Poll: Your thoughts on HMRs


What do you think needs to happen in the medicines review space?

The King Review panel has acknowledged that changes need to be made in this space, with several submissions to the review arguing that many services and programs delivered by community pharmacy are “underfunded or not funded at all”.

In particular HMRs have been recognised as a valuable and clinically effective, yet underfunded, service.

We want to know what you think about funding for medication review programs.

*You may tick as many options as you wish.

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NOTICE: It can sometimes take awhile for comment submissions to go through, please be patient.

20 Comments

  1. Kingsley Coulthard
    05/07/2017

    There is one important question not included ” Should hospital medical officers be allowed to refer patients for an HMR”………..I believe this expansion of the HMR program was recommended in the Campbell report in 2008, funded in May 2010 Federal budget but then buried by pharmacy organisations.

    • Jarrod McMaugh
      05/07/2017

      They of course can refer for an HMR any time they like, as can a pharmacist, or even allied health.

      MBS won’t pay for them though……

      I would think it would be more appropriate for a medical officer to refer the patient to their GP to be considered for HMR.

      Wouldn’t be much use in a doctor who is temporarily involved in a patient’s care generated a referral for a pharmacist to be temporarily involved in a patient’s care…. You need someone to be involved in an ongoing capacity.

      • Kevin Hayward
        07/07/2017

        Totally agree, we need to reinforce the primary care team

  2. Vicki Dyson
    05/07/2017

    If you read the new rules for HMRs to start 1/7/17, there is to be a trial of HMRs on hospital discharge. However, at the moment it is limited to a small number of hospitals. However, I would ask, if a hospital such as Monash is one of those hospitals, how will it work with a cap of 20HMRs ? I would have thought that it would require many pharmacists and that making it their full time occupation would make sense.

    • Jarrod McMaugh
      05/07/2017

      Trials and pilots tend to be funded separately from the mainstream version of a service.

  3. Debbie Rigby
    06/07/2017

    The results of this poll to date, show a high percentage of people believe HMRs should have a MBS item number. I am wondering **who** would fund a submisiion an application to MSA?

    • John Cook
      06/07/2017

      Imagine you know the process well here Debbie. I wonder if it is time to form our own accreditation body in competition to AACP?

      In my opinion the SHPA process is superior and I wonder if it is possible to form a new body perhaps aligned or part of the SHPA which would allow us to pay our dues with recognition of previous AACP accredited registrants.

      Our specialty could then dictate our own future and standards.

      The Consumers Health Forum has always comes to our aid in times of crisis and I wonder if the CHF could provide some assistance in forming such a body?

      Just some thoughts anyway.

      • Kevin Hayward
        07/07/2017

        An interesting idea, not certain how much support you would get, as many pharmacists appear to be disenfranchised, disinterested or moving on to new professions

      • Debbie Rigby
        07/07/2017

        AACP is the accrediting body, jointly owned by PSA and Guild. This sort of activity is not in the mission of the organisation. I believe it is a role for existing organizations. As it is a collaborative service and linked to Item 900 for GPs, I think any discussions leading to a MSAC application should involve medical organizations.

        • John Cook
          07/07/2017

          For SHPA registrants ie: CGP does the AACP approve certification or the SHPA? If AACP why?

          • Debbie Rigby
            13/07/2017

            BCGP is offered by SHPA for accreditation and reaccreditation to conduct CPA-funded medication reviews (HMR and RMMR). It is an alternate accreditation pathway to that offered by AACP.

        • John Cook
          07/07/2017

          $600 pa x 3000 registrants is 2m per year that could be better spent

        • Willy the chemist
          13/07/2017

          Can anyone elaborate if MSAC application is very costly? And maybe the rules of engagement should be changed. Why shouldn’t pharmacist initiate a HMR?

          • Jarrod McMaugh
            17/07/2017

            Yes it is…. but also a worthy thing for pharmacists to advocate for.

          • Willy the chemist
            17/07/2017

            Sorry for being ignorant, would you know what it would cost, ballpark? What would this involves? I would put the task to ACCP and PSA. Even SHPA & PPA. Hell, maybe it should be a collaborated approach.
            It would be an important defining moment for all pharmacists.

          • Debbie Rigby
            18/07/2017

            My understanding is that there is no fee for submissions.
            As HMRs and RMMRs are collaborative with GPs, I think it is appropriate that GPs initiate the referral together with relevant patient clinical info.
            I also think other health professionals should allowed to initiate HMRs and RMMRs especially AHWs and geriatricians.

          • Willy the chemist
            19/07/2017

            In my opinion, whilst it is definitely appropriate for GPs to initiate the referral, this should not preclude an accredited pharmacist from initiating a HMR.
            Below is taken directly from PSA website on HMR suitability.
            1. Currently taking five or more regular medicines
            2. Taking more than 12 doses of medicine per day
            3. Experiencing significant changes to their medicine regiment (in the last three months)
            4. Recently discharged from hospital
            5. Taking medicine with a narrow therapeutic index or that requires therapeutic monitoring
            6. Experiencing symptoms suggestive of an adverse medicine reaction
            7. Having difficulty managing their own medicines because of low level literacy and language skills or impaired sight
            8. Attending a number of different doctors, both general practitioners and specialists

            As evident, this can form a business rule for HMR. And how often has a community pharmacist come across patients who fall within one or more of these criteria and would benefit from a HMR if only he or she had been able to refer to an accredited pharmacist. How often has the GPS been unreceptive of a pharmacist’s suggestion?
            I’d experienced GPs been non committal to one and promptly faxed me one of their care plan instead, which incidentally we signed but are not part of the collaborative team?!

          • Debbie Rigby
            20/07/2017

            I understand your thinking. But HMRs are a comprehensive medication review which requires diagnoses, pathology and diagnostic test results, hospital discharge summaries, etc to form a clinical opinion on the patient’s medication therapy. At this time, accredited pharmacists do not have access to this information without a referral from a GP. This clinical information is fundamental to outcomes and therefore the medication review needs to be collaborative.
            I see MedsChecks as a useful ‘stepping stone’ to HMRs. You have an opportunity to identify potential medication-related problems as well as the patient’s concerns; this can lead to a request for a referral for a HMRs.
            Any MRPs on adherence issues and device technique can be addressed through a MedsCheck without the need for that additional information.

          • Jarrod McMaugh
            19/07/2017

            There isn’t a fee to submit an application for MSAC (unlike PBAC), but there is significant work involved in creating a submission.

            I know a pharmacist who has put together a submission, and they noted that it is a very thorough process that is very challenging; she is one of the most impressive pharmacists I have ever met, so this is saying a lot.

            Most submissions require the assistance of a consultant, or are prepared by the consultant. This is where the costs of an MSAC application begin.

    • Jarrod McMaugh
      07/07/2017

      The poll equally shows that respondents value Medschecks, and that pharmacists understand these are not a replacement for HMR.
      That is refreshing

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