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a few days of receiving the referral.
Category 1 consumers are typically
older people with multi-morbidities,
prescribed many medicines, and
often are taking low therapeutic index
medicines. However, straightforward
cases may also be assigned a category
1. For example, I assigned as category
1 the 50-year old lady prescribed
Clexane and warfarin for a newly
diagnosed deep vein thrombosis and
saw her the next day.
At times, the triage system does not
work as well. The best example of this
was a man in his 70s prescribed only
vitamin D, statin and an ACEI with a
diagnostic history significant only for
sleeping difficulties and vitamin D
disturbances. He was triaged as a
category 4. At the HMR interview, he
described sleep disturbances that were
progressively worsening. He was sleep
walking and falling out of bed. His wife
had moved to sleeping in another
room, and was deadlocking the front
door at night. The sleep disturbances
had started at roughly the same time
as when the statin had started a couple
of years ago. The GP and I decided to
withhold the statin for a month to trial if
the sleep disturbances would improve.
As a result, the sleep disturbances
Every Friday morning, the Medicare
Local runs a continuing education
session for health care professionals.
Until recently, it was for medical
practitioners only; now it is open to
all health professionals. It is a great
opportunity to get to know other local
health professionals. This increases
the opportunities for collaboration
Multidisciplinary collaboration is
an interesting aspect of HMRs in a
rural community. The practice nurses
promote and encourage HMR referrals.
Many people with diabetes wish to
access a diabetes educator but are
unaware that the service is available
in the town. Others are aware but
cannot access an appointment.
In these cases, the HMR may become
heavily structured around diabetes
disease state management rather than
Silver Chain provides in-home nursing
care and home support to community
members with increased care needs.
For those most in need, it will visit daily
to administer their medications. It has
been fortunate that on many occasions,
Silver Chain care or nursing staff have
been present at the HMR. They ask
many questions about medication
administration and storage. In those
cases, the HMR extends to encompass
that additional element.
For example, an HMR consumer
mentioned that she fell over 'every
time she turned her head' and fearful
about dementia due to a word finding
difficulties. There were no apparent
medication related issues. This was an
example where a case discussion with
a speech pathologist, occupational
therapist, and a nurse improved the
quality of the final report.
In a rural area there are additional
opportunities and challenges to HMRs
compared to a metropolitan area.
The tyranny of distance is the greatest
challenge. The greatest opportunity is
to collaborate and interact regularly
with other health professionals.
This collaboration is rewarding as
a practitioner, and enhances the
services provide to consumers by a
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supply of medicines and pharmacy services in rural and
remote Australia. 2013 National Rural Health Alliance.
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medication safety: Influence of a patient-specific
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reviews performed by Australian general medical
practitioners. Pharmacoepidemiology and Drug Safety.
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medication reviews by Australian pharmacists. Pharmacy
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6. Lee CY, George J, Elliott RA, Stewart K. Prevalence of
medication-related risk factors among retirement village
residents: A cross-sectional survey. Age and Ageing.
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Delivery Models in Rural and Remote Australia 1993--2006.
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Pharmacist [journal article]. 2012 March 2012;31(3):2.
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"THE TYRANNY OF DISTANCE IS THE GREATEST CHALLENGE. THE
GREATEST OPPORTUNITY IS TO COLLABORATE AND INTERACT
REGULARLY WITH OTHER HEALTH PROFESSIONALS."
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