More action needed: Psychotropic prescribing in Australian residential aged care

2018 ◽  
Vol 53 (2) ◽  
pp. 136-147 ◽  
Author(s):  
Juanita Westbury ◽  
Peter Gee ◽  
Tristan Ling ◽  
Alex Kitsos ◽  
Gregory Peterson
Keyword(s):  
New South ◽  
Care Facility ◽  
Aged Care ◽  
Residential Aged Care ◽  
Aged Care Facility ◽  
South Wales ◽  
Residential Aged Care Facility ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities

Objective: For at least two decades, concerns have been raised about inappropriate psychotropic prescribing in Australian residential aged care facilities, due to their modest therapeutic benefit and increased risk of falls and mortality. To date, the majority of prevalence data has been collected in Sydney exclusively and it is not known if recent initiatives to promote appropriate psychotropic prescribing have impacted utilisation. Thus, we aimed to comprehensively analyse psychotropic use in a large national sample of residential aged care facility residents. Method: A cross-sectional, retrospective cohort study of residents from 150 residential aged care facilities distributed nationally during April 2014–October 2015. Antipsychotic, anxiolytic/hypnotic and antidepressant utilisation was assessed, along with anticonvulsant and anti-dementia drug use. Negative binomial regression analysis was used to examine variation in psychotropic use. Results: Full psychotropic prescribing data was available from 11,368 residents. Nearly two-thirds (61%) were taking psychotropic agents regularly, with over 41% prescribed antidepressants, 22% antipsychotics and 22% of residents taking benzodiazepines. Over 30% and 11% were charted for ‘prn’ (as required) benzodiazepines and antipsychotics, respectively. More than 16% of the residents were taking sedating antidepressants, predominantly mirtazapine. South Australian residents were more likely to be taking benzodiazepines ( p < 0.05) and residents from New South Wales/Australian Capital Territory less likely to be taking them ( p < 0.01), after adjustment for rurality and size of residential aged care facility. Residents located in New South Wales/Australian Capital Territory were also significantly less likely to take antidepressants ( p < 0.01), as were residents from outer regional residential aged care facilities ( p < 0.01). Antipsychotic use was not associated with State, rurality or residential aged care facility size. Conclusion: Regular antipsychotic use appears to have decreased in residential aged care facilities but benzodiazepine prevalence is higher, particularly in South Australian residential aged care facilities. Sedating antidepressant and ‘prn’ psychotropic prescribing is widespread. Effective interventions to reduce the continued reliance on psychotropic management, in conjunction with active promotion of non-pharmacological strategies, are urgently required.

scholarly journals Integrating pharmacists into aged care facilities to improve the quality use of medicine (PiRACF Study): Protocol for a cluster randomised controlled trial

2020 ◽  
Author(s):  
sam kosari ◽  
Jane Koerner ◽  
Mark Naunton ◽  
Gregory M Peterson ◽  
Ibrahim Haider ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Medication Management ◽  
Care Facility ◽  
Cluster Randomised Controlled Trial ◽  
Aged Care ◽  
Residential Aged Care ◽  
Aged Care Facility ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities

Abstract BackgroundMedication management in residential aged care facilities is an ongoing concern. Numerous studies have reported high rates of inappropriate prescribing and medication use in aged care facilities, which contribute to residents’ adverse health outcomes. There is a need for new models of care that enhance inter-disciplinary collaboration between residential aged care facility staff and healthcare professionals, to improve medication management. Pilot research has demonstrated the feasibility and benefits of integrating a pharmacist into the aged care facility team to improve the quality use of medicines. This protocol describes the design and methods for a cluster randomised controlled trial to evaluate the outcomes and conduct economic evaluation of a service model where on-site pharmacists are integrated into residential aged care facility healthcare teams to improve medication management.MethodsIntervention aged care facilities will employ on-site pharmacists to work as part of their healthcare teams. Pharmacists will assume responsibility for medication management, and collaborate with facility nurses, prescribers, community pharmacists, residents and families to improve the quality use of medicines. The intervention will last for 12 months. Aged care facilities in the control group will continue usual care. The target sample size is 1,188 residents from a minimum of 13 aged care facilities. The primary outcome is the appropriateness of prescribing, measured by the proportion of residents who are prescribed at least one potentially inappropriate medicine according to the 2019 Beers Criteria. Secondary outcomes include hospital and Emergency Department presentations, fall rates, prevalence and dose of antipsychotics and benzodiazepines, Anticholinergic Cognitive Burden Score, staff influenza vaccination rate, time spent on medication rounds, appropriateness of dose form modification and completeness of resident’s allergy and adverse drug reaction documentation. A cost-consequence and cost-effectiveness analysis will be embedded in the trial.DiscussionThe results of this study will provide information on clinical and economic outcomes of a model that integrates on-site pharmacists into Australian residential aged care facilities. The results will provide policymakers with recommendations relevant to further implementation of this model.Trial registrationACTRN: ACTRN12620000430932, retrospectively registered with ANZCTR on 1 April 2020. Available from https://www.anzctr.org.au/TrialSearch.aspx#&&conditionCode=&dateOfRegistrationFrom=&interventionDescription=&interventionCodeOperator=OR&primarySponsorType=&gender=&distance=&postcode=&pageSize=20&ageGroup=&recruitmentCountryOperator=OR&recruitmentRegion=&ethicsReview=&countryOfRecruitment=&registry=&searchTxt=ACTRN12620000430932&studyType=&allocationToIntervention=&dateOfRegistrationTo=&recruitmentStatus=&interventionCode=&healthCondition=&healthyVolunteers=&page=1&conditionCategory=&fundingSource=&trialStartDateTo=&trialStartDateFrom=&phase=

