Hospital-initiated Medication Reviews

On the 21^st of April 2020, landmark policy changes occurred to medication review programs, allowing for Hospital-initiated medication reviews to be federally funded. These changes were in response to the ‘Interim Report: Neglect’ released by the Royal Commission into Aged Care Quality and Safety. Since this date, the government has expanded the funding of medication review programs (HMR and RMMR’s) to allow certain hospital-based doctors to refer patients directly to a community based accredited pharmacist for a comprehensive medication review.  These doctors now include; specialist physicians, palliative care physicians, specialist pain physicians, specialist psychiatrists and general practitioners.  This pathway of funding for a comprehensive medication management review is known as a “Hospital-initiated medication review” or HIMR.

Many studies have proven that discontinuity of care can occur when a patient transitions from the hospital to the community. Discontinuity of care can be due to poor communication between patients and primary healthcare professionals, particularly in relation to medication changes, contributing to medication misadventure in the post-discharge period. The Final Report: Implementing and evaluating a parallel post-discharge HMR Model, investigated the application of a HIMR system in Australia.  The Report concluded that the average time taken to conduct a HIMR (6.54±4.73 days) was less than a HMR (11.11±7.44), meaning direct referral to an accredited pharmacist is more time-efficient than through a general practitioner (previous program model). The introduction of federally funded HIMR aims to expand access to medicine management services, improve patient care and reduce medication misadventure in the immediate post-discharge period.

At the time the Federal government introduced changes to the HMR and RMMR program rules, no clear guidelines on how hospital sites should implement these changes existed. In response, SHPA created a framework (Hospital-initiated medication reviews: Hospital Pharmacy Practice Update) which provides general guidance on how ‘at risk’ patients could be identified and referred from hospital settings for a medicines review. The framework outlines the process for; screening and referral of patients, home visits, HMR reports, medication management plans and follow up.

If you wish to review the framework written by SHPA Transitions of Care and Primary Care Leadership Committee please go to: shpa.org.au.