When fire brigade officer Colin O’Rourke left hospital after a heart procedure, he ended up on 32 different medications.
Not all of them agreed with him.
“When I got home, I felt that the meds were having adverse side effects … I was suffering from nausea and vomiting,” he said.
“I ended up back in [hospital] and spent the night there.”
But in consultation with his GP, Mr O’Rourke was offered a home medicines review — a program in which pharmacists check and consolidate medicines.
“Through those conversations and reviews with the pharmacist and other health professionals … [I’ve] reduced the number of medications by more than half,” he said.
“Almost immediately I started to feel well.”
Mr O’Rourke is not alone in having issues with medications.
About 250,000 Australians are admitted to hospital each year as a result of medication-related problems — including errors, inappropriate use, misadventure and interactions — according to a report published in 2019 by the Pharmaceutical Society of Australia (PSA).
An additional 400,000 annual presentations to emergency departments are likely due to medication-related problems.
The report also found that more than 95 per cent of people living in aged care facilities had at least one problem with their medicines detected at the time of a medicines review, but most had three problems.
Now pharmacists are calling for the government to increase funding to the lifesaving scheme so more Australians can access it.
What is a home medicine review?
Home medicine reviews are Medicare-subsidised home visits from a pharmacist that are arranged by a doctor to monitor and evaluate medication intakes, and note any conflicting prescriptions or over-the-counter products.
There are also equivalent schemes for people in aged care, called the Residential Medication Management Review, and Quality Use of Medicines.
In these reviews, a pharmacist visits a patient in their home to assess the current medications they are taking, educate the patient about side effects, and reduce the likelihood of adverse medical events coming from contraindications on medication.
They then advise a GP about potential medicines that can be cut back, changed or combined that may produce a better outcome for the patient.
About 100,000 home medicine reviews are conducted within Australia each year, with another 100,000 reviews within aged care homes.
Pharmacists who are part of the Home Medicines Review Program say that they are always overbooked. (Getty Images: Svitlana Romadina)
Rural consultant pharmacist Deborah Hawthorne said longer face-to face visits allowed a pharmacist to unpack more than a regular GP had time for.
“I go into someone’s home, and I’m trying to be the medicine detective and figure it all out,” she said.
“Is [that medicine] contributing to their falls? Is it contributing to their cognition? Is it contributing to the lack of sleep or pain?”
Currently, organising a home medicine review can take months, particularly in regional and rural areas, which Ms Hawthorne said was partially due to a cap on the number of visits allowed per month.
Pharmacists are only allowed to see 30 patients through the program each month, meaning once the cap is hit, they cannot bill Medicare for any more reviews that month, regardless of how many patients may be waiting.
“In a rural area … there’s just not as many feet on the ground. I have recently trained up another two pharmacists in my area and they’re full already,” Ms Hawthorne said.
She said there was appetite in her region for more visits, and she could easily do them if Medicare allowed.
“I [currently] have about 40 or 50 medication reviews sitting in my inbox waiting to be actioned, but I’ve already done 30 this month,” she said.
“The need is there, but we’ve been blocked in providing that need.”
Anyone with a valid Medicare card can request a referral for a home medicine review from their general practitioner or specialist.
Why are there caps on reviews?
The program was launched in 2001 and rolled out in a bid to optimise medication management.
Caps were introduced in 2014 limiting pharmacists to 20 Medicare-subsidised visits per month, although in 2020 it was raised to 30.
Pharmacist Amy Page is an associate professor at the University of Western Australia who studies minimising medicine-related harm.
Dr Page said caps were implemented as a response to expectations that budgets were going to be higher than anticipated, and some pharmacists were booking large numbers of reviews.
“Instead of reviewing what was happening with those particular individuals, like what happened with any other program funded through Medicare, the response was to put a cap in place for all service providers,” she said.
“This has led to a situation where it’s really hard to be able to provide this service to the people who need it most.“
The caps are a limit for both the provider (pharmacy) and the pharmacist under the scheme.
A spokesperson from the Department of Health told the ABC the caps were designed to ensure sustainability of the program.
“The monthly cap on HMRs [home medicine reviews] is in place to help ensure the program remains sustainable, high quality and accessible for patients who need it most,” the spokesperson said.
“The cap helps manage program demand and funding while supporting safe, effective delivery of HMRs. It is designed to ensure reviews are conducted where they are clinically appropriate and that credentialed pharmacists have the capacity to deliver thorough, patient‑centred services.”
Patients sometimes end up on dozens of different medications. Unpacking how they relate to each other can be an intensive process. (Getty Images: The Good Brigade)
Medicare rebates for home medicine reviews have also been frozen for almost a decade, limiting the chargeable amount to $222.77.
“I’m still getting paid exactly what I was getting paid in 2019,” Ms Hawthorne said.
The Pharmaceutical Society of Australia (PSA) is appealing to the government ahead of the federal budget to lift monthly caps to enable pharmacists to increase visits under the scheme, and allow indexation on the Medicare rebates.
PSA interim chief executive Bridget Totterman said removing the cap would help expedite critical care and reduce hospital visits for high-risk patients.
“An immediate benefit of uncapping Home Medicines Reviews would be that high-risk patients are seen more quickly, usually within days, avoiding more hospitalisations,” she said.
“[The reviews] help fix problems patients have with medicines before they end up causing hospitalisation or death.”
Not a replacement for GP
Dr Page said the reviews were not a substitute for a general practitioner.
“Often the GP will review the medications first before they refer to the pharmacist,” she said.
The Royal Australian College of General Practitioners (RACGP) said home medicine reviews were “an important tool for promoting a model of patient-centred care”.
Bradley Butt, the pharmacist who worked with Mr O’Rourke to check his medications, said GPs and pharmacists needed to work together to make sure they had the patient’s best interests at heart.
“Sometimes in medicine, we can be a bit of a one-size-fits-all approach and we just sort of go down this treatment regime because that’s what we’ve always done for everybody,” he said.
“But when you’re on 32 medications … it’s not just how the medications react with one another, it’s how they react with you.
“If we are capped, someone misses out and the whole premise of the Australian healthcare system is that it should be fair and equitable.“