Rehabilitation in Residential Aged Care Facilities: Barriers and Facilitators in a Dementia Context

2013 ◽  
Vol 19 (1) ◽  
pp. 57-63 ◽  
Author(s):  
Leander K. Mitchell ◽  
Nancy A. Pachana
Keyword(s):  
Care Facility ◽  
Aged Care ◽  
Communication Process ◽  
Residential Aged Care ◽  
Open Communication ◽  
Aged Care Facility ◽  
Potential Barriers ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities

This review of the literature sought to highlight key barriers to the implementation of rehabilitation-based interventions in an aged care facility context. It then identifies how such barriers might be actively countered with a view to facilitating rehabilitation-based strategies within such contexts. Key barriers identified included staffing issues, heterogeneity of residents, and the potential complexity behind establishing appropriate forms of rehabilitation for the residents. The most successful facilitators identified included training, the provision of appropriate support, and an open communication process. Having an awareness and an appreciation of potential barriers to the use of rehabilitation interventions in aged care facilities provides the opportunity to actively plan around them, thereby increasing and improving their use.

scholarly journals Integrating pharmacists into aged care facilities to improve the quality use of medicine (PiRACF Study): protocol for a cluster randomised controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sam Kosari ◽  
Jane Koerner ◽  
Mark Naunton ◽  
Gregory M. Peterson ◽  
Ibrahim Haider ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Medication Management ◽  
Care Facility ◽  
Cluster Randomised Controlled Trial ◽  
Aged Care ◽  
Residential Aged Care ◽  
Aged Care Facility ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities

Abstract Background Medication management in residential aged care facilities is an ongoing concern. Numerous studies have reported high rates of inappropriate prescribing and medication use in aged care facilities, which contribute to residents’ adverse health outcomes. There is a need for new models of care that enhance inter-disciplinary collaboration between residential aged care facility staff and healthcare professionals, to improve medication management. Pilot research has demonstrated the feasibility and benefits of integrating a pharmacist into the aged care facility team to improve the quality use of medicines. This protocol describes the design and methods for a cluster randomised controlled trial to evaluate the outcomes and conduct economic evaluation of a service model where on-site pharmacists are integrated into residential aged care facility healthcare teams to improve medication management. Methods Intervention aged care facilities will employ on-site pharmacists to work as part of their healthcare teams 2 to 2.5 days per week for 12 months. On-site pharmacists, in collaboration with facility nurses, prescribers, community pharmacists, residents and families will conduct medication management activities to improve the quality use of medicines. Aged care facilities in the control group will continue usual care. The target sample size is 1188 residents from a minimum of 13 aged care facilities. The primary outcome is the appropriateness of prescribing, measured by the proportion of residents who are prescribed at least one potentially inappropriate medicine according to the 2019 Beers Criteria. Secondary outcomes include hospital and emergency department presentations, fall rates, prevalence and dose of antipsychotics and benzodiazepines, Anticholinergic Cognitive Burden Score, staff influenza vaccination rate, time spent on medication rounds, appropriateness of dose form modification and completeness of resident’s allergy and adverse drug reaction documentation. A cost-consequence and cost-effectiveness analysis will be embedded in the trial. Discussion The results of this study will provide information on clinical and economic outcomes of a model that integrates on-site pharmacists into Australian residential aged care facilities. The results will provide policymakers with recommendations relevant to further implementation of this model. Trial registration ACTRN12620000430932. Registered on 1 April 2020 with ANZCTR

scholarly journals A multi-organisation aged care emergency service for acute care management of older residents in aged care facilities

