The Australian Medical Association (AMA) has successfully lobbied against Recommendation 65 of the Royal Commission into Aged Care Quality and Safety Final Report which would have seen GPs restricted from prescribing antipsychotic medications in aged care.
The AMA welcomed the Pharmaceutical Benefits Advisory Committee (PBAC) recent decision not to recommend making amendments to the PBS listings of antipsychotic medication so that only a psychiatrist or a geriatrician could initially prescribe antipsychotics to aged care residents.
The care of older people in residential aged care facilities (RACFs) could have otherwise been severely compromised.
This decision reflects the AMA submission to PBAC which opposed the proposed restrictions on the basis that:
- It was a simplistic solution to the use of chemical restraints in aged care and failed to acknowledge the environmental factors that have driven the use of antipsychotics and would have made access to care for patients in nursing homes unnecessarily difficult.
- GPs are well qualified to prescribe these medications and it is the environment in which antipsychotics are prescribed that needs to change as opposed to the imposition of ill-considered restrictions on prescribing.
- Restricting antipsychotic prescriptions to geriatricians and psychiatrists would have created a bottleneck of care for residents in RACFs that are not appropriately set up to deal with the consequences.
- The Government must implement changes to aged care that support the delivery of high-quality care and that will in turn reduce the risk of inappropriate prescribing.
- The proposal was an attempt to deal with the symptoms of a broken aged care system while ignoring the causes.
- It is the AMA position that restrictive practices should only be used as a last resort – where any potential risk or harm caused by the restraint itself is less than the risk of the patient not being restrained.
- While non-pharmacological measures should be considered before the use of antipsychotics, which have a limited role in managing behaviour, some patients still have a legitimate need for them.
Following consultation with stakeholders, the PBAC considered Recommendation 65 was not implementable at present due to the substantial risk of unintended consequences.
The PBAC in making their decision noted that changes already made to the PBS restrictions for risperidone, the only medicine registered in Australia for the treatment of behavioural and psychological symptoms of dementia, have reduced utilisation.
The PBAC will continue to monitor the use of antipsychotics in aged care.
The recommendations from the November 2021 Pharmaceutical Benefits Advisory Committee (PBAC) meeting are now available.