Carer Lawrence Scerri, consultant pharmacist Esther Hernandez and King Street Dental and Medical co-owner and pharmacist Rehana Kermali are supporting the push for changes to the Home Medicine Review. Photos: Keeli Dyson.
Pharmacists and carers are calling for changes to a lifesaving health service which could prevent patients consuming dangerous combinations or doses of medications, with provider limitations currently preventing many from accessing the care.
Consultant pharmacist Esther Hernandez is changing lives.
She is one of just a handful of medical professionals offering the Home Medicine Review (HMR) service in the Illawarra which assesses the medications patients are on to identify conflicts, duplications, dosage issues, misusage or medicines which are no longer relevant to the patient.
“It’s conducted in the patient’s home so we get to see exactly how medicines are being used,” Esther said.
“We identify if there are any ways we can make the medication more effective or safer.”
Esther sits down with patients in their own homes to understand the entirety of their medical situation and pharmaceutical intake, including supplements and over-the-counter medications.
Many of her patients have extremely complex cases with dozens of medications, some of which have not been revised in years.
“As we get older our body changes, some of the preventative medicine that’s not going to work for another 10 years; I believe the patient has the right to decide if they need to keep taking it and put up with the side effects and if it is worth it,” Esther said.
“I also try to combine two medications together if they do exist, so you’re paying one PBS price instead of two or look for medication that can be taken once a day instead of two or three times a day.”
It’s about more than just cost and comfort, with urgent cases potentially life-threatening.
“It could be that someone can’t swallow suddenly due to some conditions and they need help to change the medication – it could be life depending medication or they could be in a lot of pain,” Esther said.
“I also saw a lady transitioning from care from one GP to another GP not knowing that she was already having maximum dose of paracetamol in her webster pack and then a new GP prescribed two more paracetamol containing products and she took it for quite some time.”
Lawrence Scerri has seen how the service has helped his 87-year-old mother who was taking 29 medications and supplements and suffering from painful migraines.
“We come into doctors and unfortunately it’s five minutes and you’re out and you need that time to have explained that this one has side effects or it could affect your kidneys,” he said.
“In the past she would go to a doctor and having limited English or broken English, if you can’t understand fully all this terminology or language, you’re not going to get the best treatment for yourself.
“There might be a brand-new medication that has come out that might have less side effects, but you just go with what they tell you and you take it for years and years.”
Esther supported Lawrence’s mum with managing medications to target persistent migraines.
Through meeting with Esther, they were able to better manage insulin medication causing weight gain and further joint pain, as well as identify iron deficiencies not previously picked up through bloodwork.
“It’s really worthwhile,” Lawrence said.
“When you’re elderly and mobility is a problem, this is very tailored and it’s really patient-centred.
“I think around this area in Warrawong, Port Kembla, Lake Heights, there’s a lot of southern European and cultures like Macedonians, Italians, Portuguese and Maltese, and they would prefer that.”
But despite the impact, the government has capped consultations to just 30 a month.
“For me it’s about a month wait,” Esther said.
“Some of my colleagues have three months’ wait, and the referral actually only lasts for three months so they will have to get a doctor to write a new referral.
“I have more than 10 GPs that refer to me and that is still expanding.”
Pharmacists require additional training to perform the service and receive a fixed claim of $222.70 per consultation, regardless of day, time or how far they need to travel.
The price has not increased since 2019, making it difficult to incentivise more pharmacists to offer the service.
There is no telehealth option, so if someone is too ill to have someone visit their home or is simply too far away from a consultant, they simply cannot access the service.
“There are people who desperately need it and they cannot access it because either we can’t get to them or they can’t let us in.
“There are people just missing out.”
Now pharmacists are pushing for change, with the Pharmaceutical Society of Australia calling for Health Minister Mark Butler and the Federal Government to lift the cap, increase the fee cover and allow it to be offered remotely.
The hoped-for boost in the upcoming budget could not only help more people to utilise this service but also attract more pharmacists like King Street Dental and Medical co-owner and pharmacist Rehana Kermali, who is currently undergoing training.
“Medication reviews can be complex, they can be time intensive and really going into that pathway, I would like to see the funding reflect the reality of the service,” Rehana said.
“Flexibility doesn’t necessarily reduce the quality of the service. What it does is it expands the access when it’s required.
“It’s a win for the GPs because they are able to extend this service to their patients, it’s a win for consultant pharmacists who really want to deliver this kind of service because it’s very fulfilling and very rewarding and it’s a win in general and for the hospital system. Having this sort of service is just crucial.”
“The monthly cap helps ensure the HMR program is sustainable and allows each pharmacist to deliver reviews for the patients who need them most, in their homes,” a government spokesperson said.
“The cap applies to reviews funded under the government program. Providers can deliver additional reviews privately if a patient chooses.
“All funding decisions are a matter for government and we are unable to pre-empt what will be announced in the budget.”
For more information or a referral, contact your GP.
