Pharmacy
Summary of public submissions in response to the paper ‘Implementation of a hospital referral pathway to enable urgent Home Medicines Reviews (HMR)'
PDF printable version to the Summary of public submissions in response to the paper ‘Implementation of a hospital referral pathway to enable urgent Home Medicines Reviews (HMR)' (PDF 23 KB)
This document provides a summary of the 75 responses that were provided in the recent public consultation process for a proposed hospital referral pathway for the Home Medicines Review program. In general, responses came from individual pharmacists, hospitals, pharmacy organisations, medical organisations, consumer organisations, indigenous health organisations, peak bodies and individuals.
Please note that while not all suggestions received on the hospital referral pathway have been directly reflected, they will be considered in shaping the proposed pathway. There were a range of other suggestions made which were outside the scope of the current consultation, however these may be considered in the context of longer-term policy planning. A summary of the responses is provided below.
1. Suggested patient eligibility criteria
The questions raised in the paper regarding patient eligibility criteria were an area of focus for the majority of submissions. A large number of suggestions were made about specific criteria that could be used for determining whether a hospital referral should be made. Conversely several submissions suggested that the criteria should be that of the existing community-based HMR service, with the addition that a medically-led team within the hospital consider a referral is needed. Opinions were divided between those organisations and individuals that considered the proposed criteria were overly restrictive, and those that considered the proposed criteria appropriate.It should be noted that the intention of developing a hospital referral pathway for HMRs is not to expand the existing HMR service where other services may be more appropriate. Rather, the aim is to improve timely access for patients in the immediate post-discharge period. Limitations of existing resources, including funding, must also be considered.
2. Timeframe for referral/completion
Submissions providing suggestions about the timeframe for hospital referrals to be completed did not consistently identify particular timeframes for completing parts of the referral and HMR service within the suggested 10 day period. In general the submissions suggested that the pharmacist component of the HMR service (the interview of the patient, and subsequent report to the GP) should be completed within 10 days. The creation of the GP management plan within a short timeframe was considered less of a concern, with the reasoning given that this part of the service is more about ongoing management of the medication issue, rather than dealing with the clinical circumstances that require an urgent referral.Most respondents agreed that the hospital should be responsible for the timeframe being met.
3. Coordination
Several themes were apparent in suggestions relating to how the referral and HMR service should be coordinated. The majority of respondents indicated that the referral should come from a medically led team, although some respondents advised this should be flexible in rural and remote areas to account for differences in the staff available in such areas. Similarly, the majority of respondents advised that the HMR interview report should be provided to all involved (the hospital, community pharmacy if appropriate, and the GP).Many submissions noted that the use of standard tools and processes, including a personally controlled E-health record, would assist in simplifying the process. Some submissions called for a re-establishment of the local HMR facilitator role, or for funding of a similar facilitator role within hospitals.
Medico-legal responsibility for the service was considered in several responses. In general it was considered that the GP should be responsible for the overall and ongoing care of the patient. The question of who is medico-legally responsible for the patient’s care remains to be considered in the context of the system set up to allow hospital referrals for HMR.
4. GP involvement
There were limited numbers of submissions responding to the questions about GP involvement in a HMR hospital referral. Some suggested that GP involvement in the referral should be mandatory, whilst others indicated that involving a GP in a decision to refer would not be practical, particularly in rural and remote area hospitals where the patient’s GP may not be contactable or the patient may have no usual GP.5. Patient characteristics
There were many different suggestions for patient characteristics and populations that would benefit or pose particular challenges in terms of referral and follow-up post HMR, some of which mirrored the suggested patient characteristics provided in the consultation paper. A few examples are provided below:- Patients who are homeless or itinerant;
- Patients who are cognitively impaired;
- Patients who have difficulties speaking, reading and writing English;
- Patients who are frail due to illness or ageing; and
- Patients with mental illness.
6. Pharmacy involvement
Submissions received that discussed pharmacy involvement generally supported keeping the community pharmacy in the loop with information regarding the referral and/or report.7. Hospital settings
Several submissions suggested that there should be flexibility built into how the hospital referral pathway caters for different hospitals and settings.The majority of comments received in relation to hospital settings suggested that hospitals, and hospital pharmacists, should be involved in not only the referral, but the provision of the service.
However there was not universal support for hospital pharmacists being able to provide HMR services.
It should be noted that as part of the National Health Reform Agreement (NHRA), the Commonwealth and State and Territory governments have agreed that the Commonwealth will not fund patient services if the same service, or any part of the service, is funded through a program managed under the NHRA or any other Commonwealth program. Consideration of the above suggestion made by a number of stakeholders will need to be made in light of the NHRA.
8. Training and support
A number of suggestions were made as to how training could be provided on a new HMR hospital referral pathway. These included putting information on various web sites, leveraging off existing training sources, having new training packages developed by peak bodies, or that hospitals develop their own training. There was also suggestion that a strong communication/promotional campaign be developed to raise awareness of the new pathway.9. Evaluation
The majority of submissions received supported either a 1-2 year evaluation period, or ongoing evaluation. Some examples of suggestions for data to be collected included:- The number of referrals made;
- Timeframe for completion of the service;
- Patient experiences/feedback;
- Readmission rates to hospital; and/or
- Compliance rate with taking medicines post-HMR.
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