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Home Medicines Reviews – why have these been a hot topic in pharmacy?

Pharmacy

Okay….. so before we go into all the recent controversy that has surrounded the Home Medicines Review (HMR) program, let’s talk about what this scheme is all about……..

Basically, a Home Medicines Review is what takes place when a general practitioner (GP) identifies that a patient might need a review to ensure that they have been prescribed the most appropriate medications, and are taking them correctly. There are many reasons why this may be required, ranging from patients being confused about different brand names for their medications, and therefore possibly doubling-up, to complex cases where the best combination of medications may not be straightforward. The patient is referred to an accredited pharmacist, who sees the patient in the patient’s home. Therefore the pharmacist can assess whether the patient has been prescribed and is using the medications appropriately, and make recommendations to the GP. The whole point of the HMR program is to avoid adverse medication events, which often require (costly) hospitalization.

Rightio…. so now we’ve got that out of the way…. let’s talk about what’s been happening with these HMRs across Australia….

1.       Budget for the Home Medicines Review Scheme – the Department of Health and Ageing had projected that the cost of the program for the 2012/2013 financial year would be $8 million, but by the end of December 2012 (just over half-way through the financial year), it had blown out to $13.04 million.

2.       Pharmacy Guild of Australia – In January 2013, the Pharmacy Guild of Australia raised concerns that the budget blowout made the scheme unsustainable, and that a moratorium was required. That is, the Guild recommended a suspension of the HMR program until a review had taken place. An un-named ‘Guild insider’ stated that some GPs had pharmacists coming into their clinics for weekly sessions to do HMRs, claiming to have done up to 10 reviews in a day. Obviously there are simply not enough hours in a day to do 10 medicines reviews in patient’s homes, and it is believed that the reviews were taking place in GP clinics.

3.       Pharmaceutical Society of Australia – In February 2013, the PSA rejected the Guild’s calls for a moratorium on HMRs, but stated that pharmacists needed to follow the rules for the HMRs, including performing the reviews in the patient’s homes.

4.       Department of Health and Ageing – Tanya Plibersek, Minister for Health and Ageing, announced that there would not be a moratorium on the HMR program. On 8th March 2013, she announced that there would be new measures to ensure that the HMRs would be delivered as initially intended. “The evidence is clear that the very best way for us to help patients who might be at risk of accidently taking the wrong medicine is for an accredited pharmacist to visit the person at their home,” Ms Plibersek said. She was also quoted saying “In the future, medication reviews under the program will only be conducted outside the home of clients where there is pre-approval for defined circumstances – such as patient or pharmacist safety, or for cultural reasons.”

So what has really happened here?

Obviously there is a need for the Home Medicines Review scheme, as it is a means of helping patients to avoid potentially serious and life-threatening consequences of taking medications incorrectly. Unfortunately there have been some practitioners who have used the scheme inappropriately. At My Health Career we hope that the new measures will ensure proper use of this much-needed service!!

Image: Dana Rothstein – Dreamstime

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