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Home
Medicines Review
(HMR)
HMR is a service to consumers living at home in the community.
The goal of HMR, as a consumer focussed service, is to maximise an individual
consumer's benefit from their medication regimen, and prevent medication-related
problems through a team approach, involving the consumer's general practitioner
and preferred community pharmacy, with the consumer as the central focus.
How
often
Who qualifies
Required criteria
The process of completion
Accredited Pharmacists
HMR / DMMR Forms
How often can a HMR be conducted?
A patient may have a HMR once every twelve months
or sooner if there has been a significant change in the patient's condition or
medication regimen and the general practitioner decides that a new HMR is
warranted.
Who can have a HMR?
People living in the community setting who meet
the criteria for a HMR. The review is not available for in-patients of a
hospital, day hospital facility, or care recipients in residential aged care
facilities.
What are the criteria for a HMR?
The patient's regular general practitioner must assess that a review is
clinically necessary to ensure quality use of medicines or to address the needs
of patients living at home
Examples of risk factors known to predispose people to medication related
adverse events are:
-
currently taking 5 or more regular medications;
-
taking more than 12 doses of medication per day;
-
significant changes made to medication treatment regimen in the
last 3 months;
-
medication with a narrow therapeutic index or medications
requiring therapeutic monitoring;
-
symptoms suggestive of an adverse drug reaction;
-
sub-optimal response to treatment with medicines;
-
suspected non-compliance or inability to manage medication
related therapeutic devices;
-
patient's having difficulty managing their own medicines
because of literacy or language difficulties, dexterity problems or impaired
sight, confusion or dementia or other cognitive difficulties;
-
patients attending a number of different doctors, both general
practitioners and specialists; and
-
recent discharge from a facility or hospital (in the last four
weeks).
What is the
process for completion of a HMR?
General practitioners will refer consumers who need a HMR to their
consumer's preferred community pharmacy which coordinates the pharmacy component
of the HMR service. Accredited Pharmacists The referral will contain relevant medical information
including information about the person's medications. An accredited pharmacist
employed by an approved community pharmacy is always responsible for producing
the HMR clinical assessment of information and the resulting recommendations and
report. The community pharmacist coordinating the service will either be an
accredited pharmacist themself, or otherwise employ or contract an accredited
pharmacist.
The community pharmacy
coordinates the HMR, letting the general practitioner know the arrangements for
the HMR and the contact details of the accredited pharmacist. The pharmacist
conducts the HMR including an examination of all the patient's medications and
related devices. The pharmacist also identifies any issues the patient may have
with their medications, for example, compliance, storage and administration
techniques. They write a report that includes their findings and
recommendations. The reviewing pharmacist will then discuss the report either
face-to-face or by phone, with the general practitioner, who decides on a course
of action. The general practitioner arranges a consultation with the patient to
discuss the results and develop a written medication plan for agreement with the
patient.
The process of completion of a HMR.
-
Assessment by
general practitioner of clinical need for service from a quality use of
medicines perspective with the consumer as the focus and formal initiation of
HMR if appropriate
-
Informed consent
obtained by the general practitioner during consultation
-
Referral by
general practitioner to consumer's preferred community pharmacy
-
Community
pharmacy coordinates service delivery on receipt of referral and notifies the
general practitioner of details of the service provider
-
The preferred venue and time for medication review are arranged
with consumer
-
Appropriately
accredited pharmacist conducts HMR
-
Review of
information by appropriately accredited pharmacist and development of
suggested management strategies
-
Preparation of
report by appropriately accredited pharmacist
-
Report provided to and discussed with general practitioner and
community pharmacist
-
Medication management plan agreed between consumer and general
practitioner
-
Implementation
of agreed actions with appropriate follow up and monitoring
HRM / DMMR
Forms
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