Home' Australian Pharmacist : Australian Pharmacist September 2012 Contents Australian Pharmacist September 2012 I ©Pharmaceutical Society of Australia Ltd. 673
THE NATIONAL PRESIDENT SAYS
integrity of HMRs
The integrity of the HMR program is
critical to its uptake by patients and to its
recognition as an essential health service
provided by pharmacists.
For this reason I was concerned recently
to receive an invitation to join a venture
through which accredited pharmacists
would provide HMRs at a clinic.
The invitation came to me in my capacity
as an accredited pharmacist, not as
President of PSA.
I was rst surprised and then concerned
at the invitation because I can see that if
such clinic-based HMR schemes get o
the ground they could do a great deal
The idea is simply not right! The very
name of the service -- Home Medicines
Reviews -- de nes that they are to be
held in the patient's home, except in very
exceptional circumstances. HMRs have
been developed, after a great deal of
consultation, to be conducted in a patient's
home where the pharmacist has the
opportunity to review all the medicines
and medical devices used and to take into
account other factors that may a ect the
patient's health. In fact, the program was
funded on the basis of outcomes obtained
in the home environment. Other models
may threaten the viability of the program.
I have been undertaking HMRs since
they were rst initiated and I can recount
many examples of where the home
environment has added greatly to the
robustness and e cacy of the review.
For example, I completed an HMR for a
patient with asthma. It was critical that
I also examined her nebulising equipment
and medications to ensure the HMR was
thorough. I really doubt that a person
would take their nebuliser or other health
and medical equipment with them to a
clinic-based HMR situation. Further, my
experience shows me that in the home the
patient is more comfortable and relaxed
and o ers information more readily.
I am passionate about HMRs. My
determination to ensure they are not
undermined stems in part from the fact
that I sat on the original Implementation
Steering Group which established HMRs.
We spent a great deal of time ensuring
their robustness and e cacy.
Part of this process has seen PSA develop
its guidelines which importantly state: 'An
HMR is a consumer-focussed service that
aims to identify, prevent and resolve actual
or potential medication-related problems,
optimise pharmacotherapy and assist
in achieving better health outcomes for
consumers living at home. Best practice
requires that all aspects of the HMR
service are conducted by an accredited
pharmacist in the consumer's home.'
However, there is also recognition that
there may be exceptional circumstances
where the normal HMR business rules
may not apply. For example, a registered
pharmacist may conduct the interview
in special circumstances and provide the
information to an accredited pharmacist
who completes the clinical assessment and
writes the report.
There are also exceptions where
cultural and safety concerns may occur.
These allow for an occasional HMR to be
conducted in a clinic or a GP's surgery.
However, allowing exceptions does
not justify anyone trying to establish a
clinic-based HMR service to convert these
speci c exceptions into a mainstream HMR
We must also be very aware that there is
a nite budget for the provision of HMRs,
and this budget is based on the reviews
being conducted in a home. Setting up
fast-track clinics to 'conveyor-belt' HMRs
will have a massive impact of the budget
for these services in a very short time.
Business models for HMRs such as at these
clinics are simply aimed at exploiting
recent changes to HMRs under which we
have moved from a referral to the patient's
regular pharmacy to a system where GPs
can provide an HMR referral directly to
an accredited pharmacist, as well as to
a patient's usual community pharmacy.
If the clinic concept can convince GPs
and patients to initiate HMRs, then the
numbers of HMRs provided will increase,
not for the good of patient outcomes
but to capitalise on funding available for
provision of the services.
Such behaviour also threatens to damage
our professional integrity and the good
which have been built up over time
in relation to HMRs. When developing
and implementing HMRs we had many
meetings with GPs and consumer groups
to establish what the service would be
and de ne the roles each profession
would play. Further, at a time of signi cant
health reform, there is an opportunity
for pharmacists to expand our role but
this behaviour could threaten those
I am also concerned by reports of some
doctors charging accredited pharmacists
an administration fee for GP-initiated
HMRs. While an administration fee is of
itself no concern, it is worrying that these
fees are being charged over and above
the fee the doctor gets for their role in the
HMR service. Cleary this is not within the
spirit of the business rules.
Accredited pharmacists thinking of a new
model for the provision of HMR services
should examine the PSA guidelines at:
services.pdf or go to the Medicare
HMR website: www.medicareaustralia.
home-medicines-review.jsp and make
themselves fully aware of the appropriate
model and their responsibilities.
I am interested in feedback where
accredited pharmacists are seeing
inappropriate models being developed
or used. Please email me at psa.nat@psa.
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