6.2 Medication management reviews, 75 years and older

A medication management review (MMR) is a comprehensive, structured assessment of a person’s medicines. It aims to:

• Help people get the most benefit from their medicines
• Minimise people’s risk of medicines-related harm.

MMRs that are subsidised under the Medicare Benefits Schedule (MBS) and include:

• Residential MMR (RMMR) for people in aged care homes
• Home Medicines Review (HMR) for people living at home.

RMMRs and HMRs are done in a collaborative way. Medical practitioners assess if a patient may benefit from a review, and a pharmacist carries out the review usually with the patient.

Many people who have an MMR are aged 75 years and over. This is because older people are more likely to have chronic diseases and be taking multiple medicines.

The appropriate rate of MMR services for older people is unclear.

In 2018–19:

• 96,533 people aged 75 years and over had at least one MBS-subsidised MMR, representing 5,392 people per 100,000 people aged 75 years and over (the Australian rate)
• The number of MBS-subsidised MMR services across 314 local areas ranged from 1,618 to 19,006 per 100,000 people aged 75 years and over
• The rate of MBS-subsidised MMR services was 11.7 times as high in the area with the highest rate compared with the area with the lowest rate
• Rates were higher in major cities than in other areas
• Rates generally increased with socioeconomic disadvantage in major cities and in outer regional areas
• Older age groups had more MMRs – the rate was 3,896 per 100,000 people aged 75–84 years, and 10,180 per 100,000 people aged 85 years and over.

Rates are standardised to remove age and sex differences between populations.

Variation in rates of MMR is likely to be due to differences in:

• Patient need – areas with higher rates of chronic disease are likely to have more people taking multiple medicines, and more people who may benefit from an MMR
• Access to services – MMRs may be less accessible outside major cities
• Clinical decision-making – not all GPs believe that MMRs have benefits
• Consumer awareness – not all consumers are aware of MMR services, or they may not want to have one.

Implement current recommendations for RMMRs in aged care homes.

Improve access to MMRs in rural and remote areas.

Improve collaboration between pharmacists and GPs, and encourage GPs to implement pharmacist recommendations after an MMR.

Develop indicators for audit and monitoring of MMRs in aged care homes.

Use evidence-based tools to support MMRs, including electronic decision support tools.

Improve consumer awareness about MMR programs.

The Commission consulted widely, but is solely responsible for making the recommendations; as such, the recommendations may not reflect the views of all contributors to the Atlas.

6a. The Commission, in collaboration with the Australian Government Department of Health, the Aged Care Quality and Safety Commission, NPS MedicineWise and relevant groups, to develop nationally consistent:

i. Guidance for people taking multiple medicines

ii. Guidance about the communication of reports to medical practitioners from Residential Medication Management Reviews and Home Medicines Reviews

iii. Measures for aged care homes to compare the percentage of residents who have received Residential Medication Management Reviews and the percentage of pharmacists’ recommendations, in line with the Commonwealth’s development of the National Aged Care Mandatory Quality Indicator Program

iv. Guidance for the establishment, governance, composition and operation of Medication Advisory Committees within aged care homes.

6b. The Australian Government Department of Health to investigate ways of collecting patient-level data on the supply of PBS medicines through the S100 Remote Area Aboriginal Health Services Program to gather accurate information about the use of medicines in rural and remote Aboriginal communities.

Download the Medication management review, 75 years and over section of the Atlas below, to read more about the context, data, key findings, interpretation, and addressing of variation for this clinical item:

Contents:

Context

• What is a medication review?
• Rules and guidelines for conducting RMMR and HMR
• Other types of MMRs
• Effectiveness of RMMR and HMR
• Factors influencing effectiveness of RMMR and HMR
• Rates of RMMR and HMR in Australia
• Why map rates of RMMR and MHR? 

About the data

What do the data show?

• Magnitude of variation
• Analysis by remoteness and socioeconomic status
• Analysis by age group

Interpretation

• Possible reasons for variation in rates of MMR
• Patient need
• Access to services
• Clinical decision-making

Promoting appropriate care

• Audit and monitoring
• Improving collaboration between pharmacists and GPs
• Use of evidence based-tools to support reviews
• Consumer awareness

Resources

Australian initiatives

References