Couzos, S., Smith, D., Buttner, P., and Biros, E. (2020) Assessment of Home Medicines Review (HMR) and non-HMR in Aboriginal and Torres Strait Islander patients with chronic disease receiving integrated pharmacist support within Aboriginal Community -Controlled Health Services (IPAC Project). External Commissioned Report. Australian Government, Canberra, ACT, Australia.

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Abstract

Objective: To assess the effect of integrated pharmacist interventions on utilisation of Home Medicine Reviews (HMR, MBS item 900) and medication reviews not fully meeting HMR criteria (non-HMR) in Aboriginal and Torres Strait Islander adults with chronic disease attending Aboriginal Community Controlled Health Services (ACCHSs) enrolled in the IPAC study, compared with usual care.

Design and participants: Consented participants enrolled in a non-randomised, prospective, pre and post quasi-experimental community-based, participatory, and pragmatic study that integrated a registered pharmacist within ACCHS in Qld, NT and Vic. The intervention comprised non-dispensing medicines-related services, collaborative and coordinated care, including the provision of medication management reviews. Deidentified participant data was electronically extracted from health records including claims for Medicare Benefits Schedule (MBS) item 900 (HMR). Pharmacists electronically logged HMR, non-HMRs and descriptive data. Medication related problems (MRPs) were defined mostly by Medication Appropriateness Index criteria.

Outcome measures: Number and proportion of participants with at least one HMR over a 12-month pre-intervention period representing usual care compared to post-intervention at the end of the study; number and proportion of non-HMRs; reasons for reviews and follow-up reviews, and their characteristics including the prevalence of MRP and proportion of participants with MRPs by type of review.

Results: Participants (n=1,456) from 18 ACCHSs involving 26 integrated pharmacists had a 3.9 times (p<0.001) significant increase in HMR access (based on MBS claims) compared with usual care whilst the number of HMRs (MBS claims) increased 4.1 times (p<0,001). There were 609 (41.8%) HMR, and 719 (49.4%) non-HMR recipients after a mean of 284 days (SD ±11.5) following study enrolment. HMR recipients had a mean age was 58.7 years (SD ±21.9), a mean of 8 prescribed medications each, and 89% had comorbidity. The vast majority of HMR and non-HMR recipients were Aboriginal and/or Torres Strait Islander. Almost all HMRs were undertaken by IPAC pharmacists. A HMR or non-HMR was most commonly indicated for participants taking 5 or more regular medications (78% and 66%, p=0.037) and/or suspected non-adherence (38% and 43%, p=0.364 respectively) The median time for completing a non-HMR was 1 hour 15 mins (30 mins less than an HMR). Of non-HMRs, 91% (n=689) were conducted within the ACCHS; whilst most recipients were from remote (19.8%) or very remote ACCHSs (21.4%); and had the non-HMR commonly completed for opportunistic reasons being at risk of forgoing a HMR [48.1% (n=364)]. Limited access to an accredited pharmacist (30.6%), and patient preference (14.1%) were also reasons for a non-HMR. Pharmacists delivered 1,548 follow-up assessments to HMR or non-HMR- recipients (median time to assess was 30 mins). Of HMR recipients, 87.9% (n=535) compared with 70.0% (n=503) of non-HMR recipients had at least one MRP (p=0.035). Non-HMR eligibility criteria, participant need for a medication review, pharmacist recommendations, and identified types of MRPs in recipients were similar to a HMR.

Conclusion: Within ACCHS, integrated pharmacists significantly increased access to medication management reviews (HMR and non-HMR), and follow-up to these reviews for Aboriginal and Torres Strait Islander adults with chronic disease. Pharmacists needed to assess only 5 participants for one to receive an HMR. Pharmacists integrated within ACCHSs are well placed to deliver medication management reviews to patients who experience barriers in accessing HMRs under current program rules, especially for patients who would otherwise forgo a medication review. Generalisability of the outcomes observed from the integrated pharmacist intervention to the broader ACCHS adult patient population with chronic disease who are at risk of developing medication related problems, is supported.

Item ID:	87222
Item Type:	Report (External Commissioned Report)
Keywords:	Home Medicines Review, medication review, Medicare, chronic disease, medication adherence, Aboriginal, Torres Strait Islander, Primary health care, pharmacy, pharmacists, chronic disease, diabetes,
Additional Information:	Report to the Pharmaceutical Society of Australia for the IPAC Project. This report is publicly available at the following website: https://www.health.gov.au/resources/publications/integrating-practice-pharmacists-into-aboriginal-community-controlled-health-services-final-report
Funders:	Australian Government Department of Health & Ageing
Projects and Grants:	Pharmacy Trials Program
Date Deposited:	03 Oct 2025 03:52
FoR Codes:	42 HEALTH SCIENCES > 4203 Health services and systems > 420319 Primary health care @ 50% 32 BIOMEDICAL AND CLINICAL SCIENCES > 3214 Pharmacology and pharmaceutical sciences > 321403 Clinical pharmacy and pharmacy practice @ 50%
SEO Codes:	20 HEALTH > 2001 Clinical health > 200102 Efficacy of medications @ 50% 20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 50%
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