GP North

What is HMR?

HMR is collaborative service used to assist the quality use of medicines by improving the outcomes surrounding at home medicine use. It is consumer-focused and can be provided to people of all ages living at home in the community.

The goal of HMR is to maximise an individual patient's benefit from their medication regimen, accomplished through a team approach involving the general practitioner (GP) and the patient's preferred community pharmacist, with the patient as the central focus. It can involve other relevant members of the healthcare team, such as practice or community nurses or carers.

A Home Medicines Review can help you to help patients manage their medicines better.

What support can I get?

Anne Todd, an accredited pharmacist and HMR lead program officer, is available to provide support, advice, education and information to GPs, accredited pharmacists, community pharmacies and consumer groups in their local area about Home Medicines Reviews. This facilitation role is funded though the Fourth Community Pharmacy Agreement.

Support is provided to GP practices by the practice support teams and HMR lead program officer. The practice support teams can assist with practice systems to:-

• Identify patients likely to benefit from HMR 
• Incorporating HMR into regular cycles of care including using HMR in conjunction with Chronic Disease Management Item Numbers 
• Developing the role of practice support staff including Practice Nurses in HMR
• Referral process to community pharmacies 
• Templates for referrals
• Forging local links and networks between your practice and community pharmacies

Other support aimed at implementing HMR includes:

• Providing collaborative CPD events
• Integrating HMR with other activity areas e.g. Practice Support, chronic disease programs, hospital clinical integration and discharge programs and other QUM initiatives 
• Participating in multi-disciplinary forums and networks that encourage and improve communication between GPs and community pharmacists
• Increasing awareness of HMR in the local community through presentations to community groups
• Providing resources for GPs or pharmacists to use to promote HMR to consumers
• Regular evaluation of HMR activities

Support is also provided to community pharmacy and pharmacists by the HMR lead program officer.

We can assist with:

• Incorporating HMR into the community pharmacy’s regular medication management services
• Templates for reports and requests for referrals
• Forging networks with GP practices
• Availability of accredited pharmacist to conduct reports
• Peer support network for accredited pharmacists or those undertaking accreditation

Residential Medication Management Review (RMMR)

RMMR is a service provided to patients living in Residential Aged Care Facilities. The goal of a collaborative RMMR is to maximise an individual patient's benefit from their medication regimen, accomplished through a team approach involving the general practitioner (GP), Facility staff and the Accredited Pharmacist conducting the review, with the patient remaining as the central focus.

DVA – Dose Administration Aid Scheme Information

The Department of Veteran Affairs has initiated a new program for eligible veterans from the beginning of March 2008 The Dose Administration Aid (DAA) Service builds on DVA’s Quality Use of Medicines programs, which include the Veterans’ Medicines Advice and Therapeutics Education Services (Veterans’ MATES) program, and aims to assist the veteran community to get the most out of their medicines and to reduce medication mismanagement.

The DAA Service provides veterans, war widows and other eligible DVA clients, living in the community with regularly secure dose administration aids and the ongoing coordinated care of their doctor and pharmacist. Suitable veterans are identified through a Home Medicines Review and then placed on a one-month trial where they are monitored regularly by their GP and pharmacist. After a successful trial, veterans take up the service for six months, all the while under the supervision of the GP and pharmacist, before their suitability is reassessed.

A Dose Administration Aid (DAA) is a secure, usually disposable style - “Webster”®, “MedicoPak”® or similar, not a re-useable plastic slide style “Dossette® Box” even though the term used in the Veteran section of the website information refers to a “pillbox”. Prescriptions for the DVA DAA Service are provided to veterans through the normal Repatriation Pharmaceutical Benefits Scheme (RPBS) Authority approval process. GP's need Veterans' Affairs Pharmaceutical Advisory Centre (VAPAC) Authority approval to prescribe, which can be given over the phone.

The aims of the DAA Service are to improve veterans’ health outcomes through better, safer use of medication. Eligibility criteria apply.  For more information go to the DVA-DAA website.

What are the objectives of Quality Use of Medicine Activities including HMR and RMMR?

• Achieve safe, effective, and appropriate use of medications by detecting and addressing medication related problem/s that interfere with desired patient outcomes
• Improve the patient's quality of life and health outcomes using a best practice approach, that involves a collaborative effort between the GP, pharmacist, other relevant health professionals, and the patient (and where appropriate, their carer)
• Improve the patient's and health professionals' knowledge and understanding about medications
• Facilitate cooperative working relationships between members of the health care team, in the interests of patient health and well-being.

Who is eligible to receive a HMR?

The HMR process is available to people living in their homes. It does not apply to in-patients of a hospital, day hospital facility or care recipients in residential aged care facilities.

