Medicines use before and after comprehensive medicines review among residents of long-term care facilities: a retrospective cohort study

Abstract

Background Residential Medication Management Review (RMMR) is a subsidized comprehensive medicines review program for individuals in Australian residential aged care facilities (RACFs). This study examined weekly trends in medicines use in the four months before and after an RMMR and among a comparison group of residents who did not receive an RMMR. Methods This retrospective cohort study included individuals aged 65 to 105 years who first entered permanent care between 1/1/2012 and 31/12/2016 in South Australia, Victoria, or New South Wales, and were taking at least one medicine. Individuals with an RMMR within 12 months of RACF entry were classified into one of three groups: (i) RMMR within 0 to 3 months, (ii) 3 to 6 months, or (iii) within 6 to 12 months of RACF entry. Individuals without RMMRs were included in the comparison group. Weekly trends in the number of defined daily doses per 1000 days were determined in the four months before and after the RMMR (or assigned index date in the comparison group) for 14 medicine classes. Results 113909 individuals from 1979 RACFs were included, of whom 55021 received an RMMR. Across all three periods examined, decreased use of statins and proton pump inhibitors was observed post-RMMR in comparison to those without RMMRs. Decreases in calcium channel blockers, benzodiazepines/zopiclone, and antidepressants were observed following RMMR provision in the 3–6 and 6–12 months after RACF entry. Negligible changes in antipsychotic use were also observed following an RMMR in the 6–12 months after RACF entry by comparison to those without RMMRs. No changes in use of opioids, ACE inhibitors/sartans, beta blockers, loop diuretics, oral anticoagulants, or medicines for osteoporosis, diabetes or the cognitive symptoms of dementia were observed post-RMMR. Conclusions For six of the 14 medicine classes investigated, modest changes in weekly trends in use were observed after the provision of an RMMR in the 6–12 months after RACF entry compared to those without RMMRs. Findings suggest that activities such as medicines reconciliation may be prioritized when an RMMR is provided on RACF entry, with deprescribing more likely after an RMMR the longer a resident has been in the RACF.

The Impact of Pharmacist Medication Reviews on Geriatric Patients: A Scoping Review

“…A significant number of studies supporting a decrease in the rates of DRPs and PIMs were of particular interest, thus prompting this study to examine the characteristics of the included articles. There was no substantial variation in sample sizes across the selected articles, except for the study by Sluggett et al 8) which was conducted with a large sample size of 11,309 participants. This variation is attributed to the cohort study design employed in the study.…”

“…Most articles included in this review indicated that pharmacists' medication reviews did not significantly affect the rate of hospitalization (Table 3). 8,11,12,17,18,21, Most articles discussing hospitalization focused on medication re-views without any additional interventions. However, three studies by Kua et al 29) in 2020, Santolaya-Perrín et al, 30) and Zwietering et al 31) included other healthcare professionals such as geriatricians and nurses as part of the medication review process.…”

National surveillance using a clinical quality indicator for prolonged antipsychotic use among older Australians with dementia who access aged care services

“…Comprehensive medicines reviews are one potential strategy to limit antipsychotic initiation and trigger deprescribing. However, few individuals accessing HCP or PRAC receive comprehensive medicines reviews, 57 and the modest impact this stand‐alone intervention has on overall antipsychotic use suggests additional supportive interventions may be required 58 . There is some evidence that multifaceted interventions informed by behavior change theories can support successful withdrawal of antipsychotics in PRAC settings 46,59 and resources to guide review, tapering and withdrawal are available 60,61 .…”

“…Additional limitations included the inability to ascertain appropriateness of antipsychotic use, use for managing symptoms at end‐of‐life, or reasons for cessation. Consistent with other analyses of prescription claims data that do not capture dosing instructions, 35,58 prescription durations were derived from claims data (based on the number of days in which three‐quarters of individuals receive a prescription refill) to estimate antipsychotic duration of use; hence overestimation or underestimation is possible. Our analysis presumes that all medicines dispensed were consumed which means exposure misclassification is also possible for (i) individuals who ceased treatment and did not consume the full quantity dispensed or (ii) those who restarted therapy soon after treatment cessation.…”