Home medicines review program: methods and outcomes MCQs With Answer

Introduction
Home Medicines Review (HMR) programs are pharmacist-led, patient-centred services designed to optimise medication use in the community by reviewing prescriptions, identifying drug-related problems, and improving outcomes. For M.Pharm students, understanding HMR methods and measurable outcomes is vital for practice in hospital and community pharmacy settings. This blog presents a focused set of multiple-choice questions that probe referral criteria, clinical tools, documentation, interprofessional communication, economic and clinical outcome measures, and study designs used to evaluate HMRs. The MCQs aim to reinforce key concepts, critical appraisal of evidence, and practical decision-making skills necessary for conducting and assessing effective home medicines review programs.

Q1. What is the primary objective of a Home Medicines Review (HMR) program?

• To provide emergency medications to patients at home
• To audit pharmacy dispensing records for billing accuracy
• To collaboratively identify and resolve medication-related problems to optimise therapy
• To replace general practitioner (GP) responsibility for prescribing

Correct Answer: To collaboratively identify and resolve medication-related problems to optimise therapy

Q2. Which professional usually initiates a referral for an HMR in countries with established HMR schemes?

• Hospital discharge nurse
• General Practitioner (GP)
• Community social worker
• Pharmacy technician

Correct Answer: General Practitioner (GP)

Q3. Which of the following methods is central to conducting an effective HMR visit?

• Random blood testing for therapeutic drug levels in all patients
• Comprehensive medication reconciliation and a patient-centred interview at home
• Providing a printed medication leaflet without discussion
• Only reviewing prescriptions in the pharmacy computer system

Correct Answer: Comprehensive medication reconciliation and a patient-centred interview at home

Q4. Which tool is commonly used to assess medication appropriateness during HMRs for older adults?

• Framingham Risk Score
• STOPP/START criteria
• APGAR score
• Glasgow Coma Scale

Correct Answer: STOPP/START criteria

Q5. What is a key clinical outcome often used to evaluate the effectiveness of HMR programs?

• Number of prescriptions dispensed per month
• Reduction in drug-related problems (DRPs) and adverse drug events
• Increase in pharmacy retail sales
• Percentage of patients refusing the HMR service

Correct Answer: Reduction in drug-related problems (DRPs) and adverse drug events

Q6. Which adherence assessment instrument might be used within an HMR to quantify patient self-reported medication-taking behaviour?

• MELD score
• MMAS (Morisky Medication Adherence Scale)
• Beck Depression Inventory
• APACHE II

Correct Answer: MMAS (Morisky Medication Adherence Scale)

Q7. During an HMR, which activity best represents deprescribing practice?

• Substituting a brand-name drug for a generic
• Systematic discontinuation or dose reduction of inappropriate medications
• Increasing the number of symptomatic medications
• Switching all oral medications to injectables

Correct Answer: Systematic discontinuation or dose reduction of inappropriate medications

Q8. Which outcome measure is most suitable for economic evaluations of HMR programs?

• Quality-adjusted life years (QALYs) and healthcare utilisation costs
• Number of pharmacist training hours
• Volume of medicines supplied
• Length of the HMR visit in minutes

Correct Answer: Quality-adjusted life years (QALYs) and healthcare utilisation costs

Q9. Which documentation is essential to share with the referring GP after completing an HMR?

• A copy of the patient’s supermarket receipts
• A structured HMR report including medication list, identified DRPs and recommendations
• Only the pharmacist’s personal notes with no recommendations
• A summarized promotional brochure about the pharmacy

Correct Answer: A structured HMR report including medication list, identified DRPs and recommendations

Q10. What is the role of risk stratification in targeting HMR services?

• To prioritise low-risk patients who need no follow-up
• To identify patients at higher risk of medication-related harm for targeted reviews
• To exclude patients with complex regimens
• To allocate patients based on proximity to the pharmacy only

Correct Answer: To identify patients at higher risk of medication-related harm for targeted reviews

Q11. Which study design provides the strongest evidence for causality when evaluating HMR effectiveness on clinical outcomes?

• Cross-sectional survey
• Randomised controlled trial (RCT)
• Case report
• Ecological study

Correct Answer: Randomised controlled trial (RCT)

Q12. Which metric specifically quantifies how many drug-related problems are identified per patient during an HMR?

• Medication Possession Ratio (MPR)
• DRP rate (number of DRPs per patient)
• Body Mass Index (BMI)
• International Normalised Ratio (INR)

Correct Answer: DRP rate (number of DRPs per patient)

Q13. Which legal/ethical consideration is critical before conducting a home medicines review?

• Prescribing a new drug without informing the GP
• Obtaining informed consent and ensuring patient privacy and confidentiality
• Publishing patient photos on social media
• Sharing the HMR report with neighbours

Correct Answer: Obtaining informed consent and ensuring patient privacy and confidentiality

Q14. Which communication strategy enhances uptake of pharmacist recommendations after an HMR?

• Sending an unsigned, unstructured email
• Face-to-face or telephone discussion with the GP using structured clinical recommendations
• Printing the report and leaving it at reception without follow-up
• Posting recommendations on public forums

Correct Answer: Face-to-face or telephone discussion with the GP using structured clinical recommendations

Q15. Which validated instrument can be used to measure medication regimen complexity in HMR evaluations?

• Medication Regimen Complexity Index (MRCI)
• Ranson criteria
• Charlson Comorbidity Index
• Harris Hip Score

Correct Answer: Medication Regimen Complexity Index (MRCI)

Q16. Which barrier commonly reduces the effectiveness or uptake of HMR services?

• High levels of interprofessional trust and collaboration
• Inadequate reimbursement and limited time for pharmacists
• Abundant patient engagement and scheduling flexibility
• Clear referral pathways and protocols

Correct Answer: Inadequate reimbursement and limited time for pharmacists

Q17. Which outcome indicates a successful HMR in terms of healthcare utilisation?

• Increased unplanned hospital admissions
• Reduced emergency department visits and hospital readmissions related to medications
• Higher number of polypharmacy prescriptions initiated
• Longer average length of hospital stay

Correct Answer: Reduced emergency department visits and hospital readmissions related to medications

Q18. Which analytic approach is appropriate for evaluating change in adherence before and after an HMR intervention?

• Paired statistical tests comparing pre- and post-intervention adherence scores
• Descriptive narration without quantitative comparison
• Comparing unrelated cross-sectional cohorts without baseline data
• Using only qualitative anecdotes from one patient

Correct Answer: Paired statistical tests comparing pre- and post-intervention adherence scores

Q19. Which is an important quality assurance activity for HMR services within a pharmacy or health service?

• Never reviewing or updating the HMR protocol
• Regular clinical audits, feedback, and continuing education for pharmacists
• Allowing untrained staff to perform clinical reviews
• Refusing to track outcomes or metrics

Correct Answer: Regular clinical audits, feedback, and continuing education for pharmacists

Q20. Which patient group is typically prioritised for HMRs because of higher medication-related risk?

• Young adults taking a single over-the-counter vitamin
• Elderly patients with polypharmacy and multiple comorbidities
• Individuals with no chronic conditions and no medications
• Healthy adolescents receiving routine vaccinations

Correct Answer: Elderly patients with polypharmacy and multiple comorbidities

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