Home Medicine Reviews (HMRs) help the pharmacist to scope out the patient’s home and have that added personal touch, although some changes need to be made
Home-based primary care has been shown to be effective, leading to greater patient satisfaction and a better quality of life, particularly for frail older adults.
For example, a 2016 Canadian review of patient experiences has found home-based care provides social support, familiarity, and effective medical management.
It found that for frail older people who are perhaps homebound, having teams going to the person’s home including pharmacists and doctors may have a lot of benefits, especially for those with multi-morbidities.
HMRs, in turn, are special in that they allow the pharmacist to get an idea of the environment in which the patient lives, says consultant clinical pharmacist Debbie Rigby.
The findings of the Canadian review can certainly be applied to Australian HMRs, which are an integral part of home-based primary care, says Rigby.
“Going into a person’s home is a different dynamic – you can see the environment they’re living in and assess things like fall risk and other needs.
“The conversation you would have would be very different from within a community pharmacy. One of my areas is respiratory disease. We know a lot of people don’t take their meds properly, but many people don’t want to demonstrate how they take their medication, for example a puffer, in public.
“I have never had an issue getting a demonstration through an HMR,” Rigby says.
Brisbane GP Dr Justin Coleman agrees that home-based care comes with many benefits and refers patients for HMRs whenever someone has complex medication needs.
“There’s a lot to be gained by visiting someone’s home and seeing the actual situation on the ground, and checking adherence,” he says.
“Many patients are on multiple medications, and these people’s medication taking is a lot more chaotic – so they may need someone to check on the environment, where their medications are kept and how this setup might be affecting adherence,” says Coleman.
If someone is taking a complex array of medications (between seven and 12) HMRs are a very useful thing, he says, as the interactions between all the medications can be difficult to wrap your head around.
HMRs are also invaluable for the deprescribing process. However, there are issues.
The caps imposed (20 per month for an accredited pharmacist) can be quite problematic in rural areas, Rigby points out. There is also a need for better targeting of HMRs, she says.
There is still a low uptake of HMRs in Australia, AJP has previously reported.
“In Australia….. studies of HMR uptake have found that only 5-10% of older people discharged from hospital, who are referred to an ACAS or community nursing service or who reside in supported accommodation, receive an HMR,” senior aged care pharmacist Rohan Elliot and colleagues wrote in a letter to the BMJ.