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=

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

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.

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 Multicentre stepped-wedge cluster randomised controlled trial of an antimicrobial stewardship programme in residential aged care: protocol for the START trial

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e046142
Author(s):  
Natali Jokanovic ◽  
Terry Haines ◽  
Allen C Cheng ◽  
Kathryn E Holt ◽  
Sarah N Hilmer ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Aged Care ◽  
Residential Aged Care ◽  
Stepped Wedge ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities ◽  
Start Trial ◽  
Randomised Controlled ◽  
Tract Infections

IntroductionAntimicrobial resistance is a growing global health threat, driven by increasing inappropriate use of antimicrobials. High prevalence of unnecessary use of antimicrobials in residential aged care facilities (RACFs) has driven demand for the development and implementation of antimicrobial stewardship (AMS) programmes. The Stepped-wedge Trial to increase antibiotic Appropriateness in Residential aged care facilities and model Transmission of antimicrobial resistance (START) will implement and evaluate the impact of a nurse-led AMS programme on antimicrobial use in 12 RACFs.Methods and analysisThe START trial will implement and evaluate a nurse-led AMS programme via a stepped-wedge cluster randomised controlled trial design in 12 RACFs over 16 months. The AMS programme will incorporate education, aged care-specific treatment guidelines, documentation forms, and audit and feedback strategies that will target aged care staff, general practitioners, pharmacists, and residents and their families. The intervention will primarily focus on urinary tract infections, lower respiratory tract infections, and skin and soft tissue infections. RACFs will transition from control to intervention phases in random order, two at a time, every 2 months, with a 2-month transition, wash-in period. The primary outcome is the cumulative proportion of residents within each facility prescribed an antibiotic during each month and total days of antibiotic use per 1000 occupied bed days. Secondary outcomes include the number of courses of systemic antimicrobial therapy, antimicrobial appropriateness, antimicrobial resistant organisms, Clostridioides difficile infection, change in antimicrobial susceptibility profiles, hospitalisations and all-cause mortality. Analyses will be conducted according to the intention-to-treat principle.Ethics and disseminationEthics approval has been granted by the Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/591). Research findings will be disseminated through peer-reviewed publications, conferences and summarised reports provided to participating RACFs.Trial registration numberNCT03941509.

scholarly journals Behavioural activation in nursing homes to treat depression (BAN-Dep): study protocol for a pragmatic randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e032421 ◽  
Author(s):  
Diana Velasquez Reyes ◽  
Hema Patel ◽  
Nicola Lautenschlager ◽  
Andrew H Ford ◽  
Eleanor Curran ◽  
...  
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Controlled Trial ◽  
Aged Care ◽  
Residential Aged Care ◽  
Behavioural Activation ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities ◽  
Randomised Controlled

IntroductionDepression is a common disorder among older people living in residential aged care facilities. Several trials have demonstrated the effectiveness of behavioural therapies in treating depressive symptoms in older adults living in the community and in residential aged care. Behavioural Activation is demonstrably effective even when delivered by non-specialists (staff without formal psychological training), although strategies for adapting its use in residential aged care facilities are yet to be explored. This study will determine whether training residential care staff in the use of a structured Behavioural Activation programme is more effective at decreasing depressive symptoms among older residents than internet-based training about depression recognition and management alone.Method and analysisThe behavioural activation in nursing homes to treat depression (BAN-Dep) trial is a pragmatic two-arm parallel clustered randomised controlled trial. It will recruit 666 residents aged 60 or older from 100 residential aged care facilities, which will be randomly assigned to the Behavioural Activation or control intervention. Staff in both treatment groups will be encouraged to complete theBeyondblueProfessional Education to Aged Care e-learning programme to improve their recognition of and ability to respond to depression in older adults. Selected staff from intervention facilities will undergo additional training to deliver an 8-module Behavioural Activation programme to residents with subthreshold symptoms of depression-they will receive ongoing Mental support from trained Behavioural Activation therapists. Outcome measures will be collected by blind research officer at baseline and after 3, 6 and 12 months. The Patient Health Questionnaire-9 is the primary outcome measure of the study.Ethics and disseminationThe trial will comply with the principles of the Declaration of Helsinki for Human Rights and is overseen by the University of Western Australia (reference RA/4/20/4234) and Melbourne Health (reference number HREC/18/MH/47) Ethics Committees. The results of this research project will be disseminated through publications and/or presentations in a variety of media to health professionals, academics, clinicians and the public. Only de-identified group data will be presented.Trial registrationACTRN12618000634279.

scholarly journals A qualitative study exploring issues related to medication management in residential aged care facilities

2017 ◽  
Vol Volume 11 ◽  
pp. 1869-1877 ◽  
Author(s):  
Mariani Ahmad Nizaruddin ◽  
Marhanis-Salihah Omar ◽  
Adliah Mhd-Ali ◽  
Mohd Makmor Bakry
Keyword(s):  
Qualitative Study ◽  
Medication Management ◽  
Aged Care ◽  
Residential Aged Care ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities

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. 

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