Beyond Barriers: Developing an Optimised Workflow to Increase Home Medicines Review Uptake in Support at Home Recipients
Through Nominal Group Technique sessions with healthcare professionals, this study identified key enablers such as improved identification systems, education, and multidisciplinary communication to develop a multi-level workflow model aimed at increasing Home Medicines Review uptake among Support at Home recipients.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Medications are the most common tool doctors use to help people stay healthy, yet for older adults living at home, these same tools can sometimes cause more harm than good. When a person takes many different medicines at once, the risk of confusion, dangerous interactions, or simply forgetting to take a dose increases significantly. To prevent this, governments in places like Australia have created a specific service called a Home Medicines Review. This is a structured check-up where a doctor sends a patient to a specially trained pharmacist. The pharmacist looks closely at every pill the person takes, finds problems, and works with the doctor to create a safer plan. While this service is designed to keep people out of the hospital and living well, it is rarely used. Even among older adults who receive government support to live at home and who clearly need these reviews, only a tiny fraction actually receive one. The system exists, but it is not reaching the people who need it most.
A team of researchers set out to understand why this gap exists and how to fix it. They gathered a group of twenty-six healthcare workers, including doctors, pharmacists, and nurses, who work directly with older adults receiving home care. Instead of just asking them to fill out a survey, the researchers brought them together in a series of focused discussion sessions. In these meetings, the professionals were asked a simple but critical question: what would make it easier to get these medication reviews done for their patients? The researchers listened carefully as the group generated ideas, discussed them, and then voted on which solutions were the most important. This process allowed the team to move beyond general complaints and identify specific, actionable steps that could change how the system works.
The discussions revealed that the main reason so few people get these reviews is not a lack of interest, but a breakdown in how the system identifies who needs help. Currently, the process relies almost entirely on a doctor to notice that a patient needs a review and then make a formal referral. However, doctors are often too busy to spot every single patient who fits the criteria, and many other health workers, like nurses and pharmacists, are not allowed to start the process even though they see these patients every day. The group agreed that the most powerful way to improve the situation was to create a better system for finding the right patients. They suggested that nurses and pharmacists should be empowered to flag patients who need a review and pass that information to the doctor, rather than waiting for the doctor to find them on their own.
Beyond just finding patients, the healthcare workers identified two other major hurdles: a lack of knowledge about how the service works and poor communication between the different professionals involved. Many nurses and pharmacists did not fully understand the steps required to get a review started, and when they did refer a patient, the feedback they received was often vague. The researchers found that if the final report from the pharmacist was clearer and more focused on the specific medical needs of the patient, doctors would be much more likely to refer them in the future. The group also emphasized that everyone involved needs to understand their role. If nurses know they can help identify patients, and pharmacists know how to write reports that doctors find useful, the whole process becomes smoother.
To turn these ideas into reality, the researchers built a new map of how the service should work. They took the current, rigid process and redesigned it to include actions at three different levels. At the individual level, they proposed that every health worker should talk to patients about the benefits of a review and that reports should be written in a way that is easy for doctors to use. At the organizational level, they suggested that home care agencies should put simple screening tools into their daily routines, such as checklists that automatically alert staff when a patient's health changes or when they have been on a complex set of medicines for too long. At the highest level of government policy, they recommended changing the rules to allow nurses and pharmacists to play a bigger role in starting the referral process and to remove limits on how many reviews a pharmacist can do in a month.
The study concludes that fixing this problem requires a shift from a model where one person does all the work to a model where the whole team shares the responsibility. The researchers suggest that by spreading the task of finding patients across doctors, nurses, and pharmacists, and by making the paperwork and communication clearer, the number of older adults receiving these vital safety checks could increase significantly. This approach does not require inventing a new service or waiting for a miracle; it simply requires organizing the existing team to work together more effectively. By making small, practical changes to how they identify patients and talk to each other, the healthcare system can ensure that the people who need these reviews the most actually get them.
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