The patient should not have received an HMR service within the past 12 months (unless there has been a significant change in their condition or medication regimen).

The GP must assess the need for an HMR based on potential patient benefits and quality use of medicines goals. Those patients most likely to benefit are:

Patients at risk of medication related problems because of their co-morbidities, age or social circumstances;

• the characteristics of their medicines (e.g. warfarin)
• the complexity of their medication treatment regimen;
• patients recently discharged from hospital with multiple changes in therapy;
• suspected non-compliance or difficulties managing medication related therapeutic devices.

Who is involved in HMR

• The patient and their carer, where appropriate, as the central focus;
• The general practitioner;
• A pharmacist from the patient's preferred community pharmacist;
• The accredited pharmacist (if different from the preferred community pharmacist);
• Other members of the health care team that are identified as appropriate, such as community nurses, physiotherapists, diabetes educators.

What are the MBS Item requirements for HMR?

The MBS Item Number for a GP completing a HMR is Item 900.  The item number is intended to include the initial consultation at which the patient's eligibility for HMR is assessed and the referral form completed; liaison with the pharmacist; and development of the medication management plan for discussion and agreement with the patient at a second consultation. Any further follow-up, if required, would be part of subsequent consultations separate to the HMR.

Item 900 requires participation by a general practitioner, in a Home Medicine Review (HMR) for a patient living in the community setting, where the medical practitioner:

• Assesses a patient's medication management needs, and following that assessment, refers the patient to a community pharmacy for a HMR, and provides relevant clinical information required for the review, with the patient's consent; and
• Discusses with the reviewing pharmacist the results of that review including suggested medication management strategies; and
• Develops a written medication management plan following discussion with the patient.

HMR utilises the specific knowledge and expertise of each of the health care professionals involved in the team to help patients know and use their medicines better.

Who is involved in RMMR?

• The patient and their carers, where appropriate, as the central focus;
• The general practitioner;
• The accredited pharmacist;
• Other members of the health care team that are identified as appropriate, such as the facility staff including administration, nurses, physiotherapists, dietitian.

What are the MBS Item requirements for RMMR?

The MBS Item Number for a GP completing a RMMR is Item 903.  Item 903 requires participation by a general practitioner, in a collaborative Residential Medication Management Review (RMMR) for a permanent resident of a residential aged care facility, where the medical practitioner:

• Discusses and seeks consent for an RMMR from the new or existing resident;
• Collaborates with the reviewing pharmacist regarding the pharmacy component of the review;
• Provides input from the resident's Comprehensive Medical Assessment (CMA), or if a CMA has not been undertaken, provides relevant clinical information for the resident's RMMR;
• Discusses findings of the pharmacist review and proposed medication management strategies with the reviewing pharmacist (unless exceptions apply);
• Develops and/or revises a written medication plan for the resident; and
• Consults with the resident to discuss the medication management plan and its implementation.

How do you claim the MBS HMR or RMMR benefit?

GPs can use Medicare Online, submit a Medicare direct bill assignment form or provide the patient with an account. For either service to be eligible for a Medicare rebate, the requirements for the item must be met, including patient consent for the service and agreement with the medication management plan developed.

Cost to patient

• Cost to patients is dependent on individual GP practice billing policy.
• Pharmacies claim directly from Medicare Australia and do not charge a fee to patients for either RMMR or HMR services.

Resources

• HMR Practice Summary
• HMR Information for Practice Staff
• HMR Outline - including Medicare billing arrangements
• How to use HMR Templates in MD
• HMR Flower Chart outlining CDM Items
• Better Outcomes using HMR & CDM Items - Chart
• RMMR Outline
• How to use RMMR Templates in MD

Pharmacy Resources

• HMR Pharmacy Checklist
• HMR Pharmacy Flow Chart
• HMR Information for Pharmacy Staff
• HMR Contact List
• HMR Promotional Kit Order Form
• HMR Medicare Claim and Confirmation Form 

Web Sites

HMR Specific:

• Australian General Practice Network – QUM Program
• Medicare Australia – HMR information
• Department of Health and Ageing – information on medication management reviews (HMR & RMMR)
• DVA-DAA Program - Information for GPs and Pharmacists
• Australian Association of Consultant Pharmacy - including Comprehensive Medication Management Process Modules
• Pharmacy Guild of Australia (PGA)  

Other useful sites

• Pharmaceutical Society of Australia (PSA)
• Auspharmacist - Pharmacist Relevant Sites - links to many major health information websites.
• Medscape Today - Pharmacotherapy home page useful starting place for medicine information, many links to other tools including a useful drug interaction checker.

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