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?