HOME MEDICATION REVIEW (HMR)

Presented By:MOHD AZREEN BIN MUSTAPA

PRP 2009/2010 Session21/12/2009

Common Issues:

Patients come to doctor’s appointment with progressing complication of the disease.Patient has repeated admission to hospital due to disease progressionWhat happened with medication that we dispensed?No respond towards the drug?Geriatrics with multiple medication.Most of the patients actually don’t understand how to take their medication correctly as prescribed.

HOME MEDICATION REVIEW…

Will it be the best solution???

OVERVIEW

Definition The need for HMRHMR in Australia & MalaysiaConcept – objectives, assessment parameters, work-flowBenefitsIssues to be highlighted Conclusion References

Definition

HMR = a service designed to assist consumers living at home to maximise the benefit of their medication regimen & prevent medication related problems

A.k.a. domiciliary medication management review (DMMR) / domiciliary service

The need for HMR

Increasing number of prescription drug consumersMultiple medication & complex drug schedulesPolypharmacy Use of complementary medicinesCompliance issuesPotential for adverse drug events

Counseling at home

HMR in Australia & MalaysiaIn Australia:

Started on Oct 1, 2001Funded by Commonwealth GovCollaborative medication team approachSupport for implementation:

Infrastructure support – local facilitators Professional organisation supportContinuing professional education Liaison with gov.On-going multidisciplinary approach Evaluation of programmeAccreditation & education

Australian model for HMR:

1. Identify patient2. GP refers to patient’s preferred

community pharmacy3. Pharmacist visits patient at home &

review their medication4. Pharmacist provides GP with an HMR

report5. GP & patient agree on medication

management plan

Pilot projects in Malaysia:

Kedah (2004)Selangor (2005) – 4 KK, 25 patients recruited Negeri Sembilan (2006)Melaka (2006)

Patient selection:

By doctor & then referred to pharmacistPt have problems with med compliance

Have >1 chronic disease, being prescribed with ≥5 medications for maintenance therapyGeriatric with chronic disease with no caregiverPsychiatricPoor technique of medical aid device despite counseling

Concept

Main objective = to improve the outcome of pharmacotherapy by HMR conducted by pharmacist

Specific objectives:

1. To increase – patient’s adherence to medication and patient’s knowledge on medication

2. To identify – factors affecting non-compliance & DRP

3. To review – patient’s method of managing their medication at home

4. To reduce – wastage (d/t over-stoking of medicine)

5. To improve – patient’s Quality of Life

Medication Being Stored At Home

Unused Medication

Assessment Parameters:Medication knowledgeMedication complianceLaboratory indices

Blood Glucose Level (FBS, RBS / 2HPP)Urine proteinSerum CreatinineBlood pressure (BP)Lipid profile (Kolesterol & TG)BMI (Body Mass Index)

Quality of LifeStorage of medication at home.Cost saving (unused medication)Intervention done

Flow ChartRefer to

Pharmacist

Dispensing & Counseling

Recording

MO

Pharmacist

Pharmacist

Recruiting Patient

HMR 1/07

HMR 2/07

Remind Patient : Phone

Visit Patient’s Home

Record all information HMR 3/07

Assess storage of medication at home Counseling

Unsatisfied

Satisfied

Record findings

Send report to DoctorMemo HMR

Pharmacist

Pharmacist

Pharmacist

Pharmacist

Pharmacist

Home Visit

Pharmacist

HMR Form 1

Tarikh

Nama TelDiagnosis Merokok Pengambilan Alkohol Umur Ya : btg/hari Ya :Berat Tidak TidakTinggi Ubat Bukan PreskripsiBangsa Ya Tidak Ya TidakJantina Catatan : Catatan :PekerjaanTahap PendidikanTidak Sek :Sek. Ren : Lupa ambil ubat

Sek. Men : Lain-lain, sila nyatakan

Uni/Kolej :Catatan :

SendiriBantuanNyatakan

Tarikh Mula DosTarikh Ubah

Dos DosTarikh

BerhentiTarikh Mula

Semula Dos

HMR 1/07 HOME MEDICATION REVIEW

BAHAGIAN PERKHIDMATAN FARMASI KEMENTERIAN KESIHATAN MALAYSIA

No Rujukan Pesakit

:::

: :

::

::

Kesan Adverse Ubat

Sejarah Pengubatan :

Ubat

*Isi borang ADR & kepilkan salinanJangkamasa menghidap penyakit

Sebab-sebab Ubat Diberhentikan :Sebab-sebab BerhentiUbat

( ) Ya ( ) Tidak

Mengambil ubat

Pernahkah mendapat kaunseling dari pegaw ai farmasi?

Faktor Ketidakpatuhan Ubat

::

HMR Form 2

Tarikh

2. Parameter Dikaji

Dos (D) Selang masa (F)

Indikasi ( I )Cara

Pengambilan (T)

Skor Parameter BacaanJulat /

Bacaan Normal

TarikhFBSRBS (P2)HbA1cUrine AlbSr CrClBPPulseTCTG

Ya (0) Tidak (1) Skor

Tandakan √

Kuantiti Perlu diambil (A)

Lebihan Didispen (B)

Baki Didapati (c)

Perbezaan (D=C - B)

(A-D)/A %

Baik (DFIT = 100%)

Baik (>11markah MAS)Tidak (<11markah MAS)Baik (> 80%)Tidak (< 80%)

Nota Peg FarmasiKefahaman DFIT pesak it

Lain-Lain :

3. Kajiselidik Kepatuhan Ubat Pesakit (Medication Adherence Scale 'MAS')* Betul : 1 Salah : 0 [Jumlah (%)]

8)Kesukaran mengingat cara pengambilan ubat (rawatan)

1)Pernahkah anda lupa mengambil ubat anda ?2)Dalam tempoh 2 minggu kebelakangan ini, pernahkah anda terlupa mengambil ubat?3)Pernahkan anda mengurangkan dos anda sendiri tanpa pengetahuan doktor ?4)Pernahkah anda terlupa membawa ubat anda semasa anda pergi bercuti ?

