FAQ for hospital doctors

FREQUENTLY ASKED QUESTIONS BY HOSPITAL DOCTORS 

Q: What is a Home Medicines Review (HMR/DMMR)?

A: A Domiciliary Medication Management Review (DMMR), also known as Home Medicines Review (HMR), is intended 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 accredited pharmacist or community pharmacy.

Q: Can a hospital doctor or specialist refer for a medication review?

A: Yes. If you are concerned about medication related issues to do with a patient who is being discharged you can refer that patient for a medication review. Information can be found at the following link: hospital initiated medication reviews. Only certain specialists and GPs are currently able to refer a HMR. For more information regarding the HMR service, see NPS medicinewise Medication Management Reviews: Information for medical practitioners

Q: Which of my patients should I consider referring for a Medication Review?

A: It is important to follow hospital policy, standards and guidelines as to when an how to refer, however examples of patients that may benefit includes:

                  •Polypharmacy (patients with a high number of medications, especially those with multiple medication changes in hospital)

               •The presence of high-rish medicines (eg. opioids, antipsychotics, insulin, anticoagulants)

               •Patients with complex needs (eg. multiple comorbidities such as COPD, heart failure, chronic pain, diabetes)

               •Patients with recurrent hospitalisations

               •Patients living alone

               •Vulnerable populations including:

                                •Aboriginal and Torres Strait Islander patients

                                •Patients with coginitive impairment

                                •Patients with cognitive impairment

                                •Patients with mental health problems

                                •Patients with an intellectual disability

                                •Frail Patients

Q: Does the Pharmacist need to be specially qualified to conduct the medication review (DMMR/HMR/RMMR), or can all pharmacists conduct them?

A: In order to conduct a Home Medicines Review the pharmacist must have done extra training and be accredited to conduct the reviews. These pharmacists are called "Credentialed  Pharmacists".

Q: How do I do a referral for a HMR?

A: Many of the current prescribing software can create a referral for you, alternatively here is a link to our referral form.

Q: How often can I get a HMR done for a patient?

A: A subsequent HMR may only be conducted if more than 24 months has elapsed since the date of the most recent Patient Interview or when the referring doctor specifically deems a subsequent review is clinically necessary, such as when there has been a significant change to the Patient’s condition or medication regimen.

Reasons why an additional review may be requested include but are not limited to:

            •Discharge from hospital after an unplanned admission in the previous four weeks

            •Significant change to a patient’s medication regimen in the past three months

            •Change in medical condition or abilities (including falls, cognition, physical function)

            •Prescription of a medicine with a narrow therapeutic index or requiring therapeutic monitoring

            •Presentation of symptoms suggestive of an adverse drug reaction

            •Sub-therapeutic response to therapy

            •Suspected non-compliance or problems with managing medication-related devices

               •Risk of, or inability to continue managing own medicines, due to changes in dexterity, confusion or impaired vision.

Note: Program Rules indicate 24 months between reviews, whereas MBS Item number 900 indicates 12 months

Q: What happens after the Home Medicines Review service is conducted by the accredited pharmacist?

A: The accredited pharmacist will write a report to the referring doctor. This report will use information gained from the review, as well as current guidelines and resources to outline recommendations for the patient. The pharmacist is then available to the doctor to discuss any findings and management plans. If it is deemed necessary due to the patient's clinical status, the pharmacist may conduct up to 2 followup reviews, with followup reports being forwarded to the referring doctor.

Q: I have a question about Home Medicines Reviews?

A: If you have any questions at all, please contact us at: ramseykr@protonmail.com

Q: Do you protect the privacy of the doctors and patients?

A: Yes, our operations are governed by strict privacy principles. Here is a link to the patient consent form the pharmacist will ask the patient to sign before conducting the review. In order to maximise confidentiality, we use protonmail which is a HIPAA complaint email service. We also use password protection on documents we send through email to add another layer of security.