National Trends and Policy Impacts on Provision of Home Medicines Reviews and Residential Medication Management Reviews in Older Australians, 2009–2019

Sluggett, Janet K.; Collier, Luke; Bartholomaeus, Jonathan; Inacio, Maria C.S.; Wesselingh, Steve; Caughey, Gillian E.

doi:10.3390/ijerph18189898

Cited by 6 publications

(10 citation statements)

References 22 publications

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“…Our finding that RMMRs were provided to only one in five residents (21.8%) who had not previously received this service and accessed RACF care for at least 6 months is consistent with previous research showing low RMMR uptake [ 20 , 23 , 28 , 47 ]. Our comprehensive examination of clinical outcomes linked with RMMR provision highlights opportunities for program refinements that could better target unplanned medicines-related hospitalisations.…”

Section: Discussionsupporting

confidence: 91%

“…Our comprehensive examination of clinical outcomes linked with RMMR provision highlights opportunities for program refinements that could better target unplanned medicines-related hospitalisations. Use of standardised report templates, decision support tools and digital health systems, increased input from RACF medicines advisory committees, remunerating pharmacists to participate in case conferences with GPs and RACF staff and enabling RMMR referrals from nurse practitioners have been previously suggested [ 47 ]. At present, there are only two process measures mandated for routine monitoring of the RMMR program (overall number of RMMRs provided and cost).…”

Section: Discussionmentioning

confidence: 99%

“…Limitations include possible underestimation of RMMR provision due to fewer claims being lodged by GPs ( n = 54,803 RMMR, n = 63,872 HMR claims in 2014–2015) than pharmacists ( n = 93,517 RMMR, n = 72,607 HMR claims in 2014–2015) [ 20 , 23 , 28 , 47 , 50 , 51 ], with any resulting bias towards the null. We were unable to ascertain RMMR quality, specific pharmacist recommendations or GP implementation of recommendations.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…GPs accept two thirds (64%) of recommendations focusing on medicines cessation, while 85–98% of recommendations not directly involving changes to medicines (i.e., referrals to other health professionals, pathology testing or education) are accepted by GPs [ 13 ]. Together, these findings indicate RMMR program changes and other system changes are needed to address known barriers, enhance service delivery, support interprofessional collaboration and incorporate new models of care [ 52 ] to support deprescribing in RACFs.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…Home Medicines Review (HMR) and Residential Medication Management Review (RMMR) are long-standing, Commonwealth-funded programs, yet the provision of timely HMRs and RMMRs to patients at risk of medication-related harm, both in general and after discharge from hospital, is unacceptably low. 6 HMRs and RMMRs are effective at identifying and resolving inappropriate medication use and other medication-related problems. Systematic reviews have found, on average, three or four medication-related problems in people receiving a HMR or RMMR.…”

Section: Home Medicines Review and Residential Medication Management ...mentioning

confidence: 99%

Hospital‐initiated post‐discharge medication reviews in Australia: expert opinion on the barriers and enablers to implementation

Angley¹,

Criddle

Rigby³

et al. 2022

Pharmacy Practice and Res

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Medication‐related harm can occur during transitions of care. Revised Home Medicines Review (HMR) and Residential Medication Management Review (RMMR) program rules were published in April 2020 which allowed provision for some hospital medical practitioners to refer at‐risk patients for medication review. In turn, the Society of Hospital Pharmacists of Australia's (SHPA's) Transitions of Care and Primary Care Leadership Committee developed a framework to support hospitals facilitating Hospital‐Initiated Medication Reviews (HIMRs) via three pathways: HMR, RMMR, and Hospital Outreach Medication Review. Following the compilation of draft barriers and enablers to implementation of the SHPA HIMR framework, refinement occurred after broad consultation with hospital‐ and primary care‐based pharmacists with transitions of care experience. The finalised list of barriers and enablers can inform broadscale implementation of the SHPA HIMR framework to reduce medication‐related harm when high‐risk patients transition from hospital to primary care and aged care.

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National Trends and Policy Impacts on Provision of Home Medicines Reviews and Residential Medication Management Reviews in Older Australians, 2009–2019

Cited by 6 publications

References 22 publications

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

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

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

Hospital‐initiated post‐discharge medication reviews in Australia: expert opinion on the barriers and enablers to implementation

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