HOME MEDICATION

REVIEW (HMR)

Presented By:
MOHD AZREEN BIN MUSTAPA

PRP 2009/2010 Session

21/12/2009
Common Issues:
Patients come to doctors 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 dont
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. Identify patient
2. GP refers to patients preferred
community pharmacy
3. Pharmacist visits patient at home &
review their medication
4. Pharmacist provides GP with an HMR
report
5. 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. To increase patients adherence to
medication and patients knowledge on
medication
2. To identify factors affecting non-
compliance & DRP
3. To review patients method of
managing their medication at home
4. To reduce wastage (d/t over-stoking of
medicine)
5. To improve patients 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 MO
Pharmacist

Dispensing &
Pharmacist
Counseling

HMR 1/07 Pharmacist

Recording
HMR 2/07
 Home Visit Remind Patient : Pharmacist
Phone

Visit Patients Home Pharmacist

HMR 3/07 Record all information Pharmacist

Pharmacist
Assess storage of
medication at home Counseling
Unsatisfied

Satisfied

Record findings Pharmacist

Send report Pharmacist

Memo HMR to Doctor
No Rujukan Pesakit Tarikh HMR 1/07
HOME MEDICATION REVIEW
BAHAGIAN PERKHIDMATAN FARMASI KEMENTERIAN KESIHATAN MALAYSIA
Nama : Tel :
Diagnosis : Merokok Pengambilan Alkohol
Umur : Ya : btg/hari Ya :
Berat : Tidak Tidak
Tinggi : Ubat Bukan Preskripsi Kesan Adverse Ubat
Bangsa : Ya Tidak Ya Tidak
Jantina : Catatan : Catatan :
Pekerjaan :
Tahap Pendidikan Jangkamasa menghidap penyakit *Isi borang ADR & kepilkan salinan
Tidak Sek : Faktor Ketidakpatuhan Ubat
Sek. Ren : Pernahkah mendapat kaunseling dari Lupa ambil ubat
pegaw ai f armasi?
Sek. Men : Lain-lain, sila nyatakan
Uni/Kolej : ( ) Ya ( ) Tidak
Mengambil ubat Catatan :
Sendiri :
Bantuan :
Nyatakan

Sejarah Pengubatan :
Tarikh Ubah Tarikh Tarikh Mula
Ubat Tarikh Mula Dos Dos Dos
Dos Berhenti Semula

HMR Form 1

Sebab-sebab Ubat Diberhentikan :

Ubat Sebab-sebab Berhenti
No Ruj Pesakit Tarikh HMR 2/07
HOME MEDICATION REVIEW
BAHAGIAN PERKHIDMATAN FARMASI KEMENTERIAN KESIHATAN MALAYSIA
1. Kajiselidik Kefahaman Pesakit * 2. Parameter Dikaji
Cara Julat /
Selang
Ubat-ubatan Dos (D) Indikasi ( I ) P engambilan Skor Parameter Bacaan Bacaan
masa (F) (T) 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) Skor
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 ?
HMR Form 2
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)
Kuantiti P erlu Lebihan Baki Perbezaan Catatan
Ubat-ubatan (A-D)/A %
diambil (A ) Didispen (B) Didapati (c) (D=C - B)

Nota Peg Farmasi

Kefahaman DFIT pesak it
Baik (DFIT = 100%)
Tidak (DFIT < 100%)

Kepatuhan Ubat Pesak it

Baik (>11markah MAS)
Tidak (<11markah MAS)
Baik (> 80%)
Tidak (< 80%)

Lain-Lain :
Piawai Kepatuhan Ubat adalah > 80%
Cadangan Intervensi Pengubatan
 No Rujukan Pesakit HMR 3/07
BORANG HOME MEDICATION REVIEW
BAHAGIAN PERKHIDMATAN FARMASI KEMENTERIAN KESIHATAN MALAYSIA
TARIKH LAWATAN MASA MULA MASA BERAKHIR LAWATAN OLEH

1. CARA SIMPANAN UBAT-UBATAN

Label Ubat Simpan jauh daripada Bekas
Overstocking
Kanak- Kelembapan kedap Medication
Bil Nama ubat Tarikh
udara/ Box
Nama (N) kanak Cahaya (L) dan Haba
Luput (E) Kuantiti Kos
(C ) (M ) tertutup

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 Kuantiti
Minuman
Jenis Kuantiti
Aktiviti Harian
HMR Form 3
Sarapan:

Minum
pagi

Makan
Tengahari

Minum
petang :

Makan
Malam :

Minum
Malam :

CATATAN (Jika ada)

Suggested HMR Schedule
Month Activities
1st Month Patient referred to Pharmacist
2nd Month 1st Visit
3rd Month Doctor appointment
4th Month Part supply medication
5th Month Doctor appointment
6th Month 2nd Visit
7th Month Doctor appointment
8th Month 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 Patients
Patient RM
RM
PKD Kuala Langat 6 322.41
PKD Klang 4 449.87
PKD Petaling 4 33.20
PKD Sabak Bernam 4 198.40
PKD Sepang 2 79.30
Total Total 20 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!

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