Home > For Consumers > Health products and medicines > Medicines > Pharmacy

Pharmacy

Summary of outcomes from the Home Medicines Review Hospital Referral Pathway workshop

A summary of the key discussion points that were covered during the Home Medicines Review Hospital Referral Pathway workshop held on 29 June 2012 in Canberra.

PDF printable version of the Summary of outcomes from the Home Medicines Review Hospital Referral Pathway workshop (PDF 301 KB)

This document provides a summary of the key discussion points that were covered during the workshop held on 29 June 2012 in Canberra. In attendance were representatives from pharmacy, general practice and medical specialties, nursing, State and Federal Governments, public and private hospitals, and members of the Program Reference Group.

The workshop proved to be productive with participants demonstrating a positive and collaborative approach to finding points of convergence on critical elements in the design of a practical referral model.

It should be noted that some of the matters raised during the workshop are not captured in this summary. Additionally, while there was a consensus view on some areas, this does not imply unanimous agreement.

A number of important issues were identified as requiring attention during the creation of a hospital referral pathway, with particular emphasis on patient care, timeliness of the referral and appropriate passage of information.

1. Consumer focus

Consumer safety and care was noted as the priority, and the pathway should cater for those patients who have a high risk of medicine misadventure within ten days of discharge. This should be formed by an evidence based approach to identify ‘urgent’ patients.

Additionally, the new pathway must remain consistent with requirements of the existing HMR referrals and service provision; the patient must provide informed consent and have improved knowledge of their medicine regime after the HMR.

2. Patient eligibility

The consensus was that existing HMR eligibility criteria should apply and include the additional requirement that in the clinical opinion of the hospital medical team, an urgent HMR is needed, after due consideration of all aspects of the patient’s circumstances. These may include the presence of high risk medical conditions or medications, social circumstances and cognitive ability. There was consensus on identified clinical indicators for an urgent referral, including heart failure, airways disease, diabetes, mental health conditions, cognitive impairment and warfarin use. Social indicators that were specified included individuals with low medicines knowledge or familiarity, those lacking appropriate social support, those with a history of difficulty taking their medicines and those with particular needs for an urgent HMR based on cultural factors.

3. Referral requirements

Despite the complexity of the hospital medical team and administrative systems, general agreement was reached that a doctor must be responsible for the referral and that the patient’s general practitioner must be notified of the referral. The specifics of the administrative process to achieve this will require further consideration by the Agreement Consultative Committee due to the wide variety of hospital environments and local community health care arrangements. Regional and remote hospitals may face particular challenges in accessing a doctor to authorise referrals and the model should contain sufficient flexibility to allow for those circumstances. While not necessarily preferred by all participants, a customisable form for referral containing a minimum set of fields was one tool mentioned that would help to ensure consistency of approach and data collection while maintaining flexibility to accommodate local needs.

Unanimous agreement was reached that the timeliness of the referral was paramount to the effectiveness of the HMR in preventing misadventure. While some hospital discharge processes may allow for a referral to be incorporated and executed within a suitable time frame, other hospitals may require a distinct administrative process to enable an HMR to be conducted within ten days of discharge.

An additional issue that was discussed was that a hospital referral may require more comprehensive supporting information than is typically provided in current HMR referrals. The events of a hospital stay, and in particular the changes in medications, should be clearly identified in a post-discharge referral.

4. Medico-legal liability

It was noted that the additional stages of patient care in a hospital HMR continuum required further analysis of where medico-legal responsibility is transferred between providers. It was agreed that this matter is best followed up and resolved between the profession/s and medical insurance organisations.

5. Industry coordination

Surrounding the issue of liability was discussion regarding the availability of, and communication to, accredited service providers. Given the nature of a hospital referral as an ‘urgent’ HMR, there is a requirement that the service provider accepting the referral has the capacity to provide the HMR in a timely manner. This creates an expectation that hospitals would have an awareness of local providers that could accept urgent HMR referrals. There were suggestions from participants that lists of providers able and willing to provide urgent HMRs could be developed with the potential assistance of groups such as the Medicare Locals and the Australian Association of Consultant Pharmacy.

6. Other issues discussed

A number of other matters were discussed and noted during the course of the meeting, including:

• The need for local protocols to be developed to ensure that referrals happen and the appropriate care providers are included in the process;
• A need for education and awareness raising about the new referral pathway, once it is implemented;
• The need for rigorous evaluation to be undertaken to monitor and manage the success of the referral pathway; and
• The possibility of implementing a phased approach, using ‘early adopters’ and/or hospitals in rural and remote areas to pilot the new referral process.

7. Next steps

Outcomes of the workshop will be provided to the Agreement Consultative Committee for discussion, and the Committee will provide updates to the professions and State and Territory Health Departments as appropriate. Those interested in the progress of the referral pathway should contact the relevant peak organisation or State/Territory Health Department in the first instance.