Skip to main content

Table 2 Most common perceived benefits and barriers of the HMR program

From: Medication reviews are useful, but the model needs to be changed: Perspectives of Aboriginal Health Service health professionals on Home Medicines Reviews

Benefits of HMRs

AHS staff comments

Increased patient understanding and confidence

The HMR interview is a good opportunity to iron out some confusion about medicines. (AHW)

The clients need to know the importance of taking medicines and why they are taking them. (AHW)

It helps my patients understand their medicines a bit more. (GP)

Just having another person go over it, having a bit more time and in different words can be very useful. (GP)

There’s the empowerment they(the patient) get from a more clear understanding. (nurse)

Improve medication adherence

Because the people don’t feel they’re working, they tend not to take them. (AHW)

If you explain to them (the patients) what it is, how it works and what to watch out for, then there’s some informed decision making and they’re more likely to take them (medicines). (AHW)

It gave my patient more confidence to take his medicines, just having someone reassure him that the medicines he was taking were appropriate. (GP)

Supporting GP practice

You get to learn stuff that you wouldn’t normally know about your patient. You learn about the gap, about what you think is going on and what is really going on, and you also learn stuff about medicines that you didn’t know. (GP)

The reports can be revelationary. You find out people are taking all sorts of things, some that you ceased months ago. (GP)

When a locum comes, and we have lots, they just prescribe the drugs because the patient asks for them. They don’t review them or work out if they really need them. (AHW)

Barriers to HMRs

AHS staff comments

Lack of awareness

None of us here know about home medicines review. (AHW)

People are not aware they can ask for, or should ask for their medicines to be reviewed. (AHW)

They (the patient) don’t know that pharmacists can do things like reviews. (AHW)

Workload

Time is the main thing that has put me off (GP)

We are already inundated with administrative tasks (GP)

Aboriginal Medical Service workloads are pretty demanding. A lot of these people that qualify for an HMR also qualify for EPC, care plans, health assessments and that kind of stuff, so that might be where they’re going first. (nurse)

One of the difficulties is having enough health workers on board to do it (participate in an HMR). Having a health worker who is trained enough to go with the pharmacist, who is trained in quality use of medicines and who understands what the pharmacist is talking about and take a lead in the whole process would be the ideal. (AHS manager)

Protection of the Clinician-client relationship

They’re (patients) already getting referred to lots of different people for lots of different things. So another referral might just feel like too much (GP)

Gaining someone’s confidence and trust and having a meaningful clinical interaction requires proper cross cultural training and working with the community over some time.(GP)

Doctors are concerned about overloading the patient. (nurse)

Lack of Clinician/AHS pharmacist relationship

The GPs aren’t driving it (HMR referrals) as they don’t have a relationship with a pharmacist who can do it for them (GP)

The relationship between the doctor and the pharmacist might not be established. If they had a rapport and a referral pathway going already that would really help. (nurse)

The community pharmacists around here are very busy. I don’t think they have time to get it done (GP)

It would be important for the pharmacist to have some cross cultural training (AHW)

The chronic health nurse or AHW needs to have a direct link with the accredited pharmacist, not the pharmacy. (nurse)

Generally our clients do not have a relationship with a pharmacist (nurse)

Lack of an HMR facilitator/driver/ program manager

We need someone at the health service allocated to encouraging the home medicines review, co-ordinating it, blocking out time for GPs to do referrals, taking on the role of doing the consent. (GP)

It needs something set in place so that it can be done regularly (GP)

We rely on a co-ordinator to organize all the logistics (GP)

There needs to be a single point of contact, health worker to patient.(AHW)

Somebody who is well known to the patient needs to ring and explain the process. (AHW)

Complex HMR model and rules

It took a while to make sense of the steps (GP)

I think the criteria are a bit restrictive. (GP)

It was not clear that all pharmacists were not accredited. I was sending off referral letters and nothing happened (GP)

It would be better if someone else could refer. For a multidisciplinary team to work effectively everything should not be done by the GP. (GP)

A lot of them think it is all done once the pharmacist has left the house. (AHW)

The health service should promote it (HMR) and align it with other programs or something they do already.(nurse)

We don’t organize home medicine reviews for all sorts of reasons – around privacy, judgment, people not being home, lots of people being transient or homeless, lots of people in 1 household and people not wanting strangers in their home. (nurse)

We need a flexible mixed model where some people can come here on an appointment, or we can go there if it suits today or where a pharmacist can just add on to an existing program. (AHW)

Lack of Financial Reimbursement

The AMS should be able to claim something for organizing an HMR. (AHS manager)

It should be the AMS who is doing all the organizing who gets a cut, not the pharmacy. (nurse)

AHWs are very important to the process. They need to be reimbursed for their time, just like the pharmacists and GPs. (GP)