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Tuesday, August 9, 2022

Medication reviews are frustratingly rare, more onsite pharmacies will hopefully change that

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New research from the Registry of Senior Australians (ROSA) at SAHMRI, funded by the Australian Association of Consultant Pharmacy (AACP), has linked medication reviews to a lower risk of death for aged care residents.

The study, led by Dr Janet Sluggett, pharmacist and senior research fellow at the University of South Australia, followed 57,719 residents living in aged care homes across Australia for up to a year, analysing whether they were hospitalised, went to the emergency department (ED), or died during that period.

“We found that individuals who had a medication review within a 12-month period had a 5 per cent lower risk of death,” Sluggett said.

“There was no difference in the risk of hospitalisation between residents who had a medication review and those who hadn’t; the impact was solely based on mortality rates.”

Dr Janet Sluggett, pharmacist and researcher, says that her latest project found that medication reviews are largely underused, despite reducing risk of patient mortality.

Only 22 per cent of residents involved in this study underwent a medication review, despite all of them being eligible to access the free service.

Previous studies have shown residents take an average of 10 medications each day, yet only one in five receive a medication review from a pharmacist, which typically identifies up to four problems per person.

Another recent ROSA study, also funded by the AACP, focusing on the differences in medication use before and after a review, found use of some medications decreased following a review.

“Reviews often show which medicines can be adjusted or stopped, reducing the burden on the resident and boosting the quality of care,” Sluggett said.

“There’s a clear link between getting a review and a reduction in the use of some medicines, such as those for reducing reflux, which are often taken for longer than needed.”

Currently, obtaining a medication review involves multiple steps, with a lack of an automatic referral system meaning elders and their carer’s must first seek a doctor’s referral.

A pharmacist then needs to visit the resident to make recommendations, before the doctor and nursing staff implement any changes.

“The aim should be to streamline this process to make it more easily accessible for all involved,” Sluggett said.

She added that a lack of awareness among GPs and aged care providers about the utility of medication reviews for residents is another barrier that needs to be addressed.

“A key component of this is building strong relationships between pharmacists, GPs and providers, together with residents and their families, so that all parties are on the same page, resulting in the highest possible level of care.

“We hope this will be facilitated by the Government’s recent announcement of $345.7 million in new funding for pharmacists to work onsite in aged care homes from January 2023.”

The study was completed in response to the recommendation from the Royal Commission into Aged Care Quality and Safety that called for the evaluation of the medication review system.

Grant Martin, AACP CEO, said the association felt it was crucial to support the ROSA studies to further progress Australia’s aged care system upgrades.

“The new evidence generated from this project enables accredited pharmacists to speak positively to the benefits of medication reviews in discussions with aged care residents and their doctors,” he said.

The research team is calling for medical practitioners to be more diligent in making referrals for medication reviews and encouraging aged care residents to be proactive in asking their GP for a review.

Better integration of pharmacy into the aged care system is currently a key focus of the Pharmaceutical Society of Australia (PSA).

In a recent white paper, the PSA highlighted some sobering statistics that support the need for greater pharmacist oversight of the medication taken by older Australians in care:

  • More than 95 per cent of people living in aged care facilities have at least one problem with their medicines detected at the time of a medicines review; most have three problems.
     
  • 50 per cent of people with dementia are taking medicines with anticholinergic properties (commonly used for incontinence or other conditions involving cramps or spasms), which can worsen confusion and other symptoms of dementia.
     
  • One fifth of people living in aged care are on antipsychotics; more than half use the medicine for too long.

“The data is clear. New approaches are needed to improve medicine use in aged care,” the report reads.

Dr Fei Sim, newly appointed president of the PSA, agreed that pharmacists must play an active role in the reform process.

“There’s more work to be done, and we need to work collaboratively to integrate pharmacists into the wider primary healthcare system,” she said.

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