A PDF file should load here. If you do not see its contents
the file may be temporarily unavailable at the journal website
or you do not have a PDF plug-in installed and enabled in your browser.
Alternatively, you can download the file locally and open with any standalone PDF reader:
http://www.biomedcentral.com/content/pdf/s12875-015-0227-8.pdf
General practitioners’ perceptions on home medicines reviews: a qualitative analysis
Amrith Kaur Dhillon
0
Hendrika Laetitia Hattingh
0
Andrew Stafford
0
Kreshnik Hoti
0
0
School of Pharmacy, Curtin University
,
Bentley, Perth 6845
,
Australia
Background: Home Medicines Review (HMR) is an Australian initiative introduced in 2001 to improve quality use of medicines. Medication management services such as HMRs have the potential to reduce medication related problems. In 2011, changes to the HMR program were introduced to allow for referrals directly to accredited pharmacists in addition to the community pharmacy referral model. These changes were introduced to improve efficiency of the process. This study explored the perceptions of Western Australian general practitioners (GPs) on benefits and barriers of the HMR service and process, including their insights into the direct referral model. Methods: Purposive sampling of GPs who had experience ensured that participants had a working knowledge of the HMR service. Semi structured interviews with 24 GPs from 14 metropolitan Western Australian medical centres between March and May 2013. Transcribing and thematic analysis of data were performed. Results: Most GPs had positive attitudes towards the HMR service. Main perceived benefits of the service were poly-pharmacy reduction and education for both the GP and patient. Strategies identified to improve the service were introduction of a standard HMR report template for pharmacists and better use of technology. Whilst reliability and GPs' familiarity were the main perceived benefits of the direct referral model, a number of GPs agreed that patient unfamiliarity with the HMR pharmacist was a barrier. Conclusions: Despite recognition of the value of the HMR service participating GPs were of the opinion that there are aspects of the HMR service that could be improved. As one of the success factors of HMRs is relying on GPs to utilise this service, this study provides valuable insight into issues that need to be addressed to improve HMR uptake.
-
Background
There is an increasingly high prevalence of
medicationrelated problems (MRP) in the Australian primary health
care setting [1-5]. The government has therefore
implemented a number of interventions to improve medication
management services. Home Medicines Reviews (HMR)
has been in place since 2001, introduced to improve
quality use of medicines [6]. It is a collaborative medication
review service that involves a referral from a general
practitioner (GP) to a community pharmacy or an
accredited pharmacist. The aim is to facilitate community-based
patients medication therapy and minimise the prevalence
of MRPs [7]. GPs plays a vital role in determining whether
patients are likely to benefit from this service as HMRs
require a referral from a GP. Previous literature indicated
that some GPs believe HMRs potentially improve
medication safety, awareness and management [8,9]. However,
others have expressed concerns regarding the complexity
of the HMR process, time constraints and inconsistency in
the reporting format and quality [6,10,11]. Considering the
variance in GP opinions towards HMRs, an understanding
of their attitudes and beliefs is integral in addressing
potential barriers in order to improve HMR uptake.
Prior to 2011, the only available option to refer a patient
for a HMR was to the patients nominated pharmacy. This
changed in 2011 whereby a second referral model directly
to accredited pharmacists was introduced to improve
efficiency of the process [12]. No research has been
conducted to determine whether this direct referral
model has improved HMR uptake.
Our aim was to explore Australian GPs' perceptions of
the benefits and barriers of the initial HMR process and
service as well as their perceptions of the new model. It
was anticipated that a better understanding of GPs'
attitudes towards the HMR service would inform the
development of strategies to improve the HMR process. The
objectives of this study were to obtain GPs perspectives
and views on:
1) The role and value of HMRs,
2) The most beneficial aspects of the HMR service
3) Strategies to improve the HMR process and
4) The direct HMR referral model to accredited pharmacists.
Methods
Low-risk ethical approval was granted by the Human
Research Ethics Committee of Curtin University (Approval
PH-O1-13). This study involved semi-structured interviews
with GPs practising in Perth, Western Australia (WA) who
had utilised the HMR service. Purposive sampling of GPs
who had experience ensured that participants had a
working knowledge of the service which added value to the data.
There were no pre-existing relationships between the
researchers and the participants. This study was carried out
by a final year pharmacy student (AD) under supervision
of three pharmacy practice academics who were also
experienced accredited pharmacists (LH, AS, KH).
Qualitative methodology was selected to allow for
in-depth exploration of participants views [13]. A
semistructured interview guide was developed (...truncated)