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Australian Journal of Pharmacy : April 2005
Pharmacist identifies patient with moderate to severe asthma without a written asthma action plan GP identifies patient with moderate to severe asthma Referral to GP HMR referral sent to community pharmacy of the patient’s choice HMR visit conducted by pharmacist. Review of technique, concordance, development of written asthma management plan Patient consent to undertake HMR obtained and documented in notes Planned 2nd visit. Review of HMR report, and confirmation of asthma management plan. Discussion with pharmacist for HMR, email, phone, case confernce Planned 3rd visit. Review of asthma management plan Figure One: Integrating HMRs into the Asthma 3+ Plan than any problem with the HMR process. In fact, as a result of the practice visits and evening there have been more than 25 HMRs conducted in the area since the consultant pharmacist encouraged their uptake. There is a key role for consultant phar- macists to improve the uptake of HMRs by acting as a conduit between pharma- cies and GPs. Consultant pharmacists are in an ideal position to establish an agree- ment with community pharmacies to pro- vide medication review services on their behalf. This agreement should also state that the consultant pharmacist will visit the local general practices to discuss and promote HMRs. This is a ‘win-win’ for community pharmacists and for the con- sultant pharmacist. We need to be aware that there is a viable revenue stream avail- able through medication reviews and the only way that this can happen is for con- sultant and community pharmacists to work together. The consultant pharmacist is the ideal person to open communication channels between GPs and pharmacists. These channels are sometimes non-existent due SIP payment to the professional isolation of the two professions. The consultant pharmacist can visit a GP and discuss the process (the community pharmacist may not always be able to do this) and can ask ‘what do you want me to focus on as part of my review?’. The consultant pharmacist can also explain that the role of an HMR is multifaceted, covering compliance, pre- scribing and social issues. The consultant pharmacist can discuss with the GP the preferred format of the reports, so that the generation of a management plan for the patient is time efficient for the GP. Community pharmacists can be actively involved in the process by refer- ring patients to GPs to discuss HMRs, knowing that they have a consultant phar- macist who will conduct these in a timely and time-efficient manner. They can also see that there is another source of income for their practice. Dependent on the agreement that is negotiated with the consultant pharma- cist, the community pharmacist may expect between 10 and 20 per cent of the total remuneration for HMRs to come back to the community pharmacy; a rea- Standard Medicare item HMR item 900 Standard Medicare item sonable return for providing a service that can have immeasurable benefits. In conclusion, we believe that it should be emphasised, both during and following the training for accreditation, that the consultant pharmacist’s role should not only be the competent performance of HMRs, but also extend to the promotion of medication reviews. There must be an element of selling ourselves if the scheme is to be sustainable and fully achieve the beneficial outcomes for society that the government envisaged. *Gregory Peterson (Professor of Pharmacy) and Dr Shane Jackson (National Institute of Clinical Studies Postdoctoral Fellow), Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania. Professor Peterson and Dr Jackson are also community pharmacists. 1. Peterson GM. The future is now: the importance of medication review. Aust Pharmacist 2002; 21: 268–75. 2. Runciman WB, Roughead EE, Semple SJ, Adams RJ. Adverse drug events and medication errors in Australia. Int J Qual Health Care 2003; 15 Suppl 1: i49–59. 3. Australian Council for Safety and Quality in Health Care. Second National Report on Patient Safety.Improving Medication Safety.Canberra: July 2002 (The full text of this report is available on line at www.safetyandquality.org/articles/Publications/ med_saf_rept.pdf) 4. Peterson GM, Jackson SL. When medication misadventure results in patient harm: too many holes in the cheese. Aust Pharmacist 2004; 23: 782–7. 5. Peterson GM. Continuing evidence of inappro- priate medication usage in the elderly. Aust Phar- macist 2004; 23: 533–5. ¦ The AJP thanks the Pharmacy Guild of Australia for its support in the development of this column THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 APRIL 2005 ? 247