Provision of a comprehensive medicines review is associated with lower mortality risk for residents of aged care facilities: a retrospective cohort study

Abstract

Background no studies have examined the impact of residential medication management review (RMMR, a 24-year government subsidised comprehensive medicines review program) in Australian residential aged care facilities (RACFs) on hospitalisation or mortality. Objective to examine associations between RMMR provision in the 6–12 months after RACF entry and the 12-month risk of hospitalisation and mortality among older Australians in RACFs. Design retrospective cohort study. Subjects individuals aged 65–105 years taking at least one medicine, who entered an RACF in three Australian states between 1 January 2012 and 31 December 2015 and spent at least 6 months in the RACF (n = 57,719). Methods Cox regression models estimated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for associations between RMMR provision and mortality. Adjusted subdistribution hazard ratios were estimated for associations between RMMR provision and next (i) emergency department (ED) presentation or unplanned hospitalisation or (ii) fall-related ED presentation or hospitalisation. Results there were 12,603 (21.8%) individuals who received an RMMR within 6–12 months of RACF entry, of whom 22.2% (95%CI 21.4–22.9) died during follow-up, compared with 23.3% (95%CI 22.9–23.7) of unexposed individuals. RMMR provision was associated with a lower risk of death due to any cause over 12-months (aHR 0.96, 95%CI 0.91–0.99), but was not associated with ED presentations or hospitalisations for unplanned events or falls. Conclusions provision of an RMMR in the 6–12 months after RACF entry is associated with a 4.4% lower mortality risk over 12-months but was not associated with changes in hospitalisations for unplanned events or falls.

Registry of Senior Australians (ROSA): integrating cross-sectoral information to evaluate quality and safety of care provided to older people

“…Despite a high burden of medicines use in this population, and some evidence of benefits in reducing use of certain medicine classes and impact on health, we have found that Home Medicines Reviews and Residential Medication Management Reviews (RMMRs) (ie, comprehensive medicines reviews conducted by pharmacists in collaboration with general practitioner) are underutilised among aged care recipients 9. Specifically, we have reported modest changes in the use of six out of 14 medicine classes after an RMMR and a 4.4% lower mortality risk in those who received a RMMR 37. However, only one in five residents received a medication review within three months after entering an RACF and only 3.0% of home care package recipients received a review annually,36 despite recommendations for these services 31 38…”

“… 9 Specifically, we have reported modest changes in the use of six out of 14 medicine classes after an RMMR and a 4.4% lower mortality risk in those who received a RMMR. 37 However, only one in five residents received a medication review within three months after entering an RACF and only 3.0% of home care package recipients received a review annually, 36 despite recommendations for these services. 31 38 …”

Primary, allied health, geriatric, pain and palliative healthcare service utilisation by aged care residents, 2012–2017

“…6,7 Health assessments, GP management plans and team care arrangements for older people receiving home care packages or medication reviews for people living in permanent residential aged care (PRAC) have been found to be associated with lower mortality rates. 8,9 Despite the Australian Medical Association's 2018 Position Statement calling for a national evaluation of the access and effectiveness of primary care services in the care of older people to ensure their needs are being met, no such evaluation has occurred to date. 10 In addition, given the recent Australian Government investments in aged care 11 and primary health care reforms, 12 an understanding of the access and trends in the use of primary, allied health and specialist services by Australian aged care recipients is necessary for future reform evaluation.…”

Exploring Australian pharmacists’ perceptions and practices towards reducing the risk of medicines-related harm in aged care residents

“…A pharmacist-conducted medication review is a common intervention for reducing medicines-related harm in aged care residents (Ali et al, 2021). A previous study in Australia reported that the provision of pharmacist-led medication reviews appears to decrease the risk of mortality in residents (Sluggett et al, 2022). Evidence also indicates that the lack of accessibility to pharmacists is an important factor affecting the rational use of medicines in RACFs (Al-Jumaili and Doucette, 2017).…”