Concerns over underuse of crucial program


Medication reviews are conducted for only a fraction of people who enter residential aged care, a new study has found

While most residential aged care residents could benefit from RMMRs, fewer than one in five receive one within three months of entry, Australian researchers have found.

A team led by Dr Janet Sluggett, from the University of South Australia and the Centre for Medicine Use and Safety, Monash University, Melbourne, examined time to first RMMR after RACF entry among a national cohort.

The study population included 176,390 residents across 2799 residential aged care facilities (RACF).

In the year before entering the RACF, residents received a median of 11 unique prescription medications, and 62% had received at least one high-risk medication.

Only 4.5% had received HMRs in the 12 months prior to RACF entry.

Among non‐Indigenous people aged 65 years or more who first entered permanent residential care between 1 January 2012 and 31 December 2015, less than one fifth (19.1%) had received RMMRs by three months after entry.

During that same time, nearly 12% had died without RMMRs, and 5.7% had left their RACF for other reasons without RMMRs.

At 12 months, less than half (43.1%) had received RMMRs, a fifth (20.6%) had died without RMMRs, and 9.0% had left without receiving RMMRs.

By 24 months, still less than one half of the study population (49.7%) had received RMMRs, 25.8% had died without RMMRs, and 10.2% had left their first RACF for other reasons without receiving RMMRs.

Potential underuse of the program may be a “missed opportunity” for identifying and resolving medication‐related problems in Australian RACFs, said the researchers in the Medical Journal of Australia.

Previous studies have found that RMMRs by accredited pharmacists and GPs identify a mean of 2.7–3.9 medication‐related problems per resident.

“The high burden of medication use at the time of RACF entry suggests that most residents could have benefited from RMMRs, but MBS claims for RMMRs were lodged for fewer than one in five residents within three months of RACF entry, and fewer than one in two within two years,” they wrote.

Dr Sluggett told AJP: “It is recommended that generally all residents should receive an RMMR on entry to an RACF, and then when the resident’s clinical circumstances change, for example, due to hospitalisation, falls, initiation of a new medicine or an adverse drug event is suspected.

“But we found that most residents are missing out on this service when they enter an RACF.”

Pharmacists need to work closely with GPs and senior nurses at the RACF, and Medication Advisory Committees to identify and address local barriers to RMMR provision, said Dr Sluggett.

“Embedding pharmacists within RACFs will enable us to provide services for individual residents but also to directly contribute to clinical governance activities to mitigate risks among all residents in the RACF,” she said.

“Our results also highlight need to be more proactive with medicines reviews and other services in older people living at home to iron out any issues as early as possible,” Dr Sluggett added.

“Only 4.5% of residents received a Home Medicines Review in the year before RACF entry but it is likely that more could have benefited.”

Read the full article here

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