Stick to the script

Put aged care support where it belongs, argues Guild NSW branch president David Heffernan in response to news of increased Home Medicine Review caps

In its haste to be seen to be doing something about the parlous state of aged care in Australia, as identified in the interim report of the Aged Care Royal Commission, the Federal Department of Health has opted to put more money into Home Medicines Reviews.

To put it bluntly: Go back, you are going the wrong way!

Without in any way disputing the merits of Home Medicines reviews, the fact is that increasing the per month cap on HMRs from 20 to 30 per provider will be of negligible benefit to residents of aged care facilities, and does not address the issues and recommendations raised in the Royal Commission’s interim report released last October.

Let’s be clear: Whatever problem lifting the HMR cap is intended to address, it certainly isn’t a problem identified in the Royal Commission.

The fact is that only about 10 per cent of HMR providers in Australia go anywhere near reaching the monthly cap of 20 services. That’s around 140 HMR providers across Australia.

Seventy per cent of providers only do between one and five HMRs per month, so lifting the cap is immaterial to them, and will not lead to any significant increase in services for aged patients.

What should the Government do instead with the $25.5 million it earmarked for this component of its response to the Royal Commission? There are clear alternatives if the Government wanted to respond more appropriately to the recommendations of the interim report. These include:

  • Amending the RMMR patient eligibility criteria to incorporate people in residential respite care and transitional care.
  • Focusing Compliance and Audit activity on RMMR services and QUM program provision.
  • Funding participation by pharmacists in case conferencing arrangements.
  • Amending the RMMR Program Rules to allow for more than one RMMR Service Provider to be contracted for a single Residential Aged Care Facility to facilitate patient choice and enable RMMRs to be conducted locally and more responsively to patient need. Breaking news: I understand this suggestion is under active consideration so let’s hope it proceeds.

And if the Government still wanted to increases the provision of medication management services outside of aged care facilities, a better path would be to increase the cap on in-pharmacy MedsChecks.

Currently around 70 per cent of pharmacies providing MedsChecks are doing between 16 and 20 services, so increasing the cap on MedsChecks would benefit far more patients than would the increase in HMRs.

The interim report of the Royal Commission was a sobering and confronting document which made quite specific recommendations about what needed to be done in relation to medication reviews. It’s a pity the advice of the Royal Commissioners has not been heeded.

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  1. Debbie Rigby

    Analysis of dispensing to over 320,000 residents published in the MJA today ( show an increase in psychotropic drug use in the months prior to admission to residential aged care. So targeting of HMRs to high risk medicines such as psychotropics is also needed.

    See pharmacist Juanita Breen’s comments in MJA Insight

    • John Wilks

      Thanks for this timely analysis Debbie.

  2. John Wilks

    And I am wondering why the author is not named?

    • Jarrod McMaugh

      The author is named. You may be referring to the “guest author” – this is due to the content management system which would link back to all articles by an author. This wouldn’t be used for people who aren’t staff writers or contracted contributors to AJP.

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