HOME MEDICATION REVIEW (HMR) Presented By: MOHD AZREEN BIN MUSTAPA PRP 2009/2010 Session 21/12/2009

Common Issues: Patients come to doctor’s appointment with progressing complication of the disease. Patient has repeated admission to hospital due to disease progression What happened with medication that we dispensed?No respond towards the drug? Geriatrics with multiple medication. Most of the patients actually don’t understand how to take their medication correctly as prescribed.

HOME MEDICATION REVIEW… Will it be the best solution???

OVERVIEW Definition The need for HMR HMR in Australia & Malaysia Concept – objectives, assessment parameters, work-flow Benefits Issues to be highlighted Conclusion References

Definition HMR = a service designed to assist consumers living at home to maximise the benefit of their medication regimen & prevent medication related problems A.k.a. domiciliary medication management review (DMMR) / domiciliary service

The need for HMR Increasing number of prescription drug consumers Multiple medication & complex drug schedules Polypharmacy Use of complementary medicines Compliance issues Potential for adverse drug events

Counseling at home

HMR in Australia & Malaysia In Australia: Started on Oct 1, 2001 Funded by Commonwealth Gov Collaborative medication team approach Support for implementation: Infrastructure support – local facilitators Professional organisation support Continuing professional education Liaison with gov. On-going multidisciplinary approach Evaluation of programme Accreditation & education

Australian model for HMR: 1. 2. 3. 4. 5.

Identify patient GP refers to patient’s preferred community pharmacy Pharmacist visits patient at home & review their medication Pharmacist provides GP with an HMR report GP & patient agree on medication management plan

Pilot projects in Malaysia: Kedah (2004) Selangor (2005) – 4 KK, 25 patients recruited Negeri Sembilan (2006) Melaka (2006)

Patient selection: By doctor & then referred to pharmacist Pt have problems with med compliance Have >1 chronic disease, being prescribed with ≥5 medications for maintenance therapy Geriatric with chronic disease with no caregiver Psychiatric Poor technique of medical aid device despite counseling

Concept Main objective = to improve the outcome of pharmacotherapy by HMR conducted by pharmacist

Specific objectives: 1.

2.

3.

4.

5.

To increase – patient’s adherence to medication and patient’s knowledge on medication To identify – factors affecting noncompliance & DRP To review – patient’s method of managing their medication at home To reduce – wastage (d/t over-stoking of medicine) To improve – patient’s Quality of Life

Medication Being Stored At Home

Unused Medication

Assessment Parameters: Medication knowledge Medication compliance Laboratory indices Blood Glucose Level (FBS, RBS / 2HPP) Urine protein Serum Creatinine Blood pressure (BP) Lipid profile (Kolesterol & TG) BMI (Body Mass Index) Quality of Life Storage of medication at home. Cost saving (unused medication) Intervention done

Flow Chart Recruiting Patient

Refer to Pharmacist

Dispensing & Counseling

HMR 1/07 HMR 2/07

Recording

MO

Pharmacist

Pharmacist

Home Visit

HMR 3/07

Remind Patient : Phone

Pharmacist

Visit Patient’s Home

Pharmacist

Record all information

Pharmacist

Assess storage of medication at home

Pharmacist Unsatisfied

Counseling

Satisfied

Memo HMR

Record findings

Pharmacist

Send report to Doctor

Pharmacist

No Rujukan Pesakit

Tarikh

HMR 1/07

HOME MEDICATION REVIEW BAHAGIAN PERKHIDMATAN FARMASI KEMENTERIAN KESIHATAN MALAYSIA : Nama Diagnosis : : Umur : Berat : Tinggi : Bangsa : Jantina Pekerjaan : Tahap Pendidikan Tidak Sek :

Tel Merokok Ya : btg/hari Tidak Ubat Bukan Preskripsi Ya Tidak Catatan :

: Pengambilan Alkohol Ya : Tidak Kesan Adverse Ubat Ya Tidak Catatan :

Jangkamasa menghidap penyakit

*Isi borang ADR & kepilkan salinan

Faktor Ketidakpatuhan Ubat Pernahkah mendapat kaunseling dari pegaw ai f armasi?

Sek. Ren : Sek. Men : Uni/Kolej : Mengambil ubat Sendiri : Bantuan : Nyatakan

(

) Ya (

Lupa ambil ubat Lain-lain, sila nyatakan

) Tidak

Catatan :

Sejarah Pengubatan : Ubat

Tarikh Mula

Dos

Tarikh Ubah Dos

Sebab-sebab Ubat Diberhentikan : Ubat Sebab-sebab Berhenti

Dos

Tarikh Berhenti

Tarikh Mula Semula

Dos

HMR Form 1

No Ruj Pesakit

Tarikh

HMR 2/07

HOME MEDICATION REVIEW BAHAGIAN PERKHIDMATAN FARMASI KEMENTERIAN KESIHATAN MALAYSIA 1. Kajiselidik Kefahaman Pesakit * Ubat-ubatan

Dos (D)

Selang masa (F)

Indikasi ( I )

