by Cathy Larkin.

Modification is required to the current HMR process before it will be viewed as a workable and useful process for clinicians and clients in remote Aboriginal communities. Below are suggested opportunities for modification. These comments are based on my experiences as a remote pharmacist in the Kimberley.

Referral Process

Comment: The current referral process requires a preferred community pharmacy. This concept is largely foreign to many members of Aboriginal communities who access medicines through the S100 supply scheme. Often access to pharmacy services is limited to the supplying community pharmacy and the visiting pharmacist (often an outsourced arrangement). The pharmacist may or may not be an accredited pharmacist.

Suggestion: The opportunity for a doctor to refer a patient to an accredited pharmacist who is known to be familiar with the community is essential.

Comment: The referral process is based on the doctor seeking consent from the patient. In many remote communities, a doctor visit may be once a week and it is usually the resident nursing and Aboriginal Health Worker (AHW staff) who are more familiar with the patients.

Suggestion: Remote area nursing staff and AHWs to be able to refer patients to pharmacist for HMRs. I would strongly recommend that the referral is done in consultation with the prescriber (ie the prescriber is phoned to alert them to this). However, consent and explanation of the process can be done by the nursing staff & AHWs.

Comment: The current referral process means that there will always be a delay between referral and actual HMR interview. This is often exaggerated in remote communities, because the pharmacist may only be visiting once every 3 months. Opportunistic care is often a very successful option for patients in remote area communities and this concept can be extended to HMRs for Aboriginal people.

Suggestion: The ability of remote area nursing staff and AHWs to refer patients will allow patients to be referred more promptly. For example, patients can be referred opportunistically on the day the pharmacist is in the clinic.

Referral form

Comment: With agreement from the clinic and patient (and as part of the clinic team), I was often able to access the patient’s information from their file. This included their progress notes, lab results and medication chart (as well as old medication charts). As the prescriber knew I had access to this information, they were often in the position to reduce the amount of medical history they had to provide me with.

Suggestion: The workload of the clinician writing the HMR referral can be reduced by a form where the referring clinician signs that themselves and the patient have given the accredited pharmacist permission to access the patient’s file (and electronic data if a patient information recall sheet exists). This means that the referring clinician need not provide lab results etc.

HMR interview

Comment: Frequently, the visiting pharmacist is largely unfamiliar with the client base of a remote AMS. Therefore, they are often reliant on the patient knowledge, community knowledge and cultural knowledge of the local staff, in particular the AHWs. The delivery of the HMR interview can be enhanced enormously by this local knowledge.

Suggestion: The financial recognition of the participation of AHWs and nursing staff in the HMR process is essential. Not only do these staff add to the outcomes of the HMR process, but they also usually expend a lot of energy and time co-ordinating the pharmacist visit. Therefore, there should be an opportunity for the AMS to claim for their involvement in the process.

Comment: I know that I used different HMR resources for different people. In particular, I used a large human body to show where all the tablets were working. I imagine there are many other pharmacists with useful tools for delivering HMRs.

Suggestion: I believe that many pharmacists (particularly new pharmacists) would benefit from a centralised location for accessing information about HMRs for remote populations.

Increased Prescriber Familiarity with the HMR Process

Comment: In my experience, there are a large number of prescribers who do not consider the option of HMRs for their patients. This may be due to lack of familiarity or due to the complexity associated with participating in this process.

Suggestion: There is a need for increased publicity of the HMR service to clinicians in remote area practice. There also needs to be an update on claiming process for those involved in MBS claiming at AMSs.

Cathy Larkin is an accredited pharmacist who has worked in the Kimberley as the Rural Pharmacist Academic and with the Kimberley Aboriginal Medical Service. She has now “turned to the dark side” and is studying medicine at Flinders University.

This is the third guest post in a series on Home Medicine Reviews in remote aboriginal Australia.
The first was by Chris Phillips and the second by Lisa Crisp.

Published in conjunction with my friends at Auspharm

For those non-pharmacists, a home medicine review is designed to “assist consumers living at home to maximise the benefits of their medication regimen and prevent medication related problems.”

* achieve safe, effective, and appropriate use of medications by detecting and addressing medication-related problems that interfere with desired patient outcomes
* improve the patient’s quality of life and health outcomes using a best practice approach, that involves cooperation between the general practitioner, pharmacist, other relevant health professionals and the patient (and where appropriate, their carer)
* improve the patient’s, and health professional’s 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.”

This section is from the Medicare Australia website.

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Tagged as: health, HMR, home medicine review, Remote Blogs