Cap on or cap off?

No cap would be ideal, PSA president says as he outlines the proposals to the HMR and RMMR programs such as expansion of the referral pathway and follow-up reviews

PSA national president Dr Chris Freeman said his ideal scenario would be for no caps to be in place for pharmacists performing HMR or RMMRs.

However, “we have to acknowledge we are operating within a confined budget,” said Dr Freeman, as he welcomed the recent announcement that the cap would be raised from 20 to 30 reviews per month.

“There has been some suggestion this is a token response, and I, and many others, would have preferred a total relaxation of those caps,” Dr Freeman said, “however, I think it’s a step in the right direction, and does allow community pharmacies to invest in them a bit more”.

“I think its also an acknowledgement that if you’re only providing one or two HMRs a week your efficiency and quality of service will suffer due to infrequency,” he added. 

Dr Freeman, speaking at the PSA NSW/ACT Annual Therapeutic Update, was discussing the PSA’s response to the Aged Care Royal Commission interim report which recommended, among other things, to “lift the cap on medication reviews and to amend the criteria to include patients undergoing respite care.”

It also recommended mechanisms be put into place to improve the quality and consistency of pharmacy services into aged care, and called for processes to be established around the monitoring of the recommendation made during the medication review process, he said. 

With the recent commitment of $25.5 million to improve medicines management in residential aged care facilities, one of the programs being worked on by the Department of Health was for follow-up medicine reviews to the initial review.

“The initial plan for HMR/RMMR was for a follow-up service by the pharmacist,” Dr Freeman said.

“As we know there is no follow-up with patient at the moment. Many accredited pharmacists have said they want to follow-up to see if their recommendations have been implemented, and to see if any new issues have emerged with these patients”.

There was “some consideration” being given for up to 2 follow-up medication reviews focused on the recommendations of the initial review for both the HMR and RMMR programs, he said.

“The sentiment is that follow-up should be done by the pharmacist who did the initial review, but there needs to be flexibility so another a handover could take place for a colleague to do follow-up review. 

In addition, he said the Department of Health was considering expanding the referral process for a review  to any medical practitioner, and even to some non-medical practitioners such as nurses and other allied health professionals.

“There has been advocacy in the past to increase the ability for people to be referred for a medication review. There is a feeling that one of the great limiting steps is the GP, in terms of identifying and referring patients for a review,” he said.



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