General practitioners’ perceptions on home medicines reviews: a qualitative analysis

BMC Family Practice, Feb 2015

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.

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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)


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Amrith Dhillon, Hendrika Hattingh, Andrew Stafford, Kreshnik Hoti. General practitioners’ perceptions on home medicines reviews: a qualitative analysis, BMC Family Practice, 2015, pp. 16, 16, DOI: 10.1186/s12875-015-0227-8