Understanding Home Medicines Reviews: A Crucial Tool for Safer, Independent Living
In the latest episode of Conversations with G&G, hosts Giovanni and credentialed pharmacist Giselle Siano pull back the curtain on a vital, government-funded healthcare initiative: the Home Medicines Review (HMR). This comprehensive service is designed to keep older Australians safe, well, and independent in their own homes by bridging the gap between clinical prescriptions and real-world daily routines.
Many families assume that because a medication has been prescribed by a trusted General Practitioner (GP) or specialist, it is automatically free from risk. However, as Giselle highlights, medication-related harm is one of the leading causes of preventable hospital entries across Australia. When an individual takes multiple doses throughout the day or receives prescriptions from different specialists, the clinical complexity scales up rapidly.
An HMR strips away this complexity. Rather than a rushed consultation in a clinic, a credentialed pharmacist visits the individual directly in their familiar home environment. This real-life setting allows the pharmacist to evaluate not just what medicines are prescribed, but exactly how they are stored, organised, and taken every day.
The process is highly collaborative and holistic. It provides an avenue to involve family carers, evaluate physical health factors like mobility or falls risks, and even coordinate care with other allied health professionals. For anyone navigating the aged care system, an HMR serves as an essential safety net that protects dignity and peace of mind.
Key Takeaways from the Episode
Preventable Harm: Medication errors and adverse reactions account for hundreds of thousands of Australian hospitalisations annually, more than half of which are entirely preventable.
In-Home Evaluation: The home environment gives pharmacists deep insight into practical factors like storage safety, expired stock, and the proper use of specialised medical tools or devices.
Collaborative Reporting: Following the home visit, the pharmacist provides a tailored recommendation report back to the patient’s GP, who then sits down with the family to establish a clear medication management plan.
Learn more about the Home Medicines Review through the following links:
Full Episode Transcription - 17 Home Medicine Reviews: Smarter Medication Management as We Age Feat. Giselle Siano
Giovanni
Hello and welcome back to Conversations with G and G. Today, we're joined by the founder of the podcast and credentialed pharmacist, Giselle Siano, to discuss Home Medicines Reviews (HMR) from a pharmacist's perspective. Giselle will share how this free service can help older Australians better manage their medications, reduce health risks, and support safer, more independent living within our community.
Welcome Giselle.
Giselle
Thank you.
Giovanni
Today it’s just you and I.
Giselle
Yeah, I know.
Giovanni
So let's talk about Home Medicines Review. And obviously, I understand that you are credentialed pharmacists to provide Home Medicines Review services.
Giselle
Yeah.
Giovanni
Now, can you tell us a little bit about the service and why it is such an important, you know, service that we offer?
Giselle
Yeah, absolutely. So, a Home Medicines Review also known as a HMR, is a government-funded service where a credentialed pharmacist visits a person in their own home to review all their medications. And it's done in a real-life setting, in their home. So that gives the pharmacist an opportunity to, not only check the prescriptions and the medications that they're on, but really understand how the medications are being taken, and how they're being stored. And just actually how they're being used day to day.
And, really looking at how the patient is managing those medications as well. So we know that in Australia we have a really safe, medicine system in the world, but medicines only really work well when we understand how the person is taking them. If they're being regularly reviewed, if they’re tailored to the person that's taking them as well. And HMRC is a really valuable tool that we have to keep patients safe, independent and well at home. So we often think medicines are automatically safe because they're being prescribed by a GP or a specialist. But medicine's actually one of the most common causes of preventable harm in healthcare.
So, medication-related harm is a real issue, and it's not a small one. We're talking about hundreds of thousands of people who get hospitalised every year because of medication-related harm. And the data actually shows that about, more than half of are probably preventable. And that's where a Home Medicines Review can really, have a huge impact.
Giovanni
Yeah, I understand how that can be really, really helpful. Someone might have, so many, you know, medicines, in their own home. And they might make mistakes and forget things. Or they might have all older medications, maybe they're no longer applicable.
Giselle
Yeah. Yeah, absolutely.
Giovanni
All of that could cause, could cause harm. I can see that.
Giselle
Yeah. And we're getting older. You know, our population is getting older, and our medical system is complex, and people have multiple prescribers. They might have a GP, they have a specialist. Their medical conditions might change. And as people get older, their body systems change as well. So that's where it's really important to be looking at the medications that people are taking and seeing whether something needs to be changed or removed completely, or whether there's something better that's available for them to take.
