Prioritizing interventions to manage polypharmacy in Australian aged care facilities

Jokanovic, Natali; Wang, Kate; Dooley, Michael; Lalic, Samanta; Tan, Edwin C.K.; Kirkpatrick, Carl M.; Bell, John

doi:10.1016/j.sapharm.2016.06.003

Cited by 41 publications

(44 citation statements)

References 27 publications

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“…Prescribing may have been performed by a small number of GPs or a single GP. The Victorian Government DHHS has identified a number of strategies to address polypharmacy, three of which are currently being implemented [ 53 ]. These include three new medication sub-indicators, creation of ‘deprescribing scripts’ to improve provider–resident communication about medication cessation, and optimizing the role of medication advisory committees.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Variability in Medications Contributing to Polypharmacy in Long-Term Care Facilities

Jokanovic

Jamsen

Tan

et al. 2017

Drugs - Real World Outcomes

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BackgroundResearch into which medications contribute to polypharmacy and the variability in these medications across long-term care facilities (LTCFs) has been minimal.ObjectiveOur objective was to investigate which medications were more prevalent among residents with polypharmacy and to determine the variability in prescribing of these medications across LTCFs.MethodsThis was a cross-sectional study of 27 LTCFs in regional and rural Victoria, Australia. An audit of the medication charts and medical records of 754 residents was performed in May 2015. Polypharmacy was defined as nine or more regular medications. Logistic regression was performed to determine the association between medications and resident characteristics with polypharmacy. Analyses were adjusted for age, sex and Charlson’s comorbidity index. Variability in the use of the ten most prevalent medication classes was explored using funnel plots. Characteristics of LTCFs with low (< 30%), moderate (30–49%) and high (≥ 50%) polypharmacy prevalence were compared.ResultsPolypharmacy was observed in 272 (36%) residents. In adjusted analyses, each of the top ten most prevalent medication classes, with the exception of antipsychotics, were associated with polypharmacy. Between 7 and 23% of LTCFs fell outside the 95% control limits for each of the ten most prevalent medications. LTCFs with ≥ 50% polypharmacy prevalence were predominately smaller.ConclusionPolypharmacy was associated with nine of the ten most prevalent medication classes. There was greater than fourfold variability in nine of the ten most prevalent medications across LTCFs. Further studies are needed to investigate the clinical appropriateness of the variability in polypharmacy.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Variability in Medications Contributing to Polypharmacy in Long-Term Care Facilities

Jokanovic

Jamsen

Tan

et al. 2017

Drugs - Real World Outcomes

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“…Adverse drug reactions (ADRs) are defined by the World Health Organization (WHO) as "a response to a medication that is noxious and unintended used in man to treat" [1]. ADRs could be a result of a preventable medication error, resulting in a side-effect as a result of medication administration, or an unforeseen error such as an allergic reaction [2,3].…”

Section: Introductionmentioning

confidence: 99%

Adverse drug reactions in primary care: a scoping review

Khalil

Huang

2020

BMC Health Serv Res

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Background: Medication-related adverse events, or adverse drug reactions (ADRs) are harmful events caused by medication. ADRs could have profound effects on the patients' quality of life, as well as creating an increased burden on the healthcare system. ADRs are one of the rising causes of morbidity and mortality internationally, and will continue to be a significant public health issue with the increased complexity in medication, to treat various diseases in an aging society. This scoping review aims to provide a detailed map of the most common adverse drug reactions experienced in primary healthcare setting, the drug classes that are most commonly associated with different levels/types of adverse drug reactions, causes of ADRs, their prevalence and consequences of experiencing ADRs. Methods: We systematically reviewed electronic databases Ovid MEDLINE, Embase, CINAHL Plus, Cochrane Central Register of Controlled Trials, PsycINFO and Scopus. In addition, the National Patient Safety Foundation Bibliography and the Agency for Health Care Research and Quality and Patient Safety Net Bibliography were searched. Studies published from 1990 onwards until December 7, 2018 were included as the incidence of reporting drug reactions were not prevalent before 1990. We only include studies published in English. Results: The final search yielded a total of 19 citations for inclusion published over a 15-year period that primarily focused on investigating the different types of adverse drug reactions in primary healthcare. The most causes of adverse events were related to drug related and allergies. Idiosyncratic adverse reactions were not very commonly reported. The most common adverse drug reactions reported in the studies included in this review were those that are associated with the central nervous system, gastrointestinal system and cardiovascular system. Several classes of medications were reported to be associated with adverse events. Conclusion: This scoping review identified that the most causes of ADRs were drug related and due to allergies. Idiosyncratic adverse reactions were not very commonly reported in the literature. This is mainly because it is hard to predict and these reactions are not associated with drug doses or routes of administration. The most common ADRs reported in the studies included in this review were those that are associated with the central nervous system, gastrointestinal system and cardiovascular system. Several classes of medications were reported to be associated with ADRs.

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“…Available evidence from studies in RACFs is more limited, but suggests the finding may extend to the RACF setting . Pharmacist‐led medication reconciliation was identified as the top priority for reducing polypharmacy in Australian RACFs by health professionals and consumers …”

Section: Introductionmentioning

confidence: 99%

Process, impact and outcomes of medication review in Australian residential aged care facilities: A systematic review

et al. 2019

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Objective: To systematically review literature reporting processes, impact and outcomes of medication review and reconciliation in Australian residential aged care facilities (RACFs). Methods: PubMed/MEDLINE, EMBASE, CINAHL, Informit Health and grey literature were searched from 1995 to July 2018. Studies reporting outcomes of a stand-alone medication review or reconciliation interventions in Australian RACFs were included. Results: Thirteen studies investigated medication review, eight of which studied Residential Medication Management Reviews (RMMRs). Five studies reported that medication reviews identified an average of 2.7-3.9 medication-related problems (MRPs) per resident. One study reported medication reviews had no impact on quality of life, hospitalisation or mortality, but was not powered to assess these. Three studies reported general practitioners' acceptance of pharmacists' recommendations to resolve MRPs, ranging between 45 and 84%. Conclusions: Medication review may be a useful strategy to identify and prompt resolution of MRPs. However, the impact on clinical and resident-centred outcomes remains unclear. K E Y W O R D Saged care, geriatric medicine, health services, medication review, medication therapy management, pharmacist interventionThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Practice ImpactThis review suggests that RMMRs identify 2.7-3.9 medication-related problems (MRPs) per resident and general practitioners (GPs) accept 45-84% of recommendations to resolve these MRPs. This highlights the value of pharmacists and GPs working together to optimise medication management in this setting.

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Prioritizing interventions to manage polypharmacy in Australian aged care facilities

Cited by 41 publications

References 27 publications

Prevalence and Variability in Medications Contributing to Polypharmacy in Long-Term Care Facilities

Prevalence and Variability in Medications Contributing to Polypharmacy in Long-Term Care Facilities

Adverse drug reactions in primary care: a scoping review

Process, impact and outcomes of medication review in Australian residential aged care facilities: A systematic review

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