National Trends and Policy Impacts on Provision of Home Medicines Reviews and Residential Medication Management Reviews in Older Australians, 2009-2019.

Janet K Sluggett,Jonathan D Bartholomaeus,Steve L Wesselingh,Maria C Inacio,Luke R Collier,Gillian E Caughey

doi:10.3390/ijerph18189898

Abstract

Comprehensive medicines reviews such as Home Medicines Review (HMR) and Residential Medication Management Review (RMMR) can resolve medicines-related problems. Changes to Australia’s longstanding HMR and RMMR programs were implemented between 2011 and 2014. This study examined trends in HMR and RMMR provision among older Australians during 2009–2019 and determined the impact of program changes on service provision. Monthly rates of general medical practitioner (GP) HMR claims per 1000 people aged ≥65 years and RMMR claims per 1000 older residents of aged care facilities were determined using publicly available data. Interrupted time series analysis was conducted to examine changes coinciding with dates of program changes. In January 2009, monthly HMR and RMMR rates were 0.80/1000 older people and 20.17/1000 older residents, respectively. Small monthly increases occurred thereafter, with 1.89 HMRs/1000 and 34.73 RMMRs/1000 provided in February 2014. In March 2014, immediate decreases of –0.32 (95%CI –0.52 to –0.11) HMRs/1000 and –12.80 (95%CI –15.22 to –10.37) RMMRs/1000 were observed. There were 1.07 HMRs/1000 and 35.36 RMMRs/1000 provided in December 2019. In conclusion, HMR and RMMR program changes in March 2014 restricted access to subsidized medicines reviews and were associated with marked decreases in service provision. The low levels of HMR and RMMR provision observed do not represent a proactive approach to medicines safety and effectiveness among older Australians.

Highlights

Older people are at increased risk of medicines-related harm
In January 2009, there were 2,869,028 individuals (54.5% women) aged ≥65 years nationally, with 2292 general medical practitioner (GP) claims for Home Medicines Review (HMR)
Rates of HMRs and Residential Medication Management Review (RMMR) per 1000 older people by age group and sex are shown in Figures 1 and 2

Summary

Introduction

Older people are at increased risk of medicines-related harm. Strategies are needed to address the harm arising from medicines use that contributes to an estimated 250,000 hospital admissions annually in Australia [1]. Comprehensive medicines reviews can improve medicines safety and efficacy in older people. Home Medicines Review (HMR) and Residential Medication Management Review (RMMR) are flagship Australian Governmentsubsidized comprehensive medicines review programs that involve an accredited pharmacist visiting the patient’s home or residential aged care facility (RACF) to obtain a best possible medicines history, provide education, and identify medicines-related problems [2]. The pharmacist provides the referring general medical practitioner (GP) with a report describing how to address any medicines-related problems, which the GP uses.

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Results

Discussion

Conclusion