2. Parameter Dikaji Cara P engambilan (T)

Skor

Parameter

Bacaan

Julat / Bacaan Normal

Tarikh FBS RBS (P2) HbA1c Urine Alb Sr CrCl BP Pulse TC TG

* Betul : 1 Salah : 0 [Jumlah (%)] 3. Kajiselidik Kepatuhan Ubat Pesakit (Medication Adherence Scale 'MAS') Ya (0) Tidak (1) 1)Pernahkah anda lupa mengambil ubat anda ? 2)Dalam tempoh 2 minggu kebelakangan ini, pernahkah anda terlupa mengambil ubat? 3)Pernahkan anda mengurangkan dos anda sendiri tanpa pengetahuan doktor ? 4)Pernahkah anda terlupa membawa ubat anda semasa anda pergi bercuti ? 5)Adakah anda mengambil ubat anda semalam ? 6)Pernahkah anda berhenti pengambilan ubat apabila anda rasa anda telah sihat ? 7)Pernahkah anda rasa rawatan ini menyusahkan ? 8)Kesukaran mengingat cara pengambilan ubat (rawatan) Tandakan √ a) Tidak pernah / jarang sekali (5 markah) b) Ada masa-masa tertentu (4 markah) cth : kenduri / ke rumah anak dll c) Kadang-kala (3 markah) cth : tertidur / melengahkan dll d) Selalu (2 markah) cth : nyanyuk / berkaitan penyakit kognitif dll e) Tidak mengambil ubat (1 markah) cth : kerana tidak boleh toleransi kesan samping (Skor 11-12 Patuh pada rawatan ubat ; Skor 1-10 Tidak patuh pada rawatan ubat) JUMLAH SKOR 4. Kajiselidik Kepatuhan Ubat Pesakit (Pill Count) Ubat-ubatan

Kuantiti P erlu diambil (A )

Lebihan Baki Didispen (B) Didapati (c)

Perbezaan (D=C - B)

Skor

Catatan

(A-D)/A %

Nota Peg Farmasi Kefahaman DFIT pesak it Baik (DFIT = 100%) Tidak (DFIT < 100%) Kepatuhan Ubat Pesak it Baik (>11markah MAS) Tidak ( 80%) Tidak (< 80%) Lain-Lain : Piawai Kepatuhan Ubat adalah > 80% Cadangan Intervensi Pengubatan

HMR Form 2

No Rujukan Pesakit

HMR 3/07

BORANG HOME MEDICATION REVIEW BAHAGIAN PERKHIDMATAN FARMASI KEMENTERIAN KESIHATAN MALAYSIA TARIKH LAWATAN

MASA MULA

1. CARA SIMPANAN UBAT-UBATAN Label Ubat Bil

Nama ubat

Nama (N)

MASA BERAKHIR

Simpan jauh daripada Kanakkanak (C )

Tarikh Luput (E)

Kelembapan Cahaya (L) dan Haba (M )

LAWATAN OLEH

Overstocking Kuantiti

Kos

Bekas kedap udara/ tertutup

‘Medication Box’

Jumlah skor 1. A dakah ubat yang anda simpan mempunyai label 'nama ubat' ? 2. A dakah ubat yang anda simpan mempunyai label tarikh luput? 3. A dakah ubat yang anda simpan dijauhkan dari kanak-kanak? 4. A dakah ubat yang anda simpan dijauhkan dari cahaya? 5. A dakah ubat y

2. INFORMASI DIET DAN AKTIVITI HARIAN Informasi Diet Makanan Jenis

Sarapan:

Minum pagi

Makan Tengahari

Minum petang : Makan Malam : Minum Malam :

CATATAN (Jika ada)

Kuantiti

Minuman Jenis

Aktiviti Harian Kuantiti

HMR Form 3

Suggested HMR Schedule Month 1st Month 2nd Month 3rd Month 4th Month 5th Month 6th Month 7th Month 8th Month

Activities Patient referred to Pharmacist 1st Visit Doctor appointment Part supply medication Doctor appointment 2nd Visit Doctor appointment Part supply medication

Benefits To pharmacists Expand professional service – new image of pharmacy service Better intervention

To patients Improve knowledge (Dosage, Frequency, Indication, Time) & compliance Reduce unscheduled appointment & repeated admission to A&E Increase pt empowerment in managing their disease at home & improve QoL

To government Cost-saving – reduce wastage of unused medicines Improved perception towards Pharmacy Dept. services

Cost saving data based on unused medication at home (Selangor data : 20 patient), 2007 PKD PKD

PKD Kuala Langat PKD Klang PKD Petaling PKD Sabak Bernam PKD Sepang Total Total

Patients Patient 6 4 4 4 2 20

RM RM 322.41 449.87 33.20 198.40 79.30 1083.18

Issues to be highlighted Complicated / multiple medication regime Complementary vs. conventional medicines Funding matters, financial rewards Prescribing behavior Cooperation from other HC professionals Training & post Multi-centre study – evaluation on HMR delivery, lack of data SOP

Conclusion The scope of pharmacy is evolving Get ready for the next momentum – establishment of rural pharmaceutical care (RPC) Other countries have been benefiting from HMR – Malaysia is the next!

Prof. Patrick Ball, Chair of Rural Pharmacy Dept at Charles Sturt University: "Nobody in Australia is in a position to say we are spending X dollars a year funding Home Medicines Review but it is saving X dollars a year on the Pharmaceutical Benefits Scheme because patients are taking their medications more effectively, fewer patients are being hospitalized and fewer patients are having operations as a result of not taking their medications“ “…whatever Australians currently spend on antihypertensive, something like 80 or 90 per cent of that might as well just go down the drain because if patients are not achieving a degree of blood pressure control then we are not getting the full benefits,"

References 2 Health Programmes Showing Results, New Straits Time, 5/08/09 Mohd Dziehan Mustapa, Home Medication Review, CPA-MPS Conference 2007, Medication Review Symposium, 4/08/07 Tim Chen, The Australian Model for Home Medicines Review, CPA-MPS Conference 2007. www.pharmacynews.com.au

Medication Management in Review: Gathering Momentum, The Australian Journal of Pharmacy, Vol. 22, April 2003 Medication Management in Review: HMR Features Widely in Recent Research & Development, The Australian Journal of Pharmacy, Vol. 87, June 2006

Thank you for your attention! ☺ Questions? Comments?