Giovanni
So what are the common triggers for someone to consider a medications review? And where to go?
Giselle
Yeah. So, the first place to go is to speak to your GP. So the GP needs to send a referral to the credentialed pharmacist, and there is eligibility criteria. To have a home medicines review because it is a government-funded service.
But some of the things that, you might like if your loved one, if you think this would benefit a loved one, you might be looking at things like whether they're having, whether their conditions are not well controlled, whether they're having some side effects, perhaps they're having some falls at home. You might not know what the cause of that is, but definitely there are medications that can contribute to that.
Perhaps you've just been discharged from hospital, and all of a sudden, they're on new medications, and they might not have a good understanding, or a good grasp of those medications and when and how to take them. So that's a good opportunity to get the pharmacist at home to explain some of those things.
Also, if the patient is on more than five drugs, multiple doses during the day, sometimes that can be very confusing, and the patient and the family might feel a little bit overwhelmed in regards to the complexity of all of that.
So there's some of the triggers, but the best place to start is to speak to the GP and asking whether they are eligible and whether a home medicine review would be good for them.
Giovanni
And also, what are the different types of, medications in terms of, how you take them out of a blister pack? You know a Webster-pak. You know, can you talk us through that a little bit?
Giselle
Yeah. So like the different, yeah. Obviously, people that are on lots of medications may choose to have a dose administration aid. So that could be a Webster-pak that the pharmacist will pack. So, it has, you know, Monday to Sunday, and it's got, morning to evening, little pockets that the pharmacist would put the meds in.
And that takes a lot of the burden out of remembering when to take doses and what to take at that particular time. So it's all done by the pharmacist, and the pack gets done every week. Having a Webster-pak, is it necessarily safer than not having it?
Giselle
Yeah.
Giovanni
Or not necessarily?
Giselle
No, there, a really good way to make sure and to assist the patient with their administration of the medications. And because it is also sealed by the pharmacist, if the seal is broken, you could identify whether someone's taking it at the wrong time, or whether they have not taken their dose at all. It is a very, very easy visual way to see that because of the foil at the back as well.
Giovanni
So, Giselle, how do you actually tailor a medicine review when someone struggles with communication, for example?
Giselle
Yes. It's not uncommon, in a HMR, particularly as we're seeing people who may be older, people might be living with dementia or have cognitive impairment, neurological conditions, or mental health or communication difficulties. So when we organise the interview, we do invite, or we allow the patient to bring along a loved one or someone that they trust into the interview as well, so that they can be there to support or to provide any information that they've observed being a carer or a loved one.
So we do we rely on carer observations, behavioral changes as well, that might be occurring because that could be a potential side effect of a medication. So if someone is experiencing sedation or drowsiness, they might be presenting with reduced participation in the interview, or you might actually physically see that they are a bit drowsy as well.
We can, you know, talk about or explore things like sleep patterns or mobility changes. So, because we're there with the patient in their own home, we can also physically see as well how they are, and how they're going. Yeah. So there's lots of different ways, and lots of different advantages of having the pharmacist actually in the home as
Giovanni
Yeah, I can see how that is incredibly beneficial to be present in their own environment and observe all of those other signs that they might not be able to communicate via, you know, verbally, for example. So it's such a great service to be there in their own environment, and you even be able to pick up other referral opportunities for other health care professionals to come in and support the patients in other ways.
Giselle
Yeah, absolutely. So the Home Medicines Review, even though, we primarily look at the medications, it's also a really holistic opportunity to look at, well, does the physio, if there are mobility issues, do we need to refer on to a physiotherapist who can come and help the patient with some exercises?
Or should we look at perhaps getting an OT to look at the environment to make sure that any risks are mitigated for the client or for the patient themselves? So yes, there is an opportunity as well to bring in other allied health professionals, to make sure that the patient is super safe at home.
Giovanni
Fantastic. And what are the benefits? There are in having this service for the patient; is there any benefits to the carers themselves?
Giselle
Yes, absolutely. So sometimes, you know, looking after a loved one who's getting older can, can put a lot of pressure on a carer, a carer. So we see that often, that caregivers might be overwhelmed, they might be experiencing burnout. Medications can become very complex, especially then as I get older and they're experiencing side effects. And it's hard to know who to go to and what to do about it. So definitely, I think having the carer in the interview, because it's a really good opportunity, a good education opportunity as well, to learn about the medications. And so, for example, if someone is on some asthma medications and they're using an asthma device, that can be really, sometimes, very hard to coordinate and do so.
