles of QUM means selecting management options wisely, choosing suitable medicines if a medicine is considered necessary, and using medicines safely and effectively.
To help consumers achieve these aims, pharmacists – working in close collaboration with the consumer’s general practitioner (GP) – can undertake what is called a Home Medicines Review (HMR) which is designed to improve health outcomes for consumers and to promote the QUM. Pharmacists performing these reviews have special accreditation to equip them for such specialised work. With HMRs the accredited pharmacist visits the patient in their home, reviews their medicines and provides their GP with a report of that visit. The GP and patient then agree on a medication management plan to optimise the patient’s health outcomes.
National President of the Pharmaceutical Society of Australia, Grant Kardachi, is accredited to perform HMRs and is well versed in them, having been involved in their initial development and implementation.
“HMRs are very important and help identify many issues which the consumers themselves may not be aware of until a review is undertaken,” Mr Kardachi told The Retiree. “The QUM aims are best achieved through collaboration between all healthcare providers involved in the service and the consumer. “HMRs are designed to assist consumers living in the community and, except in exceptional circumstances, are performed in the consumer’s home.”
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 desired patient outcomes
- Improve the patient’s quality of life and health outcomes using a best practice approach, that involves cooperation between the GP, accredited pharmacist, other relevant health professionals and the patient (and where appropriate, their carer)
- Improve the patient’s knowledge and understanding of medicine
- Facilitate cooperative working relationships between a patient’s health professionals to improve their health and wellbeing, and
- Provide medicine information to the patient and other health professionals involved in the patient’s care.
Mr Kardachi said there were many reasons why a consumer may be identified for an HMR based on their clinical need. Some examples included:
- Taking more than five regular medicines, 12 doses of medicine per day or being treated for three medical conditions
- Recently discharged from hospital
- Significant changes to their medication regimen
- Taking a medicine requiring close drug monitoring
- Symptoms suggestive of adverse drug reaction (ADR)
- Sub-therapeutic response to treatment
- Suspected non-compliance/problems and managing medication-related therapeutic devices
- Risk due to language/literacy difficulties
- Dexterity problems, impaired sight or cognitive difficulties; and increasing frailty.
“The process is simple and designed so that consumers may access an HMR when clinically indicated,” Mr Kardachi said.
“The process is simple and designed so that consumers may access an HMR when clinically indicated.”
Grant Kardachi
“In circumstances where there has been a significant change in a consumer’s medical condition or medication regimen, an additional HMR can be requested by the consumer’s general practitioner. “After a clinical need is determined, the GP provides a written referral to the accredited pharmacist. “The referral should be accompanied by appropriate and relevant clinical information such as the reason for the referral, past medical and social history, current medicines and relevant laboratory results. “After the need for a HMR has been clinically identified, the consumer’s GP obtains consent from the consumer to participate in the HMR and to arrange for their choice of an accredited pharmacist to conduct the service.”
The HMR pharmacist’s review and report is paid for by the Australian government, so it will not cost you anything. Your GP may bulk-bill or charge you for the GP consultations. If you, or someone you care for, might benefit from having an HMR, talk to your GP or pharmacist about organising one. HMRs are available in all states and territories.
“I have been involved in HMRs from the outset and I have seen just how valuable they are,” Mr Kardachi said. “Medication problems and misadventures can more often than not be avoided and HMRs are a very good tool for achieving this. “The more medicines we take as we grow older can increase the risk of unintentional problems arising and HMRs are there to minimise and counter this risk.”
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