1. The Australian Model for Home Medicines Review Dr Tim Chen Faculty of Pharmacy timchen@pharm.usyd.edu.au 9 th Commonwealth Pharmaceutical Association Conference and MPS Pharmacy Scientific Conference 2007 1 st -5 th August 2007

2. Overview Background Information – Australia Medicine use in Australia National Medicines Policy Model for Home Medicines Review in Australia Selected studies Concluding comments Supplementary materials

3. Australian Bureau of Statistics: Population: 20,502,720 Number of Approved Pharmacies (June 2002): n= 4,926 Approximate Average population per pharmacy: n= 4150 Introduction: Some Key Statistics

4. Key Statistics: Ageing Population

5. Scope of Medicine Use and Medication Incidents Safety and Quality Council. Second National Report on Patient Safety. Improving Medication Safety, July 2002 About 200 million prescriptions dispensed per year by community pharmacy (≈780 Rx/week/pharmacy) Top 10 Prescription Medicines Dispensed through Community Pharmacy Atorvastatin Simvastatin Salbutamol Celecoxib Frusemide Omeprazole Ranitidine Ramipril Amlodipine Ipratropium bromide Statistics on Drug Use in Australia 2002

6. Scope of Medicine Use and Medication Incidents Safety and Quality Council. Second National Report on Patient Safety. Improving Medication Safety, July 2002 HOSPITAL: 2-3% of all hospital admissions are medication related - 140,000 pa COMMUNITY: 400,000/100 million GP consultations pa for ADEs (0.4% of all GP visits) Estimated cost $AUD 380 million pa

7. Australia’s National Medicines Policy 1. Timely access to medicines 2. Appropriate standards of medicines: quality, safety, efficacy 3. Quality use of medicines 4. Responsible and viable medicines industry www.health.gov.au

8. Policy on Quality Use of Medicines (QUM) Judicious, appropriate, safe and efficacious use of medicines “Medication Team” – doctors, pharmacists, nurses, consumers www.health.gov.au/hbd/qum/overview.htm

9. Home Medicines Review (HMR) HMR is a service designed to assist consumers living at home to maximise the benefit of their medication regimen and prevent medication related problems Medicare Australia

10. Objectives of HMR 1.Achieve safe, effective and appropriate use of medicines 2.Improve quality of life and health outcomes 3.Improve patient’s and health professional’s knowledge and understanding about medicines 4.Facilitate cooperative working relationships between members of the health care team Medicare Australia

11. PHILOSOPHICAL SHIFT: from Product to Patient Supply role Cognitive Service Product Patient QUM

12. Australian Model for HMR

13. Key Elements of HMR Intervention

14. Interprofessional Collaboration in Medication Review

16. Randomised Comparative Study Chen, Bennett, Smith et al., 2000 http://www.guild.org.au/public/dmmrfiles/report_stgeorge.pdf

17. Research Team The University of Sydney Local Practitioners St George & Canterbury Divisions of General Practice National Organisations Pharmaceutical Society of Australia Pharmacy Guild of Australia Royal Australian College of General Practitioners Australian Medical Association Consumer Health Forum Royal College of Nursing Key Stakeholders Chen, Bennett, Smith et al., 2000 http://www.guild.org.au/public/dmmrfiles/report_stgeorge.pdf

18. Structure for Collaboration Organisational level -“Top down” International policy National policy Practice level – “Bottom up” Local – practice-based research – Division of GP – Local Government Area – Guild Zone

19. Impact on Use of Medicines N=362 cases Chen, Bennett, Smith et al., 2000 http://www.guild.org.au/public/dmmrfiles/report_stgeorge.pdf

20. Impact on Use of Medications Chen, Bennett, Smith et al., 2000 http://www.guild.org.au/public/dmmrfiles/report_stgeorge.pdf

21. Progress to Date Home Medicines Review Quarterly Statistical Bulletin March Quarter 2007 From www.guild.org.au

22. Chart 3

23. Chart 14

24. Chart 6a

25. Summary

26. Summary: HMR Process Referral from GP Patient Interview (in home) Comprehensive Medication Review Case conference with GP Treatment goals & clinical information Complete medication & medical history Chen, Bennett, Smith et al., 2000 http://www.guild.org.au/public/dmmrfiles/report_stgeorge.pdf

27. Summary: Philosophical Shift From Product to Patient Supply role Cognitive Service HMR Product Patient QUM

28. Concluding Comments HMR has been successfully implemented in Australia Funded by Commonwealth Government Collaborative medication team approach Sustainability of HMR = Support for Implementation

29. Concluding Comments HMR has been successfully implemented in Australia Funded by Commonwealth Government Collaborative medication team approach Sustainability of HMR = Support for Implementation Infrastructure support: local facilitators Professional organisation support Continuing professional education Liaison with government On-going multi-disciplinary approach Evaluation of programme Accreditation & education

30. Acknowledgements Funding Bodies – PHARM – Commonwealth Department of Health and Aged Care – Pharmacy Guild of Australia Key collaborators: – Dr Simon Bell – Dr Paula Whitehead – Dr Parisa Aslani – Prof Andrew McLachlan – Dr Alison Roberts – Prof Charlie Benrimoj – A/Prof Ines Krass – Mrs Carlene Smith – Mrs Alexandra Bennett – Dr Abilio de Almeida Neto

31. Thank you Comments … Questions …