2015 ◽  
Vol 39 (5) ◽  
pp. 514 ◽  
Author(s):  
Jane Conway ◽  
Sophie Dilworth ◽  
Carolyn Hullick ◽  
Jacqueline Hewitt ◽  
Catherine Turner ◽  
...  
Keyword(s):  
New South ◽  
Point Of Care ◽  
New South Wales ◽  
Aged Care ◽  
Residential Aged Care ◽  
Local Health ◽  
South Wales ◽  
Care Assessment ◽  
Care Facilities ◽  
Aged Care Facilities

This case study describes a multi-organisation aged care emergency (ACE) service. The service was designed to enable point-of-care assessment and management for older people in residential aged care facilities (RACFs). Design of the ACE service involved consultation and engagement of multiple key stakeholders. The ACE service was implemented in a large geographical region of a single Medicare Local (ML) in New South Wales, Australia. The service was developed over several phases. A case control pilot evaluation of one emergency department (ED) and four RACFs revealed a 16% reduction in presentations to the ED as well as reductions in admission to the hospital following ED presentation. Following initial pilot work, the ACE service transitioned across another five EDs and 85 RACFs in the local health district. The service has now been implemented in a further 10 sites (six metropolitan and four rural EDs) across New South Wales. Ongoing evaluation of the implementation continues to show positive outcomes. The ACE service offers a model shown to reduce ED presentations and admissions from RACFs, and provide quality care with a focus on the needs of the older person.

Exploring information technology (IT) sophistication in New South Wales residential aged care facilities

2020 ◽  
Vol 44 (2) ◽  
pp. 288
Author(s):  
Gregory L. Alexander ◽  
Andrew Georgiou ◽  
Joyce Siette ◽  
Richard Madsen ◽  
Anne Livingstone ◽  
...  
Keyword(s):  
Aged Care ◽  
Residential Aged Care ◽  
It Use ◽  
South Wales ◽  
Care Facilities ◽  
It Capabilities ◽  
It Integration ◽  
High Care ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities

Objective The aim of this study was to determine baseline information technology (IT) sophistication in New South Wales (NSW), Australia, residential aged care facilities. Method IT sophistication measures IT capabilities, extent of IT use and IT integration in two domains, resident care and clinical support. A survey was administered to all NSW residential aged care facilities (n = 876) between February and May 2017. A 15% response rate was achieved (130/876). Facilities were organised by organisational type, total residential places and remoteness. Using post-stratification weights, estimates of IT sophistication scores for NSW were determined. Regression was used to examine whether there was a linear relationship between IT sophistication and the ratio of residents receiving high care. Results Participating facilities were similar to other NSW facilities in residential places and remoteness, but different in organisational type. IT sophistication was highest in IT capabilities and integration in resident care. IT sophistication was lowest in clinical support. Respondents had a mean of 1.2 years of IT experience. IT sophistication varied among aged care facilities. There was a linear relationship (P &lt; 0.05) with the proportion of high-care residents and total IT sophistication Conclusion Routine reports of IT sophistication in aged care are not available. If data were available, determining the influence of IT sophistication on the quality care for residential aged care would be possible. What is known about the topic? Aged care settings that deliver care to the older population need to be contemporary in their approach to delivering high-quality and safe care. Health IT holds great potential for improving the quality and safety of care of older residents in aged care facilities. What does this paper add? This report provides a baseline assessment of IT capabilities, extent of IT use and IT integration, called IT sophistication, among aged care facilities with variable characteristics. What are implications for practitioners? Increasing IT sophistication has the potential to improve the quality of care delivered by aged care staff.

scholarly journals Residential aged care facility clinical placements for undergraduate paramedic students: An evaluation of the Australian experience

2015 ◽  
Vol 12 (2) ◽  
Author(s):  
Brigit Stratton ◽  
Emma Lea ◽  
Marguerite Bramble ◽  
Claire Eccleston ◽  
Mike McCall ◽  
...  
Keyword(s):  
Care Facility ◽  
Aged Care ◽  
Clinical Placement ◽  
Residential Aged Care ◽  
Clinical Placements ◽  
Palliative Approach ◽  
People With Dementia ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities

