Community pharmacists were “integral” to the success of a recent project published in the MJA, says the study’s lead author

A new study published this week in the Medical Journal of Australia reveals the results of a project that aimed to reduce antipsychotic and benzodiazepine prescribing in residential aged care facility (RACF) residents.

The Reducing Use of Sedatives (RedUSe) intervention achieved significant reductions in the proportions of RACF residents prescribed antipsychotics and benzodiazepines.

RedUSe was first piloted in Tasmania as a Pharmacy Guild Investigator-initiated grant under the Fourth Community Pharmacy Agreement in 2008, explains lead author Dr Juanita Westbury from the College of Health and Medicine, University of Tasmania.

It was subsequently funded by the Federal Government for national expansion to 150 aged care homes in six states and the ACT from 2014 to 2016.

Over 12,000 residents and 2000 nursing staff were involved.

The research team invited pharmacists providing Quality Use of Medicines (QUM) services to each RACF to deliver the RedUSe project, many of these being consultant pharmacists.

When the current QUM provider indicated that they lacked capacity to be involved, the researchers invited community pharmacists supplying the home to be involved instead.

Dr Westbury said that community pharmacists were “integral” to the project’s success.

“To start, prescribing data was collected from supply community pharmacies via their packing programs, validated by nursing staff and then used as the basis for a detailed benchmarked audit to identify usage patterns of antipsychotics and benzodiazepines in each home,” she tells AJP.

“This information was then presented by a pharmacist to aged care staff in a one-hour training session specially designed to challenge positive beliefs around the use of these medications. Finally, the pharmacist engaged in an interdisciplinary targeted ‘sedative’ medication review, alongside nursing staff and a GP, reviewing the use of these medications in residents prescribed them regularly.

“These QUM strategies were delivered at the beginning of the project and then again at three months.”

The results, published in the MJA on Monday, found that about 40% of those residents taking antipsychotics and benzodiazepines at the start of the project had agents ceased outright or doses reduced by six months.

Rates of benzodiazepine use experienced a relative reduction of use by 21% and antipsychotic rates of use dropped by 13% during the six-month intervention.

Out of the 150 homes involved, only eight did not report a reduction in psychotropic use, says Dr Westbury.

In comparison, a national antipsychotic reduction program in the US took over two years to achieve the same reduction in antipsychotic use that the RedUSe program achieved in six months, she says.

Benzodiazepine use during the US program also increased slightly, an effect that did not occur with RedUSe.

A total of 86 pharmacists around Australia attended RedUSe training so were prepared to deliver staff training and take part in the targeted sedative review process, in collaboration with nursing staff and each resident’s GP.

“We received feedback from nursing staff that they valued the opportunity to receive training about psychoactive medications from their community pharmacist or QUM pharmacist who they already had good working relationships with, rather than trainers they didn’t know,” says Dr Westbury.

“They also felt that the project enhanced their relationship with their pharmacist and that they could ask questions about other medications their residents were taking.”

Similar to the current 6th CPA QUM program, pharmacists did not have to be accredited to deliver RedUSe.

See the full study here