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Pharmacist-Led Home Medicines Review and Residential Medication Management Review: The Australian Model

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Abstract

Older people are often prescribed multiple medicines and have a high prevalence of polypharmacy. Polypharmacy is associated with an increased risk of inappropriate use of medicines and drug-related problems. As experts in pharmacotherapy, pharmacists are well placed to review complex medication regimens and identify causes of drug-related problems and recommend solutions to prevent or resolve them. Involvement in medication review services represents a major philosophical shift and paradigm change in the way pharmacists practice, in that the focus is shifted away from the dispensing of prescription medicines to the provision of a professional service for a patient, in collaboration with their general practitioner (GP). In Australia, there are two established medication review programs: Home Medicines Review (HMR) and Residential Medication Management Review (RMMR). The objectives of this article were to describe the process of government-funded medication review services in Australia and to evaluate the contribution of pharmacists to HMR and RMMR, using evidence-based measures, such as the Drug Burden Index (DBI) and the Medication Appropriateness Index (MAI). This review found that there is good evidence to support the role of pharmacists in delivering medication review services across different settings. Although the positive impact of such services has been demonstrated using a variety of validated measures (DBI, MAI), there remains a need to also evaluate actual clinical outcomes and/or patient-reported outcomes.

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References

  1. World Health Organization. Ageing and life course: interesting facts about ageing. Geneva: WHO; 2012. Online at http://www.who.int/ageing/about/facts/en/index.html#. Accessed 19 Jan 2016.

  2. Australian Government: The Treasury. Intergenerational report 2010. Australia to 2050: future challenges. Barton: Treasurury of the Commonwealth of Australia; 2010. Online at http://archive.treasury.gov.au/igr/igr2010/report/html/00_Preliminaries.asp. Accessed 19 Jan 2016.

  3. Pillans P. Elderly patients and polypharmacy. NPS News. 2000;13

  4. Kouladjian L, Hilmer SN, Chen TF, Le Couteur DG, Gnjidic D. Assessing the harms of polypharmacy requires careful interpretation and consistent definitions. Br J Clin Pharmacol. 2014;78(3):670–1.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, McLachlan AJ, Cumming RG, Handelsman DJ, Le Couteur DG. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. Br J Clin Pharmacol. 2012;65:989–95.

    Google Scholar 

  6. Roughead EE, Gilbert AL, Primrose JG, Sansom LN. Drug-related hospital admissions: a review of Australian studies published 1988–1996. Med J Australia. 1998;168(8):405–8.

    CAS  PubMed  Google Scholar 

  7. Roughead EE. The nature and extent of drug-related hospitalisations in Australia. J Qual Clin Pract. 1999;19(1):19–22.

    Article  CAS  PubMed  Google Scholar 

  8. Basger BJ, Moles RJ, Chen TF. Application of drug-related problem (DRP) classification systems: a review of the literature. Eur J Clin Pharmacol. 2014;70(7):799–815.

    Article  PubMed  Google Scholar 

  9. Pellegrino AN, Martin MT, Tilton JJ, Touchette DR. Medication therapy management services: definitions and outcomes. Drugs. 2009;69(4):393–406.

    Article  PubMed  Google Scholar 

  10. Blenkinsopp A, Bond C, Raynor DK. Medication reviews. Br J Clin Pharmacol. 2012;74(4):573–80.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Australian Institute of Health and Welfare. Australia’s health 2014. Australia’s health series, no. 14. Volume Cat. no. AUS 178. Canberra: AIHW; 2014.

  12. Australian Government Department of Health. National Medicines Policy. Online at http://www.health.gov.au/nationalmedicinespolicy. Accessed 19 Jan 2016.

  13. Australian Government Department of Health. The National Medicines Policy document. Online at http://www.health.gov.au/internet/main/publishing.nsf/content/National+Medicines+Policy-2. Accessed 19 Jan 2016.

  14. Australian Government Department of Health. Medication management reviews. Online at https://www.health.gov.au/internet/main/publishing.nsf/Content/medication_management_reviews.htm. Accessed 19 Jan 2016.

  15. Chen TF, de Almeida Neto AC. Exploring elements of interprofessional collaboration between pharmacists and physicians in medication review. Pharm World Sci. 2007;29(6):574–6.

    Article  PubMed  Google Scholar 

  16. Chen TF, Crampton M, Krass I, Benrimoj SI. Collaboration between community pharmacists and GPs: impact on interprofessional communication. J Soc Adm Pharm. 2001;18(3):83–90.

