Table 2

Key differences between the home nursing clinical pharmacy model and the Australian HMR model*

ComponentsHome nursing clinical pharmacy modelHome Medicines Review model*
Referral to pharmacistDirect referral by community nursesRequires nurse to request client’s GP make a referral
Likelihood of pharmacist review following nurse referral/requestHighLow†
Timeliness of pharmacist reviewRapidSlow†
Home visit processHome visit by the clinical pharmacist alongside community nurseHome visit by the clinical pharmacist alone
Medication reviewAddresses the medication management and information needs of the community nurse‡ as well as the client/carer, GP and community pharmacistDoes not address the medication management and information needs of the community nurse‡
Medication review reportCopy provided to GP, community pharmacy and community nurseCopy not provided to community nurse
GP remunerationNo remuneration other than for standard patient consultations or other Government-funded items including case conference with pharmacist and nurseGP remunerated for initiating the HMR and preparing a medication management plan
Postmedication review follow-up and supportFollow-up and ongoing support for clients, carers, community nurses and other health providers to ensure medication issues are resolvedNo follow-up or ongoing medication management support available from the clinical pharmacist
Ad hoc advice about clients’ medication managementCommunity nurses able to contact clinical pharmacist at any time for adviceNot available
Indirect careAs summarised in table 1 Not available
  • *HMR is an Australian Government-funded pharmacist medication review programme.

  • †Low uptake of HMR due to poor acceptance of community nurse requests for an HMR and programme restrictions on frequency of HMR; delays due to need for GP to see the patient to obtain consent and then make referral to an HMR pharmacist.

  • ‡Information needs of community nurses may include: assistance with clarifying ambiguous or complex medication treatment authorisations and addressing discrepancies with clients’ medicines; targeted regimen simplification (where appropriate) to minimise home nursing visits; assistance with sourcing updated medication treatment authorisations; advice about medicines storage and administration; advice about monitoring medication outcomes and adverse effects.

  • GP, general practitioner; HMR, Home Medicines Review.