Home medication Review is an activity in which the pharmacist reviews the prescription history at the patient's home to identify the deviations from the standard practice of taking medications or life style management and make a care plan for patients to improve the patient quality of life .
The patients find it difficult and uneasy to get medical care in conventional settings like hospitals, nursing homes. There are various causes and reasons why patients although aware of the importance of getting the timely health care services, fail to do so. For example, the ignorance or negligence of the patients regarding the further consequences. They are not very much enthusiastic of meeting a doctor and getting evaluated. The patient would prefer to receive the health care in a personalized approach with confidentiality where the others do not come to know regarding his/her illness. In good old days the family doctors used to visit the patients at their home and provide care. The patients felt secure and comfortable of being treated at home. This also avoided hospital ward charges as well as need for an attendant for patients. This style of health care provision vanished due to increased workload and less number of doctors.
Home medication review is an activity in which the pharmacist reviews the prescription at the patient's home during periodical visits. In this the pharmacist looks into the aspects of drug, disease and life style to identify the deviations from the standard practice. He documents to make a care plan which he explains to the patients or attendant. The care plan implementation marks the first stage of HMR. Further in subsequent periodical visits pharmacist looks for signals which connect to the care plan. For example if there was poor control of Postprandial blood sugar (PPBS) control before, due to dietary factors. The advice for the patient should have been regarding changeover of food with low glycemic index. This is verified by measuring the PPBS in subsequent periodic visits. The evidence is shared and utilized to motivate patients.
The home medication review is an offshoot of family doctors concept. Due to complexity of modern health care system there is a need to keep a constant vigil with periodical reviews in the course of treatment. Some diseases like chronic conditions (hypertension, diabetes and asthma) require the supervision of trained health care professionals. The patient education and provision of profession-wise care has become mandatory in order to achieve the expected outcomes which are cost effective and satisfying the patients. The home medication review consists of visits by a pharmacist and analyzes the patients from the point of drug, disease and life style. Here the pharmacist after having a dialogue with the patient, prepares a customized care plan and implements it to the patient by explaining and educating about the disease, drug and lifestyle modifications. He also prepares a medication therapy management plan as per the prescription. The patients are to be visited periodically to assess the outcomes and documents for further treatment. The pharmacist with his skills tries to decipher the reasons for varied or failed outcomes. He can communicate with doctors and nurses regarding the diagnosis and treatment to discuss the patient care issues. Home medication review (HMR) encourages patient centric care.
The HMR is a practical effective patient friendly intervention which will fill the gap in the health care delivery. The current health care delivery is impersonal and based on the philosophy of one cap fits all. There is gross negligence of individual requirements of patients. The patients with no systematic education of disease, drug and life style likely to be tensed and confused usually develops a sort of negative impression about medicines resulting in poor adherence. So in order to overcome the issue of compliance the patient education was thought enough. However the motivation of the patient to participate in his own health care was found to be very effective. Hence the major objective of HMR is to convert a ill informed patient into well informed patient who can self mange his condition.
How the objectives of HMR can be achieved?
The patient wellness should be the goal of the pharmacists. To implement HMR program the pharmacists should be trained not only in technical knowledge about drugs but also in social skills like empathy (shared feeling of belongingness), communicational skills and computational skills. The detailed objectives of HMR includes
* To achieve safe, effective and appropriate use of medicines
* To increase - patient's adherence to medication and patient's knowledge on medication
* To identify - factors affecting non-compliance
* To review - patient's method of managing their medication at home
* To reduce - wastage (due to over-stocking of medicine)
* To improve - patient's Quality of Life and health outcomes
The home medication review, a recent practice in developed countries has proved as a viable, cost-effective, patient-centric approach. Here, there is an opportunity to assess the patient by an individual trained pharmacist and give adequate time for each patient.
- Improved knowledge (Dosage, Frequency, Indication, Time) & compliance
- Reduce unscheduled appointment & decreased hospital stay
- Increase patients empowerment in self management of their disease at home and improved quality of life (QOL)
To the Health care system
* Decreased load of patients reporting with critical conditions
* Optimization of resources for providing the best care
- Integration of health care system
- Better intervention
- Expand the professional services and image
- Services and professional growth for pharmacists
- Cost-saving -reduce wastage of unused medicines
- Improved perception towards Pharmacy Dept. services
The question of sponsorship always remains the bottle neck for implementation of the HMR program. In Australia, the pioneers of HMR have a system of extra payment for patient related services provided by the pharmacists. In countries like UK, the national health scheme remunerates the pharmacy related services. In USA and Canada the pharmacy related services are sponsored by private insurance and recently by Government. The capital gains by HMR are really substantial and positive as it promotes the evidence based patient centric care. In developing countries where the out of pocket payments is the major style of sponsorship for health care expenses. There is needed to prove the cost effectiveness of HMR in existing health care system. The emerging evidence should be sufficient to encourage the HMR.
Figure: Home Medication Review cycle
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