IntroductionThis paper presents an evaluation of the pilot aged care clinical placement undertaken by undergraduate paramedic students in the university-based Wicking Dementia Research and Education Centre’s Teaching Aged Care Facilities Program. The objective is to examine the learning experiences of students taking part in the first paramedic student clinical placement in Tasmania to be situated in the residential aged care environment. The students’ interactions with residents with dementia and with older people requiring a palliative approach to care are discussed, as key strategies to enhance paramedic student learning.MethodTwenty-one final year undergraduate paramedic students completed a 5-day (40 hour) clinical placement in September/October 2011, in two participating residential aged care facilities in Tasmania, Australia. Qualitative data were obtained from weekly feedback meetings with students, which were audio-recorded, transcribed, and subjected to content analysis. Quantitative data from pre and post-placement questionnaires were collected and descriptive analyses performed.ResultsThe data showed that students enjoyed interaction with residents and that this built their communication skills, particularly with residents with dementia. Students also learnt about the importance of a palliative approach to care and improved their knowledge of dementia.ConclusionA supported placement program for paramedic students in residential aged care facilitates student learning in a number of areas, particularly around working with people with dementia, which is likely to enhance student readiness for the graduate paramedic role. 

scholarly journals Optimising specialist geriatric medicine services by telehealth

2021 ◽  
Vol 27 (10) ◽  
pp. 674-679
Author(s):  
Helen M Haydon ◽  
Liam J Caffery ◽  
Centaine L Snoswell ◽  
Emma E Thomas ◽  
Monica Taylor ◽  
...  
Keyword(s):  
Geriatric Medicine ◽  
Care Facility ◽  
Aged Care ◽  
Systematic Evaluation ◽  
Residential Aged Care ◽  
Specialist Care ◽  
Care Facilities ◽  
Service Activity ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities

Telehealth can effectively increase access to specialist care and reduce the need for travel. The Geri-Connect service was established in 2017 to support people living in residential aged care facilities in regional Victoria, Australia. Using the Model for the Assessment of Telemedicine, an evaluation of the Geri-Connect service identified service activity patterns and factors associated with uptake. Service activity from 2017 to 2020 and 10 semi-structured, key stakeholder interviews were captured and analysed. Between 2017 and 2020, video consultations were provided to 53 residential aged care facilities. Sustained growth (over 178%) and strong stakeholder acceptance highlight the effectiveness of this telegeriatric service. Four recommendations provide opportunities to further enhance service delivery including: implementation of an integrated health information system; systematic evaluation of service impact on stakeholders and residents, auditing and subsequent provision of targeted training; and regular auditing of software and hardware. Additionally, the need to augment fixed room hardware with mobile telehealth systems would increase access for residents with mobility problems. Dedicated personnel of the centralised team are best suited to implementing the recommendations. Whilst the provision of routine telehealth services into residential aged care facilities is challenging, the Geri-Connect service demonstrates that telehealth can be effectively provided to residential aged care facility residents needing specialist geriatric care.

scholarly journals COVID-19 Australia: Epidemiology Report 25: Fortnightly reporting period ending 13 September 2020

2020 ◽  
Vol 44 ◽  
Author(s):  
Keyword(s):  
Public Health ◽  
New South ◽  
New South Wales ◽  
South Australia ◽  
Aged Care ◽  
Residential Aged Care ◽  
Public Health Response ◽  
South Wales ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities

Cumulatively to 13 September there have been 26,753 case notifications and 674 deaths. The number of new cases reported nationally this fortnight was 764, a 61% decrease from the previous fortnight (1,948). On average this represented 55 cases diagnosed each day over the reporting period, a decrease from 125 cases per day over the previous reporting period. 84% of all cases (640/764) were reported in Victoria, with a smaller number of cases reported from New South Wales (95), Queensland (22), Western Australia (4) and South Australia (3). In Victoria, 97% of cases (621) were locally acquired and were mostly reported from residential aged care facilities; and 3% of cases (19) were reported as under investigation at the date of extract this reporting period. Excluding Victoria, 124 cases were reported nationally, 32% (40) were overseas acquired; 65% (81) were locally acquired, predominantly in New South Wales (62); and 2% (3) of cases were under investigation at this time, all reported in Queensland. The continued decrease in new cases observed this fortnight in Victoria is likely associated with the enhanced public health measures that are currently in place in Victoria. Locally-acquired cases which were predominantly associated with several interconnected clusters continued to be reported in New South Wales. In Queensland, 82% of cases (18/22) were reported as locally acquired from two clusters associated with immigration centres or correctional facilities. A total of 6 deaths were reported from cases diagnosed in this reporting period—all from Victoria, all aged 50 years or older, three male and three female. Although testing rates have declined gradually over the past month they remain high at 14.5 tests per 1,000 population per week. The overall positivity rate for the reporting period was 0.13%. Victoria reported a positivity rate of 0.39% for this reporting period while in all other jurisdictions the positivity rate was 0.05% or lower. For this report, “In focus” is paediatric inflammatory multisystem syndrome temporally associated with SARS-COV-2 (PIMS-TS). A review of Australia’s public health response to COVID-19 (as at 13 September 2020) is at Appendix A.

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