Medication reviews and people with diabetes: minding the gap

Author – Manya Angley BPharm, PhD, AACPA, Adv Prac Pharm, FPS, FSHP
Manya Angley**, a community pharmacist, visits people in their home to review their medication. Pictured above during one of her visits, Manya is a registered provider of Home Medication Reviews (HMR) and writes about the benefits and complimentary activities that can be undertaken during the review.

The RACGP general practice management of type 2 diabetes guidelines identify pharmacists as potential members of the multi-disciplinary care team around a patient with diabetes. (1) Furthermore, medication use, both conventional and complementary, should be reviewed at least once per year as part of the annual cycle of care. (2) However, it is continually noted that the skills of Australian pharmacists are under-utilised.

Research has shown that Home Medicines Reviews, conducted by appropriately credentialed pharmacists, improve medication management and reduce hospital admissions. (3, 4, 5). A HMR is a consumer-focused, structured and collaborative health care service provided in the community setting, to optimise quality use of medicines and consumer understanding. (6) HMRs were introduced in 2001 to address the high prevalence of preventable adverse drug effects and medication errors contributing to morbidity and admission to hospitals. To receive the HMR service, a patient at risk of medication misadventure must be referred to an accredited HMR pharmacist by their GP. The accredited pharmacist visits the patient in their home to conduct an interview, lasting approximately an hour, during which the patient’s medicines and medicine taking routine are examined and discussed.

A patient is deemed to be eligible for a HMR if:

  • they are a current Medicare/Department of Veterans’ Affairs (DVA) cardholder;
  • they live in a community setting;
  • they are at risk of, or are experiencing, medication misadventure; and
  • their GP confirms that there is an identifiable clinical need and will benefit from a HMR service.

After the review, the pharmacist prepares a written report for the patient’s GP reporting their findings and providing suggestions and recommendations for improving medicine management. The pharmacist and GP discuss the findings in the report and the GP then develops a medicine management plan with the patient. The HMR is a free service to consumers but pharmacists and GPs are both remunerated by the government (6).

A subsequent HMR may only be conducted if more than 2 years have elapsed or when the patient’s GP specifically deems a subsequent review is clinically necessary, such as when there has been significant change to the patient’s condition or medication regimen e.g. after discharge from hospital.

A diabetes educator, a practice nurse or another health care professional can make a recommendation to a patient’s GP if they identify a patient with diabetes could benefit from a HMR but a written referral by the GP is required for the process to be remunerated.

Below is a non-exhaustive list of activities that could be undertaken by an accredited pharmacist during a HMR for a person with diabetes:

  • Medication reconciliation i.e. compiling a best possible medication history (BPMH) using multiple sources. Compiling an accurate medication list can be laborious and challenging; when a patient has a ‘correct’ medicines list to hand, workflow of other clinicians can be improved.
  • A complete assessment of medicines (appropriateness, doses, interactions etc),
  • A review of recent blood tests, including calculation of creatinine clearance, and how current therapy impacts on them and vice versa. Dosage adjustment recommendations will be made where appropriate,
  • An assessment of any side effects experienced and provision of strategies to address them,
  • Smoking cessation counselling,
  • Reinforcement of diabetes self-management strategies,
  • Removal of hoarded medications, and/or
  • Implement strategies to improve medication adherence e.g. commence a dosage administration aid (DAA)

So, the HMR service is complementary to other services provided by members of a multidisciplinary team and pharmacists share a common goal to improve outcomes for patients with diabetes.

References
How will you integrate HMRs into the care of your patients with diabetes?

**Manya Angley is Director of Manya Angley Research and Consulting (MARAC). She is an accredited pharmacist and is available to conduct HMRs for people with diabetes in the Adelaide metro area, the Adelaide Hills and the Fleurieu Peninsula. She can be contacted via 0400 951 179 or www.marac.com.au. If Manya is unavailable or at capacity she can link you with another accredited pharmacist in your area.