    Google Scholar 

  17. de Almeida Neto AC, Chen TF. When pharmacotherapeutic recommendations may lead to the reverse effect on physician decision-making. Pharm World Sci. 2008;30(1):3–8.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Reason J. Human error: models and management. BMJ. 2000;320(7237):768–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Bell JS, Whitehead P, Aslani P, McLachlan AJ, Chen TF. Drug-related problems in the community setting: pharmacists’ findings and recommendations for people with mental illnesses. Clin Drug Invest. 2006;26(7):415–25.

    Article  Google Scholar 

  20. Basger BJ, Moles RJ, Chen TF. Development of an aggregated system for classifying causes of drug-related problems. Ann Pharmacother. 2015;49(4):405–18.

    Article  PubMed  Google Scholar 

  21. Nishtala PS, McLachlan AJ, Bell JS, Chen TF. Psychotropic prescribing in long-term care facilities: impact of medication reviews and educational interventions. Am J Geriatr Psychiatry. 2008;16(8):621–32.

    Article  PubMed  Google Scholar 

  22. Nishtala PS, Hilmer SN, McLachlan AJ, Hannan PJ, Chen TF. Impact of residential medication management reviews on Drug Burden Index in aged-care homes: a retrospective analysis. Drugs Aging. 2009;26(8):677–86.

    Article  PubMed  Google Scholar 

  23. Hilmer SN, Mager DE, Simonsick EM, et al. A drug burden index to define the functional burden of medications in older people. Arch Intern Med. 2007;167(8):781–7.

    Article  PubMed  Google Scholar 

  24. Castelino RL, Hilmer SN, Bajorek BV, Nishtala P, Chen TF. Drug Burden Index and potentially inappropriate medications in community-dwelling older people: the impact of Home Medicines Review. Drugs Aging. 2010;27(2):135–48.

    Article  PubMed  Google Scholar 

  25. Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, Cohen HJ, Feussner JR. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992;45(10):1045–51.

    Article  CAS  PubMed  Google Scholar 

  26. Castelino RL, Bajorek BV, Chen TF. Retrospective evaluation of home medicines review by pharmacists in older Australian patients using the medication appropriateness index. Ann Pharmacother. 2010;44(12):1922–9.

    Article  PubMed  Google Scholar 

  27. Castelino RL, Bajorek BV, Chen TF. Targeting suboptimal prescribing in the elderly: a review of the impact of pharmacy services. Ann Pharmacother. 2009;43(6):1096–106.

    Article  PubMed  Google Scholar 

  28. Castelino RL, Bajorek BV, Chen TF. Are interventions recommended by pharmacists during Home Medicines Review evidence-based? J Eval Clin Pract. 2011;17(1):104–10.

    Article  PubMed  Google Scholar 

  29. Gisev N, Bell JS, O’Reilly C, Rosen A, Chen T. An expert panel assessment of comprehensive medication reviews for clients of community mental health teams. Soc Psychiatry Psychiatr Epidemiol. 2010;45:1071–9.

    Article  PubMed  Google Scholar 

  30. The American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.

    Article  Google Scholar 

  31. Samsa GP, Hanlon JT, Schmader KE, Weinberger M, Clipp EC, Uttech KM, Lewis IK, Landsman PB, Cohen HJ. A summated score for the medication appropriateness index: development and assessment of clinimetric properties including content validity. J Clin Epidemiol. 1994;47(8):891–6.

    Article  CAS  PubMed  Google Scholar 

  32. Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46(2):72–83.

    Article  CAS  PubMed  Google Scholar 

  33. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–8.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Basger BJ, Chen TF, Moles RJ. Inappropriate medication use and prescribing indicators in elderly Australians: development of a prescribing indicators tool. Drugs Aging. 2008;25(9):777–93.

    Article  PubMed  Google Scholar 

  35. Basger BJ, Chen TF, Moles RJ. Validation of prescribing appropriateness criteria for older Australians using the RAND/UCLA appropriateness method. BMJ Open. 2012;2(5):e001431.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The European Society of Clinical Pharmacy is greatly acknowledged for organizing and holding their 42nd conference, at which the content of this manuscript was presented.

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  1. Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia

    Timothy F. Chen

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  1. Timothy F. Chen
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Correspondence to Timothy F. Chen.

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The author has no conflicts of interest relating to the content of this manuscript.

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Chen, T.F. Pharmacist-Led Home Medicines Review and Residential Medication Management Review: The Australian Model. Drugs Aging 33, 199–204 (2016). https://doi.org/10.1007/s40266-016-0357-2

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