Mornington Peninsula Division of General Practice

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Mornington Peninsula Division of General Practice
Domiciliary Medication Management Review
(DMMR) Home Medicines Review Dr John Siemienowicz
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Mornington Peninsula Division of General
Practice-DMMR

• Goal DMMR / Home Medication Review
• To maximise benefits from medications
  accomplished by a team approach involving the GP
  and a patients preferred community pharmacy

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Mornington Peninsula Division of General
Practice-DMMR

• Objectives
• achieve safe effective and appropriate use of
  medications
• improve patients quality of life
• improve patients and health professionals
  knowledge about medicines
• facilitate relationships between health care
  teams

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Mornington Peninsula Division of General
Practice-DMMR

• Eligibility
• People living at home
• No previous DMMR in the last 12 months
• GP assessment for need based on patients -
• co-morbidities, age or home situation
• characteristics of medications
• complexity of regimes/ ? compliance
• recent discharge from hospital

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Mornington Peninsula Division of General
Practice-DMMR

• Who is involved?
• patient and their carer
• general practitioner
• pharmacist from patients preferred community
  pharmacy
• an accredited pharmacist (if different from
  community pharmacist)
• other identified health care team members

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Mornington Peninsula Division of General
Practice-DMMR

• DMMR GP Consultations
• DMMR Fee 123 Rebate 104 Item 900
• initial consult, consent, eligibility assessed,
  referral
• liaison with pharmacist
• second consult discuss management plan
• bill after all components completed

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Mornington Peninsula Division of General Practice

• MPDGP-DMMR role
• support dissemination of information
• applied for facilitator
• practice visits
• liaison with pharmacists
• further educational events

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Mornington Peninsula Division of General
Practice-DMMR

• DMMR Process Identification
• by GP, Pharmacist, patient or carer or allied
  health team member
• GP can -
• opportunistically identify
• actively recruit (invitation letters, database
  manipulation)

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Mornington Peninsula Division of General
Practice-DMMR

• DMMR-Eligibility
• patient must live at home (not hospital, hostel
  or nursing home patients)
• only once in 12 months, (more often if a
  significant change has occurred, ie hospital
  discharge)

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Mornington Peninsula Division of General
Practice-DMMR

• DMMR-Appropriateness
• patients most likely to benefit are those for
  whom quality use of medicines may be an issue
  /or at risk of medication related problems
• May be due to co morbidities, age, social
  circumstances, type of medications, complexity of
  regimen, lack of knowledge of how to use
  medications

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Mornington Peninsula Division of General
Practice-DMMR

• DMMR-Appropriateness (cont)
• Risk factors
• 5 or more medications, 12 or more doses
• significant changes in regimen in last 3 months
• medication with a narrow therapeutic index
• adverse drug reactions, sub optimal responses
• non compliance, cognitive difficulties

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Mornington Peninsula Division of General
Practice-DMMR

• DMMR-Patient Benefits
• enhanced understanding of their medications
• proper use and safe storage
• optimisation of regimen
• improved relationship with GP pharmacist

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Mornington Peninsula Division of General Practice

• DMMR-Patient Consent
• need to obtain consent,orally or written
• record in notes
• must explain process, roles of GP pharmacist,
  information to be with held or disseminated, need
  for further visits and costs involved

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Mornington Peninsula Division of General
Practice-DMMR

• DMMR-Referral Form
• Can be form provided or computer record
• Must include
• patient demographics
• relevant clinical history
• medication list
• relevant test results
• Give to patient,fax or mail (pharmacist)

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Mornington Peninsula Division of General
Practice-DMMR

• DMMR-Pharmacist Consultation
• Occurs at home, appointment
• Pharmacist has special MMR training
• May be patients community pharmacist or
  specialist accredited pharmacist
• Provides counselling and advice
• Prepares written report

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Mornington Peninsula Division of General
Practice-DMMR

• DMMR-Discuss Pharmacists Report
• DMMR report forwarded to GP
• Discuss report either face to face or by
  telephone
• Discussion forms basis for proposed management
  plan

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Mornington Peninsula Division of General
Practice-DMMR

• DMMR-Prepare Management Plan
• Plan should include -
• Needs outlined in DMMR report
• Map proposed management and expected outcomes of
  patients medication regimen
• Specify who is responsible for further actions
  and follow ups, time lines and expected outcomes

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Mornington Peninsula Division of General
Practice-DMMR

• DMMR-Discuss Report with Patient
• Discuss proposed plan with patient
• Document actions that are agreed to
• Forward plan to other members of team if needed
• Patient to sign agreed plan
• Organise review date
• Bill patient

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Mornington Peninsula Division of General
Practice-DMMR

• DMMR-Records
• DMMR referral to community pharmacist
• DMMR report received by GP, accredited
  pharmacist community pharmacist
• Management plan for GP, patient community
  pharmacist

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Mornington Peninsula Division of General
Practice-DMMR

• DMMR-Implementation
• May involve -
• Provision of further information
• Scheduled reviews
• Further medical reviews or referral
• Further monitoring
• Separate Medicare consultations