Home medicines reviews: a national survey of Australian accredited pharmacists’ health service time investment
Background: In Australia, polypharmacy and medication-related problems are prevalent in the community. Therefore, medicines safety initiatives such as the Home Medicines Review (HMR) service are critical to health care provision. While the evidence continues to expand around HMR service, little is known of accredited pharmacists’ experiences of HMR time investment.
Objective: This study aimed to explore accredited pharmacists’ experiences of HMR practice regarding time investment in the study’s defined HMR Stages: 1 (initial paper-based assessment and review), 2 (in-home patient-accredited pharmacist consultation), and 3 (HMR report collation, generation, completion, and provision to the patient’s General Practitioner, including any liaison time).
Methods: An electronic survey was developed and piloted by a panel of reviewers. Convenience sampling was used to distribute the final anonymous survey nationally via professional pharmacy organisations. Data were analyzed for frequency distributions and a chi-square test of independence was performed to evaluate any association between demographic variables relating to HMR time investment.
Results: There was a total of 255 survey respondents, representing approximately 10% of national accredited pharmacist membership. The majority were experienced accredited pharmacists who had completed >100 HMRs (73%), were female (71%), and aged >40 years (60%). Regarding time investment for a typical instance of HMR, most spent: <30 minutes performing Stage 1 (46.7%), and 30-60 minutes performing Stage 2 (70.2%). In Stage 3, 40.0% invested 1-2 hours, and 27.1% invested 2-3 hours in HMR report collation and completion. Quantitative analysis revealed statistically significant (p=0.03) gender findings where females performed longer patient consultations than males (Stage 2). More HMR career experience resulted in statistically significant (p=0.01) less time performing Stage 1 (initial paper-based assessment and review); with a trend to less time performing Stage 3 (HMR report writing).
Conclusions: Accredited pharmacists invest significant time in performing comprehensive HMRs, especially during in-home patient consultations and during HMR report collation and completion. Their significant HMR time investment as medicines experts provides insight for program and workforce considerations and warrants further research to better understand their work processes for optimizing medicines use and improving health.
Pharmaceutical Society of Australia. Medicine Safety: Take Care. Canberra: PSA; 2019.
World Health Organization. Medication Without Harm: WHO’s third global patient safety challenge. http://www.who.int/patientsafety/medication-safety/en/ (accessed Feb 8, 2021).
World Health Organization. World report on ageing and health. https://apps.who.int/iris/bitstream/handle/10665/186463/9789240694811_eng.pdf?sequence=1&isAllowed=y (accessed Feb 8, 2021).
Page AT, Falster MO, Litchfield M, Pearson SA, Etherton-Beer C. Polypharmacy among older Australians, 2006-2017: a population-based study. Med J Aust. 2019;211(2):71-75. https://doi.org/10.5694/mja2.50244
Spinks J, Birch S, Wheeler AJ, et al. Provision of home medicines reviews in Australia: linking population need with service provision and available pharmacist workforce. Australian Health Review. 2020;44(6):973-982. https://doi.org/10.1071/AH19207
Plácido AI, Herdeiro MT, Morgado M, Figueiras A, Roque F. Drug-related Problems in Home-dwelling Older Adults: A Systematic Review. Clin Ther. 2020;42(4):559-572. https://doi.org/10.1016/j.clinthera.2020.02.005
Anderson C. Global trends in pharmacy practice. In: Remington - The Science and practice of pharmacy, 23ed. Amsterdam: Elsevier; 2020.
Griese-Mammen N, Hersberger KE, Messerli M, et al. PCNE definition of medication review: reaching agreement. Int J Clin Pharm. 2018;40(5):1199-1208. https://doi.org/10.1007/s11096-018-0696-7
Geurts MM, Talsma J, Brouwers JR, de Gier JJ. Medication review and reconciliation with cooperation between pharmacist and general practitioner and the benefit for the patient: a systematic review. Br J Clin Pharmacol. 2012;74(1):16-33. https://doi.org/10.1111/j.1365-2125.2012.04178.x
Chen TF. Pharmacist-Led Home Medicines Review and Residential Medication Management Review: The Australian Model. Drugs Aging. 2016;33(3):199-204. https://doi.org/10.1007/s40266-016-0357-2
Pharmaceutical Society of Australia. Guidelines for comprehensive medication management reviews. https://www.ppaonline.com.au/wp-content/uploads/2020/04/PSA-Guidelines-for-Comprehensive-Medication-Management-Reviews.pdf (accessed Feb 8, 2021).
Australian Government. National Medicines Policy. https://www1.health.gov.au/internet/main/publishing.nsf/content/national+medicines+policy-1 (accessed Feb 8, 2021).
Australian Government Department of Health. Medication management reviews. https://www1.health.gov.au/internet/main/publishing.nsf/Content/medication_management_reviews.htm (accessed Feb 8, 2021).
Australian Government Department of Health. Medicare Schedule MBS Online Item 900 - Domiciliary Medication Management Review. http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&qt=ItemID&q=900 (accessed Feb 8, 2021).
Jokanovic N, Tan EC, van den Bosch D, Kirkpatrick CM, Dooley MJ, Bell JS. Clinical medication review in Australia: A systematic review. Res Social Adm Pharm. 2016;12(3):384-418. https://doi.org/10.1016/j.sapharm.2015.06.007
Carson S, Kairuz T. A comparison of medication profiles held by general practitioners and those documented during Home Medication Reviews. J Pharm Pract Res. 2018;48(4):340-347. doi: https://doi.org/10.1002/jppr.1411
Lee JQ, Ying K, Lun P, et al. Intervention elements to reduce inappropriate prescribing for older adults with multimorbidity receiving outpatient care: a scoping review. BMJ Open. 2020;10(8):e039543. https://doi.org/10.1136/bmjopen-2020-039543
Dillman DA. Mail and Internet surveys: the tailored design method 2nd ed. Hoboken: John Wiley; 2007.
