Hospital‐initiated medication review – time to deliver on a decade of promises

For almost two decades researchers and clinicians have focussed on post-discharge medication management pathways to reduce the risk of medication-related harm associated with transitions of care. It is now over a decade since the final report on the Home Medicines Review (HMR) Qualitative Research Project recommended “that all possible barriers are removed to enable post hospital Home Medicines Reviews to occur within approximately 10 days of discharge (earlier if possible)”.1 Further research demonstrated the benefit of parallel post-discharge HMR,2 and in the 2010 budget the Federal Government made the promising announcement of funding for post-discharge medication reviews. Collaborative interprofessional discussions were hosted by the Department of Health in 2012,3 and while the need for such services was universally recognised by all stakeholders, the implementation processes failed to gain consensus and funding was not successful through the Fifth Community Pharmacy Agreement.4 History shows that “will” has not translated into “action”, particularly where stakeholders remain entrenched in their views. Therefore, the recently announced Department of Health plans to enable hospital-referred post-discharge medication review was met with mixed emotions by the Society of Hospital Pharmacists Transitions of Care and Primary Care Specialty Practice Group (SHPA TCPC).5 The TCPC represents clinicians who bridge the gap across the care continuum, and have previously made strong recommendations that professions put patients' needs ahead of professional agendas.6 Others have made similar calls to action, with the Minister for Health identifying medicines safety as Australia's 10th National Health priority, while the interim report from the Royal Commission into Aged Care, the Consumers Health Forum, SHPA and the Pharmaceutical Society of Australia have all called for reform in medication management within the aged care sector. Even with this announcement, will consumers, patients, and our residents of aged care homes remain casualties of collective inaction? While we do not yet know the details of the plan, we know that the proposed modified program rules will expand referral pathways for HMR and Residential Medication Management Reviews (RMMR), with funding for accredited pharmacists to undertake HMRs and RMMRs on referrals from hospital doctors, medical specialists and GPs. This flexibility means post-discharge reviews will likely occur in a timely manner. There will also be the opportunity for follow-up visits on up to two occasions, which is important for continuity of care in people at risk of medication-related harm post-discharge. Any outcomes of the initial visit and follow-up service(s) for the HMR and RMMR programs, i.e. the report and medication management plan, will be required to be uploaded to the patient's My Health Record (if there is one), or provided to the patient and their healthcare team, including the referring doctor, carer, aged care facility and community pharmacy (each if identified/applicable). The TCPC Specialty Practice Group's vision is to reform the way hospitals hand over medication management, and our mission is to have roles for pharmacists responsible for collaborative care across the continuum codified into the healthcare landscape. Hence our eagerness to see the detail which will inform the scope, remuneration and resourcing for all aspects of these pathway changes. Rather than celebrating the promise of change, let's celebrate the first patient who benefits from a hospital-initiated HMR conducted under these new rules. Actions speak louder than words. The authors declare that they have no conflicts of interest.