Home medicines reviews: a national survey of Australian accredited pharmacists’ health service time investment

Abstract

Background: In Australia, polypharmacy and medication-related problems are prevalent in the community. Therefore, medicines safety initiatives such as the Home Medicines Review (HMR) service are critical to health care provision. While the evidence continues to expand around HMR service, little is known of accredited pharmacists’ experiences of HMR time investment.
 Objective: This study aimed to explore accredited pharmacists’ experiences of HMR practice regarding time investment in the study’s defined HMR Stages: 1 (initial paper-based assessment and review), 2 (in-home patient-accredited pharmacist consultation), and 3 (HMR report collation, generation, completion, and provision to the patient’s General Practitioner, including any liaison time).
 Methods: An electronic survey was developed and piloted by a panel of reviewers. Convenience sampling was used to distribute the final anonymous survey nationally via professional pharmacy organisations. Data were analyzed for frequency distributions and a chi-square test of independence was performed to evaluate any association between demographic variables relating to HMR time investment.
 Results: There was a total of 255 survey respondents, representing approximately 10% of national accredited pharmacist membership. The majority were experienced accredited pharmacists who had completed >100 HMRs (73%), were female (71%), and aged >40 years (60%). Regarding time investment for a typical instance of HMR, most spent: <30 minutes performing Stage 1 (46.7%), and 30-60 minutes performing Stage 2 (70.2%). In Stage 3, 40.0% invested 1-2 hours, and 27.1% invested 2-3 hours in HMR report collation and completion. Quantitative analysis revealed statistically significant (p=0.03) gender findings where females performed longer patient consultations than males (Stage 2). More HMR career experience resulted in statistically significant (p=0.01) less time performing Stage 1 (initial paper-based assessment and review); with a trend to less time performing Stage 3 (HMR report writing).
 Conclusions: Accredited pharmacists invest significant time in performing comprehensive HMRs, especially during in-home patient consultations and during HMR report collation and completion. Their significant HMR time investment as medicines experts provides insight for program and workforce considerations and warrants further research to better understand their work processes for optimizing medicines use and improving health.

Development and trial of an instrument to evaluate accredited pharmacists' clinical home medicines review reports in Australia

“…2,3 One instance of HMR provision for a single patient can be time-intensive, and quality synthesis of information and knowledge transfer is imperative for clinical recommendations and documentation contained in clinical HMR reports to be enacted by GPs to achieve medication optimisation goals. [4][5][6] Home medicines review practice guidelines by various Australian professional pharmacy organisations include guidance for APs around the generation and collation of clinical HMR reports. These guidelines describe effective communication, knowledge transfer, and sharing of patient preferences between various health professionals as part of patient-centred care for home-based patients.…”

What types of information do pharmacists include in comprehensive medication management review reports? A qualitative content analysis

“…Despite the holistic nature of the reports included in our analysis, the frequency of each information type that was included in the reports varied widely. Given the inconclusive evidence surrounding the clinical bene ts of comprehensive medication management reviews (such as in terms of hospital admissions) [3,[10][11][12][13][14][15][16][17][18], the variability of reporting identi ed by our study sheds light into why the evidence of clinical bene t may be inconclusive. This variability was also recently noted by Patounas and colleagues [22].…”

“…Surrogate outcomes include identifying medication-related problems and the recommendations made as a result, and the perceptions of consumers and GPs toward the medication review process [17,21,[23][24][25][26][27][28][29][30][31][32][33]. Other retrospective studies have evaluated the types of medication-related problems identi ed, the prevalence of their identi cation, and the subsequent acceptance and implementation of medicines review pharmacist recommendations by the GPs [10,15,17,28].…”

“…Comprehensive medication management reviews are a clinical service offered by pharmacists with the aim of identifying and resolving potential medication-related problems and optimising evidence-based therapeutic care [5][6][7][8][9]. Medication reviews have been found to reduce medication-related problems such as drug-drug interactions and optimisation of pharmacotherapy, but the extent of the effectiveness on clinical outcomes, hospital admission, and mortality remains unclear [3,[10][11][12][13][14][15][16][17][18]. Nonetheless, globally, pharmacist-led medication reviews have been effective in promoting consumer-centred care through an interprofessional approach [19].…”

Just a ‘romantic idea’? – a theory-based interview study on medication review implementation with pharmacy owners

“…extra credit points for the rst 5 MRs performed) to lower the implementation threshold. With every medication review performed experience grows, and less time will be needed for an MR [51], which in turn will add to the nancial viability of the service.…”