Home medicines review at Kings Park Medical Centre

A person's hands extracting an antibiotic pill from a jar.
  15 February 2022  NWMPHN   

A home medicines review (HMR) is when an accredited pharmacist checks the medicines a patient is taking at home.

A HMR is an important tool for promoting a model of patient-centred care. An MBS item is available for patients living in a community setting.

We spoke with Diane Gargya, a credentialled diabetes educator and accredited pharmacist at Kings Park Medical Centre, about their team’s HMR quality improvement (QI) activity conducted in 2021.

A data driven QI project

The clinic’s team had long wanted to optimise its HMR process and developed a diabetes QI activity to work on this. Ms Gargya had been helping the practice to identify patients who can benefit from a HMR, with a particular focus on patients with diabetes. However – because the GPs and nurses involved are very knowledgeable about HMRs – the project team was able to identify and help many other patients.

The team used Pen CAT to identify patients who were on insulin with HbA1C > 8.0%, which automatically qualifies them for a HMR. Patients with diabetes who have high HbA1c despite being on insulin therapy have a very high risk of short- and long-term complications.

Ms Gargya said that while insulin therapy is challenging for all involved, especially the patient, a HMR has many potential benefits.

“[A HMR] is another opportunity to assist patients to optimise their medications, reduce potential side effects (such as hypo and hyperglycaemia, injection technique, correct dosing time and storage) and achieve their therapeutic goal,” said Ms Gargya.

Getting buy in from the clinical team

The project team held a project kick-off session to inform GPs and nurses about the practice’s new HMR referral criteria and get their buy in. Ms Gargya then worked closely with the nurses and GPs throughout the project, keeping them up to date with HMR delivery processes and requirements.

Doctors play an integral role in HMRs, according to Ms Gargya.

“They identify patients who need the service, those at risk of medication misadventure or [who] have a clinical need in managing their medications,” she said. Patients are also likely to be “more receptive when it’s their GP recommending the visit.”

Seeing the results

Diane Gargya.

After the target patients were identified and recalled for a GP consult, Ms Gargya or one of the team’s nurses scheduled a pharmacist home visit. HMRs were completed for 13 patients with type 2 diabetes during the project.

Feedback from everyone involved in the project has been overwhelmingly positive.

“Most of the patients were not aware of the HMR service and found it helped them understand and appreciate the role of their medications, said Ms Gargya.

“The nurses and doctors appreciate the insights from visiting patients in their home, how they are managing overall and significant information that comes about [but is not often] shared during a usual in-surgery visit.”

The project had many benefits for the practice team, who continued to enhance their approach to HMRs.

“Aside from polypharmacy, patients who were recently discharge from hospital, had recent changes to their medications, have sub-therapeutic response to therapy or use devices to assist with medications, have suspected side-effects, and possible issues with medication adherence are referred for a HMR,” said Ms Gargya.

HMRs also have considerable financial incentives for practices who can claim MBS item 900, which is $161.10 once the HMR report and a medication management plan are discussed and provided. This is in addition to remuneration (.pdf) available to approved service providers (pharmacists) for providing the initial HMR service and follow ups, if required.*

QI tips for other practices

Ms Gargya said that allocating protected time for the entire clinical team to meet and collaborate has been “the main key” to the success of the practice’s QI projects. In this case, the allocated time allowed pharmacists to help doctors better understand the HMR process and address specific patient concerns.

The practice has since continued the activity and expanded it to include more criteria. Ms Gargya said that involving and collaborating with the whole practice team is the guiding principle for quality improvement.

“Take advantage of the skills of all the other healthcare providers you have access to and collaborate in providing patient care,” she said.


For inspiration on your practice’s next QI project refer to:

NWMPHN provides this information as a guide only and recommends general practitioners familiarise themselves with the detailed descriptions contained in the MBS, available at mbsonline.gov.au. Under the Health Insurance Act 1973 practitioners are legally responsible for services billed to Medicare under their Medicare provider number or in their name.