Published by Computachem Services

P.O Box 297.
Alstonville. 2477
NSW Australia

Phone:
61 2 66285138

Working in an inner city Division of General Practice with over 60% of the GP practices being single Dr practices supported by a receptionist, many having been so for many years and now part of the establishment poses some interesting challenges when it comes to suggesting new innovations.
The MBS item number 900, the DMMR (HMR if you like) is posing one of the challenges I mentioned.
In GP land there seems to be three streams of reaction to a medication management review for their patient conducted in the home to date (early days).

There is the group that have taken to it enthusiastically and I have had many reports from pharmacists rising to the challenge of registration and then using the services of an 'accredited pharmacist' as they cope with the increasing stream of referrals from the local GP.
By and large these have been worthy activities with happy customers/patients.
There have been a few comments from GPs that suggested some pharmacists may have stepped beyond the task and offered comments to the patient that when relayed back to the GP was negative for the process.
Hopefully these have been addressed discretely and the GP is still happy to order HMR's.
The GPs who are referring multiple patients at this early stage are the converted and I hope they will remain so.
There is a second group who has responded positively being more selective with the patients.
Usually these are the very difficult cases and the reviews have been quite challenging for the pharmacist. Some innovative solutions have been suggested and much duplication of medicines picked up.
Often these involve patients for whom English is not the first language and as they are older, English is not usually spoken or understood well.
It has been useful to take along a pharmacy assistant who speaks the language of the patient as an interpreter and often this is possible, as the patient has selected the pharmacy on these grounds.
The third group is the GPs who as yet do not see the need for this service for their patients believing, as they always have been, that they are everything to the patient.
In many instances they are not placed near a pharmacy and do not have a working relationship with a local pharmacist.
This is not really a concern yet as educational activities relating to the DMMR are planned in the Division and as the service becomes more well known, and GPs talk amongst themselves, many not yet converted will recognise an opportunity to refer a patient.
Changing the culture with this great opportunity for using pharmacists' expertise is a challenge.
It is a challenge for the GPs also who must give over a bit of their autonomy with the patient to another professional who in more instances than not they do not know well.
They often do not understand a pharmacist expertise.
The HMR process has the potential to change this.
It is a challenge for the pharmacists also as they put their expertise on the line and work in partnership with GPs for the patient's well being in a new innovative way with accountability.
Following the HMR ideally will be the monitoring and a two-way dialogue on behalf of the patient into the future.
Isn't this what pharmacy is really about?