Home Medicines Review

Home Medicines Review, is a service to patients living at home in the community. The goal of Home Medicines Review (HMR) is to maximise an individual patient's benefit from their medication regimen, and prevent medication-related problems through a team approach, involving the patient's GP and preferred community pharmacy, with the patient as the central focus.

It may also involve other relevant members of the healthcare team, such as nurses in community practice or carers. The HMR process utilises the specific knowledge and expertise of each of the health care professionals involved. In collaboration with the GP, a pharmacist comprehensively reviews the patient's medication regimen in a home visit. After discussion of the visit findings and report with the pharmacist, the GP and patient agree on a medication management plan. The patient is central in the development and implementation of this plan with their GP.

DMMR (HMR) Requirements

The review can be offered to any patient for whom the GP feels it is clinically necessary to ensure quality use of medicines or address patient's needs. Some examples of risk factors known to predispose people to medication-related problems include:

• Currently taking 5 or more regular medications
• Taking more than 12 doses of medication/day
• Significant changes made to the medication 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-therapeutic response to treatment with medicines
• Suspected non-compliance or inability to manage medication related therapeutic devices
• Patients having difficulty managing their own medicines because of literacy or language difficulties, dexterity problems or impaired sight, confusion/dementia or other cognitive difficulties.
• Patients attending a number of different doctors, both general practitioners and specialists
• Recent discharge from a facility/hospital (in the last 4 weeks)
• A patient can have a Home Medicines Review once every 12 months, or sooner if there has been a significant change in the patient's condition or medication requirements.

Medicare Benefits Schedule

A.26.9 of the Medicare Benefits Schedule states:
Benefits for a DMMR service under this item are payable not more than once in each 12 month period, except where there has been a significant change in the patient's condition or medication regimen requiring a new DMMR. A significant change could be, for example, diagnosis of a new condition or discharge from hospital involving multiple or extensive changes in medication. In such cases the patient's invoice or Medicare voucher should be annotated to indicate that the DMMR service was required to be provided within 12 months of another DMMR service. The Medicare Benefits Schedule (MBS) fee for completing a Home Medicines Review is $134.10. This includes:

• the initial consultation and written referral to the patient's preferred community pharmacy, together with relevant clinical information
• discussion with the pharmacist on the findings and recommendations from the review
• a second consultation with the patient to agree on a medication management plan.
• Payment for the review under the MBS will not occur until after the second patient consultation. Once all components of the service have been completed, a GP can directly bill Medicare or provide the patient with an account, as with any other service.

Resources

A complete listing of Resources for Home Medicines Review Program are available in the Resource Centre.