Similar to existing evidence, we found a higher risk of genital infection associated with SGLT2 inhibitors (primarily dapagliflozin) but no increased risk of UTIs compared to DPP-4 use.

National multifaceted programmes targeting clinicians and consumers were effective in reducing overall PPI use and increasing use of low strength PPIs. Interventions to improve PPI use should incorporate regular repetition of key messages to sustain practice change.

BackgroundPeople with dementia may be particularly sensitive to cognitive impairment induced by anticholinergic and sedative medicines.ObjectiveThis study aimed to examine if utilisation of medicines with anticholinergic and sedative effects changed before and after initiation of anti-dementia therapy.MethodsA retrospective cohort study was conducted using Australian pharmacy claim data (Pharmaceutical Benefit Scheme). People with first (index) dispensing for a cholinesterase inhibitor or memantine between 1 January 2009 and 31 December 2010 who were aged 65 years or over at the time of initiation were included. The proportion who received sedatives or anticholinergics in the 6 months prior to and post initiation of anti-dementia therapy was determined.ResultsThe cohort included 24,110 patients, with over half aged 75−84 years. Overall, 30 % received any class of anticholinergic or sedative medicine for at least 1 month in the 6 months prior to initiation of anti-dementia agents, and 36 % post initiation. Some patients (6 %) ceased anticholinergics or sedatives post initiation even though they had them in the months prior. However, 12 % commenced therapy with anticholinergics or sedatives post anti-dementia therapy initiation even though they were naïve to them in the 6 months prior to therapy.ConclusionMedicines with anticholinergic or sedative effects were commonly dispensed in one-third of people with dementia. Prescribers need to consider a review of patients on anticholinergic therapy with cholinesterase inhibitors as the effectiveness of the cholinesterase therapy may be compromised.

We conducted a literature review to assess the current status of general practitioner services in residential aged‐care facilities (RACFs) in Australia and the impact of recent initiatives to enhance access by RACF residents to these services. Of 400 publications identified, 22 were selected as relevant to our study. We also analysed publicly available statistical data on GP services in RACFs. Recent initiatives to improve quality of care and facilitate access to GP services for RACF residents include the Aged Care GP Panels Initiative, the Enhanced Primary Care program, and an expanded role of palliative care. Despite these initiatives, many GPs still find RACF services unappealing due to a perceived poor level of remuneration for the effort involved. Further improvements in access to and quality of GP services to RACFs may require new models of care delivery and financing.

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Oxycodone is frequently initiated for non-cancer pain without first trialing other analgesics. This highlights the need for prescribing practices to be reviewed in light of increasing concerns about adverse drugs events and death due to oxycodone, particularly in older people.

Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

Our study using records of individual patient unit dose supply, which represents the intended medication consumption schedule, shows high rates of concurrent use of antipsychotics and anti-dementia medicines and long durations of use. The use of antipsychotics in patients with dementia needs to be carefully monitored to improve patient outcomes.