No Ruj Pesakit HOME MEDICATION REVIEW

BAHAGIAN PERKHIDMATAN FARMASI KEMENTERIAN KESIHATAN MALAYSIA

HMR 2/07

Ubat-ubatan

1. Kajiselidik Kefahaman Pesakit *

4. Kajiselidik Kepatuhan Ubat Pesakit (Pill Count)Catatan

Ubat-ubatan

(Skor 11-12 Patuh pada rawatan ubat ; Skor 1-10 Tidak patuh pada rawatan ubat) JUMLAH SKOR

c) Kadang-kala (3 markah) cth : tertidur / melengahkan dll d) Selalu (2 markah) cth : nyanyuk / berkaitan penyakit kognitif dll

a) Tidak pernah / jarang sekali (5 markah)

e) Tidak mengambil ubat (1 markah) cth : kerana tidak boleh toleransi kesan samping

b) Ada masa-masa tertentu (4 markah) cth : kenduri / ke rumah anak dll

5)Adakah anda mengambil ubat anda semalam ?6)Pernahkah anda berhenti pengambilan ubat apabila anda rasa anda telah sihat ?7)Pernahkah anda rasa rawatan ini menyusahkan ?

Cadangan Intervensi PengubatanPiawai Kepatuhan Ubat adalah > 80%

Tidak (DFIT < 100%)

Kepatuhan Ubat Pesak it

HMR Form 3

Kuantiti Kos

Kuantiti Kuantiti

No Rujukan Pesakit

MASA BERAKHIR LAWATAN OLEH

HMR 3/07BORANG HOME MEDICATION REVIEW

BAHAGIAN PERKHIDMATAN FARMASI KEMENTERIAN KESIHATAN MALAYSIA

Makan Tengahari

Informasi Diet

Minum pagi

Jenis

Makan Malam :

Aktiviti Harian

‘Medication Box’

Overstocking

Minuman

Cahaya (L)Kelembapan

dan Haba (M )

2. INFORMASI DIET DAN AKTIVITI HARIAN

1. CARA SIMPANAN UBAT-UBATANBekas kedap udara/ tertutup

Nama (N)Tarikh

Luput (E)

Simpan jauh daripadaKanak-kanak ( C )

Nama ubat

Jumlah skor

Bil

Label Ubat

TARIKH LAWATAN MASA MULA

Minum Malam :

Sarapan:

1. Adakah ubat yang anda simpan mempunyai label 'nama ubat' ? 2. Adakah ubat yang anda simpan mempunyai label tarikh luput? 3. Adakah ubat yang anda simpan dijauhkan dari kanak-kanak? 4. Adakah ubat yang anda simpan dijauhkan dari cahaya? 5. Adakah ubat y

Jenis

Minum petang :

Makanan

CATATAN (Jika ada)

Suggested HMR Schedule

Month Activities1st Month Patient referred to Pharmacist

2nd Month 1st Visit

3rd Month Doctor appointment

4th Month Part supply medication

5th Month Doctor appointment

6th Month 2nd Visit

7th Month Doctor appointment

8th Month Part supply medication

BenefitsTo pharmacists

Expand professional service – new image of pharmacy serviceBetter intervention

To patientsImprove knowledge (Dosage, Frequency, Indication, Time) & complianceReduce unscheduled appointment & repeated admission to A&EIncrease pt empowerment in managing their disease at home & improve QoL

To government Cost-saving – reduce wastage of unused medicinesImproved perception towards Pharmacy Dept. services

Cost saving data based on unused medication at home (Selangor data : 20 patient), 2007

Patient RM6 322.414 449.87

PKD Petaling 4 33.204 198.402 79.30

20 1083.18PKD Sepang

Total

PKDPKD Kuala LangatPKD Klang

PKD Sabak Bernam

PKD Patients RM

Total

Issues to be highlighted

Complicated / multiple medication regimeComplementary vs. conventional medicinesFunding matters, financial rewardsPrescribing behaviorCooperation from other HC professionalsTraining & postMulti-centre study – evaluation on HMR delivery, lack of dataSOP

Conclusion

The scope of pharmacy is evolvingGet ready for the next momentum –establishment of rural pharmaceutical care (RPC)Other countries have been benefiting from HMR – Malaysia is the next!

Prof. Patrick Ball, Chair of Rural Pharmacy Dept at Charles Sturt University:

"Nobody in Australia is in a position to say we are spending X dollars a year funding Home Medicines Review but it is saving X dollars a year on the Pharmaceutical Benefits Scheme because patients are taking their medications more effectively, fewer patients are being hospitalized and fewer patients are having operations as a result of not taking their medications““…whatever Australians currently spend on antihypertensive, something like 80 or 90 per cent of that might as well just go down the drain because if patients are not achieving a degree of blood pressure control then we are not getting the full benefits,"

References 2 Health Programmes Showing Results, New Straits Time, 5/08/09Mohd Dziehan Mustapa, Home Medication Review, CPA-MPS Conference 2007, Medication Review Symposium, 4/08/07 Tim Chen, The Australian Model for Home Medicines Review, CPA-MPS Conference 2007.www.pharmacynews.com.au

Medication Management in Review: Gathering Momentum, The Australian Journal of Pharmacy, Vol. 22, April 2003Medication Management in Review: HMR Features Widely in Recent Research & Development, The Australian Journal of Pharmacy, Vol. 87, June 2006

Thank you for your attention! ☺

Questions?Comments?