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Home Medicines Review (HMR)

HMR is also referred to as Domiciliary Medication Management Review (DMMR).

Project Officer: Vijay Ramanathan 8752 4915
Program Advisory Committee: Dr C Ovadia, Dr J Cordaro, Dr A Bassil, Dr A Sutherland, Dr J Korner, Mr G Vaccari (Pharmacist), Mr M Vasili(Pharmacist), Mr K Walsh (Consumer), Ms A Angelis (Consumer).

Medicines related problem:
Each year 140,000 hospital admissions and 400,000 visits to general practitioners are medicines-related. An Australian study showed that 90% of at-risk patients had a medicine-related problem, with most having three.

What is HMR?
HMR is a patient-focused collaborative service featuring:
• a GP referral to the community pharmacy of the patient’s choice
• a pharmacist interview with the patient, preferably at the patient’s home
• a verbal and written report by a HMR accredited pharmacist to the GP
• a discussion between the GP and the patient to devise a future management plan incorporating any changes

Flowchart of the steps involved in HMR (pdf)

The benefits of HMR
For GPs:
• Comprehensive, up-to-date information about all the medicines, complementary products, devices and other prescriptions being used by the patients.
• HMR reinforces the medication related advice(s) given by the GP to their patients.

For Patients:
• SUPPORT: Assistance with medications/aids/devices to improve compliance and early detection and management of medicine-related problems.
• EDUCATION: HMR helps patients to understand their medicines better and enhances their ability to manage their medicines appropriately.

What are the eligibility criteria for HMR?
• Patient MUST be living at home (community setting)
• At risk of medication misadventure
• Done annually by a regular GP

HMR can be offered to ANY patient for whom the GP feels it is clinically
necessary to ensure quality use of medicines or address patient's needs.

What are the risk factors for medication misadventure?
Examples of known risk factors that may lead to medication misadventure in patients:
• Currently taking 5 or more regular medications;
• Taking more than 12 doses of medication/day;
• Significant changes made to the medication regimen in the last 3 months;
• Medication with a narrow therapeutic index or medications requiring therapeutic monitoring;
• Symptoms suggestive of an adverse drug reaction;
• Sub-therapeutic response to treatment with medicines;
• Suspected non-compliance or inability to manage medication related therapeutic devices;
• Patients having difficulty managing their own medicines because of literacy or language difficulties, dexterity problems or impaired sight, confusion/dementia or other cognitive difficulties;
• Patients attending a number of different doctors, both general practitioners and specialists;
• Recent discharge from a facility/hospital (in the last 4 weeks) and/or
• OTHERS (e.g. loss of spouse, different health care professional involved in treatment)

The factors listed above are some of the risk factors and NOT eligibility criteria.

What is the MBS Item number, fee and rebate?
Item 900, $ 137.05c and 100%.

When a GP can claim Item 900?
A GP can claim Item 900 ONLY after completing the HMR service by doing the management plan at the second visit with the patient.

Important links:
Department of Health and Ageing
The Pharmacy Guild of Australia