1. Jia Min Liau Accredited Pharmacist/ Credentialled Diabetes Educator
Home Medicines Review
Jia Min Liau
Accredited Pharmacist/
Credentialled Diabetes Educator

2. Speaker Disclosure I am an accredited pharmacist –
Optimal Health HMR Medication Management Services

3. What is a HMR?
“A Home Medicines Review (HMR) is a comprehensive clinical review of a patient’s medicines in their home by an accredited pharmacist on referral from the patient’s general practitioner (GP). ”
- The 6th CPA

4. HMR Process A HMR Service consists of a patient interview
clinical assessment
HMR report to the referring GP
HMR report to the Patient’s usual Community Pharmacy
Research demonstrated that HMRs are an effective way to identify and resolve medicine-related problems and improve health outcomes

5. HMR likely to benefit… Those taking multiple medicines
Those with multiple prescribers
Those prescribed a new medicine
Those who have had recent hospitalization
Those taking high-risk medicines
Many people living with diabetes are taking > 5 reg med
Likely to be under multidisciplinary team- endo, cardio, ophthalmologist etc.
High risk med such as insulin

6. Pharmacist Intervention
i) Clinical Intervention
Additional drug therapy
De-prescribing
Drug substitution
Dosage adjustment
Drug interaction analysis
Adverse drug reaction
Vaccination Status
Additional drug therapy, when HbA1c failed to achieve target within predetermined time frame
Deprescribing- e.g. PPI/ BDZ
Alt drug – e.g. wt gain from SU, changed to one that is weight loss/ neutral. Active person taking SU hypo to med which does not cause hypo
Impaired renal fx- metformin dose, e.g sitagliptin to linagliptin
E.g. diuretic with SGLT2 inibitor- cause increased diuretic effects, increase risk of hypotension and electrolytes disturbance, monitoring required.
SGLT2-Ihibitor with UTI- suggest prevention tips

7. Pharmacist Intervention
ii) Lifestyle modification
Advice on healthy eating habits
Advice on weight management
Advice on stress management
Advice on being physically active

8. Pharmacist Intervention
iii) Others
Smoking cessation
Storage of medicines (insulin/ eye drops)
Injection technique
Sick day management plan
Dose administration aids

10. Further information Medication management reviews
Content/medication_management_reviews.htm
Home Medicines Review