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

Abstract 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...

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Main Authors: Janet K. Sluggett, Gillian E. Caughey, Tracy Air, Max Moldovan, Catherine Lang, Grant Martin, Stephen R. Carter, Shane Jackson, Andrew C. Stafford, Steve L. Wesselingh, Maria C. Inacio
Format: Article
Language:English
Published: BMC 2022-06-01
Series:BMC Geriatrics
Subjects:
Online Access:https://doi.org/10.1186/s12877-022-03187-0
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author Janet K. Sluggett
Gillian E. Caughey
Tracy Air
Max Moldovan
Catherine Lang
Grant Martin
Stephen R. Carter
Shane Jackson
Andrew C. Stafford
Steve L. Wesselingh
Maria C. Inacio
author_facet Janet K. Sluggett
Gillian E. Caughey
Tracy Air
Max Moldovan
Catherine Lang
Grant Martin
Stephen R. Carter
Shane Jackson
Andrew C. Stafford
Steve L. Wesselingh
Maria C. Inacio
author_sort Janet K. Sluggett
collection DOAJ
description Abstract 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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spelling doaj.art-a44e4333e4d547859dffc035897bdc1b2022-12-22T00:38:08ZengBMCBMC Geriatrics1471-23182022-06-0122111510.1186/s12877-022-03187-0Medicines use before and after comprehensive medicines review among residents of long-term care facilities: a retrospective cohort studyJanet K. Sluggett0Gillian E. Caughey1Tracy Air2Max Moldovan3Catherine Lang4Grant Martin5Stephen R. Carter6Shane Jackson7Andrew C. Stafford8Steve L. Wesselingh9Maria C. Inacio10University of South Australia, UniSA Allied Health and Human PerformanceUniversity of South Australia, UniSA Allied Health and Human PerformanceRegistry of Senior Australians, South Australian Health and Medical Research InstituteRegistry of Senior Australians, South Australian Health and Medical Research InstituteRegistry of Senior Australians, South Australian Health and Medical Research InstituteAustralian Association of Consultant Pharmacy, Australian Capital TerritorySchool of Pharmacy, Faculty of Medicine and Health, The University of SydneySchool of Pharmacy and Pharmacology, University of TasmaniaCurtin Medical School, Faculty of Health Sciences, Curtin UniversityRegistry of Senior Australians, South Australian Health and Medical Research InstituteUniversity of South Australia, UniSA Allied Health and Human PerformanceAbstract 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.https://doi.org/10.1186/s12877-022-03187-0Medication reviewMedication therapy managementPharmacistsDrug utilizationLong-term careNursing homes
spellingShingle Janet K. Sluggett
Gillian E. Caughey
Tracy Air
Max Moldovan
Catherine Lang
Grant Martin
Stephen R. Carter
Shane Jackson
Andrew C. Stafford
Steve L. Wesselingh
Maria C. Inacio
Medicines use before and after comprehensive medicines review among residents of long-term care facilities: a retrospective cohort study
BMC Geriatrics
Medication review
Medication therapy management
Pharmacists
Drug utilization
Long-term care
Nursing homes
title Medicines use before and after comprehensive medicines review among residents of long-term care facilities: a retrospective cohort study
title_full Medicines use before and after comprehensive medicines review among residents of long-term care facilities: a retrospective cohort study
title_fullStr Medicines use before and after comprehensive medicines review among residents of long-term care facilities: a retrospective cohort study
title_full_unstemmed Medicines use before and after comprehensive medicines review among residents of long-term care facilities: a retrospective cohort study
title_short Medicines use before and after comprehensive medicines review among residents of long-term care facilities: a retrospective cohort study
title_sort medicines use before and after comprehensive medicines review among residents of long term care facilities a retrospective cohort study
topic Medication review
Medication therapy management
Pharmacists
Drug utilization
Long-term care
Nursing homes
url https://doi.org/10.1186/s12877-022-03187-0
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