Urbis Keys Young. Evaluation of the Home Medicines Review Program – Pharmacy Component. Canberra: PGA; 2005.
Campbell Research Consulting. Home Medicines Review Program Qualitative Research Project Final Report. https://www1.health.gov.au/internet/main/publishing.nsf/Content/D341DA146481106ACA257BF00020A7CD/$File/HMR%20Final%20Report.pdf (accessed Feb 8, 2021).
Czarniak P, Hattingh L, Sim TF, Parsons R, Wright B, Sunderland B. Home medicines reviews and residential medication management reviews in Western Australia. Int J Clin Pharm. 2020;42(2):567-578. https://doi.org/10.1007/s11096-020-01001-8
Angley M, Ponniah A, Bong J, Padhye V, Shakib S, Spurling L. Implementing and evaluating a parallel post-discharge Home Medicines Review (HMR) model. https://6cpa.com.au/resources/fourth-agreement/implementing-and-evaluating-a-parallel-post-discharge-home-medicines-review-hmr-model/ (accessed Feb 8, 2021).
Wilson A, Childs S. The relationship between consultation length, process and outcomes in general practice: a systematic review. Br J Gen Pract. 2002;52(485):1012-1020.
Papastergiou J, Luen M, Tencaliuc S, Li W, van den Bemt B, Houle S. Medication management issues identified during home medication reviews for ambulatory community pharmacy patients. Can Pharm J (Ott). 2019;152(5):334-342. https://doi.org/10.1177/1715163519861420
HealthConsult. Initial Evaluation of Sixth Community Pharmacy Agreement Medication Management Programs: Home Medication Review. http://www.pbs.gov.au/general/sixth-cpa-pages/cpp-files/6CPA-MMR-HMR-Final-Evaluation-Report.PDF (accessed Feb 8, 2021).
Ahn J, Park JE, Anthony C, Burke M. Understanding, benefits and difficulties of home medicines review - patients' perspectives. Aust Fam Physician. 2015;44(4):249-253.
Duncan P, Cabral C, McCahon D, Guthrie B, Ridd MJ. Efficiency versus thoroughness in medication review: a qualitative interview study in UK primary care. Br J Gen Pract. 2019;69(680):e190-e198. https://doi.org/10.3399/bjgp19x701321
National Institute for Health and Care Excellence (NICE). Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. https://www.nice.org.uk/guidance/NG5 (accessed Feb 8, 2021).
National Institute for Health and Care Excellence (NICE). Multimorbidity: clinical assessment and management. https://www.nice.org.uk/guidance/ng56 (accessed Feb 8, 2021).
Advinha AM, Lopes MJ, de Oliveira-Martins S. Assessment of the elderly's functional ability to manage their medication: a systematic literature review. Int J Clin Pharm. 2017;39(1):1-15. https://doi.org/10.1007/s11096-016-0409-z
Szanton SL, Xue QL, Leff B, et al. Effect of a Biobehavioral Environmental Approach on Disability Among Low-Income Older Adults: A Randomized Clinical Trial. JAMA Intern Med. 2019;179(2):204-211. https://doi.org/10.1001/jamainternmed.2018.6026
Weir KR, Bonner C, McCaffery K, et al. Pharmacists and patients sharing decisions about medicines: Development and feasibility of a conversation guide. Res Social Adm Pharm. 2019;15(6):682-690. https://doi.org/10.1016/j.sapharm.2018.08.009
Mohammed MA, Moles RJ, Chen TF. Medication-related burden and patients' lived experience with medicine: a systematic review and metasynthesis of qualitative studies. BMJ Open. 2016;6(2):e010035. https://doi.org/10.1136/bmjopen-2015-010035
Eriksen CU, Kyriakidis S, Christensen LD, et al. Medication-related experiences of patients with polypharmacy: a systematic review of qualitative studies. BMJ Open. 2020;10(9):e036158. https://doi.org/10.1136/bmjopen-2019-036158
Carter SR, Moles R, White L, Chen TF. The impact of patients' perceptions of the listening skills of the pharmacist on their willingness to re-use Home Medicines Reviews: a structural equation model. Res Social Adm Pharm. 2015;11(2):163-175. https://doi.org/10.1016/j.sapharm.2014.07.002
Swain LS, Barclay L. Exploration of Aboriginal and Torres Strait Islander perspectives of Home Medicines Review. Rural Remote Health. 2015;15:3009.
Wheeler AJ, Spinks J, Kelly F, et al. Protocol for a feasibility study of an Indigenous Medication Review Service (IMeRSe) in Australia. BMJ Open. 2018;8(11):e026462. https://doi.org/10.1136/bmjopen-2018-026462
Swain L, Barclay L. Medication reviews are useful, but the model needs to be changed: Perspectives of Aboriginal Health Service health professionals on Home Medicines Reviews. BMC Health Serv Res. 2015;15:366. https://doi.org/10.1186/s12913-015-1029-3
Smith F. Conducting your pharmacy practice research project a step-by-step approach, 2nd ed. London: Pharmaceutical Press; 2010.
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