HMR is also known as Domiciliary Medication Management Review (DMMR).
HMR is an initiative of The Pharmacy Guild of Australia funded by the Australian Government Department of Health and Ageing as part of the Fourth Community Pharmacy Agreement.

“The person who takes medicine must recover twice, once from the disease and once from the medicine.” William Osler, M.D.

“If all the medicine in the world were thrown into the sea, it would be bad for the fish and good for humanity” O.W. Holmes, (Prof. of Med. Harvard University)

About HMR

The HMR is a consumer-focused, structured and collaborative health care service provided in the community setting, to optimise quality use of medicines and consumer understanding.  It involves the consumer, their general practitioner, their pharmacy, and other relevant members of the health care team.

Some of the benefits of HMR

For GPs:

• Comprehensive, up-to-date information about all the medicines, complementary products, devices and other prescriptions being used by the patients.
• HMR reinforces the medication related advice(s) given by the GP to their patients.

For Patients:

• SUPPORT: Assistance with medications/aids/devices to improve compliance and early detection and management of medicine-related problems.
• EDUCATION: HMR helps patients to understand their medicines better and enhances their ability to manage their medicines appropriately.

How to do HMR

What are the eligibility criteria for HMR?

• Patient MUST be living at home (community setting)
• At risk of medication misadventure
• Done annually by a regular GP

What are the risk factors for medication misadventure?

The issues listed below are some of the risk factors for medication misadventure and are NOT eligibility criteria.

Examples of known risk factors that may lead to medication misadventure in patients:

• Currently taking 5 or more regular medications;
• Taking more than 12 doses of medication/day;
• Significant changes made to the medication regimen in the last 3 months;
• Medication with a narrow therapeutic index or medications requiring therapeutic monitoring;
• Symptoms suggestive of an adverse drug reaction;
• Sub-therapeutic response to treatment with medicines;
• Suspected non-compliance or inability to manage medication related therapeutic devices;
• Patients having difficulty managing their own medicines because of literacy or language difficulties, dexterity problems or impaired sight, confusion/dementia or other cognitive difficulties;
• Patients attending a number of different doctors, both general practitioners and specialists;
• Recent discharge from a facility/hospital (in the last 4 weeks) and/or
• OTHERS (e.g. loss of spouse, different health care professional involved in treatment)

Steps involved in a HMR (MBS Item 900)

Identify patient for HMR

• Can be done by any member of the health care team, patient or carer

GP initiates and refers to community pharmacy

• GP decides if patient may benefit, using the risk factors and
obtains patient consent for the process and  the exchange of information
• Refers to community pharmacy of the patient’s choice

Pharmacist conducts patient interview

• Preferred place is the patient’s home, but venue is the patient’s choice
• Can be conducted by community pharmacists or accredited pharmacist

Pharmacist conducts Medication Management Review

• Must be conducted by an accredited pharmacist
• Using all the available information such as the patient interview, the information from the GP and  the dispensed medication history

Pharmacist reports to GP

• Verbal and written report 

GP consultative management plan for patient – claim item 900

• Done in consultation with the patient, can lead to a new GP Management Plan or Team Care Arrangement

GP sends management plan to pharmacy

• And offers a copy to the patient

Consumers

‘How to get HMR’ - Cartoon
HMR information – English
HMR information – Chinese
HMR information – Vietnamese
HMR information –  Arabic
HMR information –  Italian
HMR information – Greek

Important links:

Medicare Australia – Home Medicines Review
Medicare Benefits Schedule - Note A39
The Pharmacy Guild of Australia – Medication Management Review Program
The Australian Association of Consultant Pharmacy
The Pharmaceutical Society of Australia

Frequently Asked Questions

• What is the MBS Item number for HMR?
  Item 900
• When should the Item 900 be claimed?
  The claim MUST be done after completing the management plan on the second visit with the patient.
• Can a normal consultation item (Item 23) be claimed in addition to Item 900?
  No.
• Can a patient on less than 5 medicines have a HMR?
  YES. Please refer to the GP resources – 4: Eligibility criteria.
• Can HMR be done more than once in a 12month period?
  YES, but there should be a significant change in their condition or medication regimen, like recent discharge from hospital or diagnosed with a new medical condition. Also, the reason must be annotated on the Medicare slip.
• Which pharmacy do I need to send the HMR referral to?
  Usually the patient’s preferred community pharmacy.
• What to do if the patient is not willing to have the HMR interview at home?
  It is preferred but not mandatory to have the interview at home. The place of interview can be negotiated between the patient and the pharmacy.
• How long will it take to receive the HMR report from the pharmacy?
  It is a requirement for the pharmacy to send the report within 4 weeks of receipt of the HMR referral. The pharmacy need to notify the GP in case of any unexpected delays. Please contact the Facilitators at CSGPN for any follow-up.
• How to know whether the patient had a HMR by another GP within 12 months?
  Currently there is no provision for the GP to find this information from Medicare. In doubt, you may ask the patient to contact Medicare and check this information for you.
• What to do when the HMR report is not up to your expectation?
  Usually the MR accredited pharmacists address all the issues raised by the GP and patient. Should you have any concerns about the report, please discuss it with the pharmacist. Still not convinced, please contact the HMR Facilitators at CSGPN.