And you know, a lot of people find that it's really beneficial to get a refresher on how to use that device periodically. So having a carer present can help reinforce and support the client and patient as they're doing it.
So definitely, I think it's very empowering for carers to, to be involved in that because of that education and the support and just having someone knowing that there's someone else there that can help assist them, if they've got any questions and they're doing a good job as it is, and perhaps learn about some other things that might be available to make their life easier, like a Webster-pak. And you know, who do you go to if you want to set one of those up? So definitely, I think, very supportive way to to help our carers.
Giovanni
Very, very valuable. So basically, you need a referral directly from their GP.
Giselle
Yes. That's great.
Giovanni
First step is to contact the GP and share your concerns with the GP. And then you will basically ascertain if I refer to a pharmacist. Is that relevant?
Giselle
Yeah, absolutely. That's it. That's exactly right. And then once the GP sends that referral on to the pharmacist, the pharmacist will contact the patient directly to organise that interview and book a time. And then after that is done, the interview is done, the credentialed pharmacist writes a report, with recommendations back to the GP. So, the GP would meet with the patient to make any changes or implement a medication management plan.
Giovanni
I see, so how long is an appointment? How long does it typically go for?
Giselle
Yeah. So, an appointment interview, I mean, it depends on how complex the conditions are and how many medications, but usually, about an hour, an appointment goes for about an hour
And so it's very thorough. So we're looking at storage. We're looking at if any devices are being used, creams, eye ointments, eye drops, ear drops, patches, Webster-paks, or separate medication bottles. And so it is a very thorough interview, and I just recommend for the patients and their families, before their interview, just to have everything ready to go. So, you know, grab all the medication boxes and over-the-counter products, herbal medications, vitamins, anything that you buy at the supermarket, that's all included in the review. Because they can also have side effects and interact with other things as well. So it's very important that we look at all of those, medicines as well, including your vitamins
Giovanni
I see. And for those participants that have a Support at Home, you know, funding arrangement, what are the benefits to perhaps the care partners themselves managing those participants? How do you relate to them?
Giselle
Yeah. I guess from a provider perspective, providers would have, you know, if providers are having services, putting in services, their workforce might be noticing, the client might be having more falls, or perhaps they know that they're taking lots of medications, or maybe there's medication incidents, or they've seen that the client themselves is not taking their meds.
That's all important information that the provider has. And then if they can either speak to the family or speak to the GP, so the GP's aware of it. And then of course, it's up to the GP to decide whether a referral is necessary. But definitely the care partner or caregivers at the provider, or any allied health, have an opportunity to highlight if they think something is not quite right with the medications and just pass that information on.
Giovanni
Very good. A very important role that they have as well. The caregivers and the care partners as well.
Giselle
Yeah, because they’re the eyes and ears. The eyes and ears for the patient and the family as well, because they're in the house and they know what's going on.
Giovanni
Yeah, what a fantastic service.
Giselle
It is a fantastic service.
Giovanni
And you're available immediately to go out and meet participants.
Giselle
Yeah, yep.
Giovanni
That's great.
Giselle
Yeah. Absolutely.
Giovanni
Yep. Fantastic. So Giselle, can you give us a quick summary on the service that you offer?
Giselle
Yes, absolutely. So it's the Home Medicines Review, which is a government-funded service. It does require a GP referral to a credentialed pharmacist. So that's pharmacists that has done some specialised training in this. Some of the things that patients might experience that could be related to medications, they could develop slowly over time. So that could be months or years, but they might have cognitive decline, increasing falls, more fatigue, more dizziness, constipation, loss of appetite, anything that sort of declining could be attributable to medication. So it's really important to consider that. Also, some things that might trigger a Home Medicines Review would be post-hospital. Could be.
Giovanni
Missed medications?
Giselle
Missed medications or if they’re taking lots of medications or conditions that aren't really well controlled. It's definitely worth considering and speaking to a GP, about whether this service would be a benefit to the, to the patient, to yourself or your loved one.
Giovanni
And then your GP would then?
Giselle
Refer on
Giovanni
Directly to a?
Giselle
Credential pharmacist. Yep.
Giovanni
Perfect.
Giselle
Yeah. Perfect.
Giovanni
Sounds wonderful.
Giselle
It does.
Giovanni
Thank you very much.
Giselle
Thank you. Thanks for having me.