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Pharmacists sidelined leaving residents at risk, experts warn

Researchers from the University of South Australia are calling for an increase in on-site pharmacist visits for residential aged care.

Each month, one in five older people living in aged care homes has an adverse response to medication while over half of these cases are preventable. 

Medication-induced harm can be significantly reduced with regular pharmacist reviews, the study found.

The ReMinder trial received $2.8 million in funding from the Australian Department of Health and involved nearly 250 residents across 39 aged care homes.

"We found that at least 60 per cent of them had problems with medicines," co-researcher Dr Renly Lim says.

"Over the whole year, pretty much everyone had issues with their prescriptions. 

"Usually, after a GP prescribes something and the nurses give them, nobody sees whether there have been any adverse events. At the moment, pharmacists don't go into aged care regularly.

"So, having pharmacists coming in more often to review is very important."

During the 12-month intervention, pharmacists visited residents every eight weeks to monitor their medication use.

They made 309 recommendations, and two-thirds of residents were advised to cease or reduce their pharmaceutical consumption.

After the trial, the study found that people had fewer adverse effects from their medications and less cognitive deterioration. 

"This was likely due to recommendation by the pharmacist to stop medicines, such as anticholinergic and sedative medication, that increase the risk of cognitive impairment," Renly explains.

"We need to recognise that residents take a lot of medicines but are currently not supported well in making sure that the drugs they're taking are safe and effective.

"People in aged care are already quite frail, so they're at high risk of adverse events, but nobody really monitors these things."

Renly describes instances where residents are on proton pump inhibitors (medicines for reflux) for too long due to a lack of supervision.

"The recommendation is to use those medicines for about eight weeks, but many people in aged care are on long-term prescription without it being reviewed," she says.

"So they're at a higher and longer risk of obtaining adverse health effects using proton pump inhibitors and probably minimal benefits.

"Pharmacists don't only have the expertise to monitor and review, but also the ability to detect early signs of deterioration."

Pharmacists are trained to perform periodic residential medication management reviews (RMMR) to monitor and adjust residents' drug use.

Yet, research from 2019 suggests that residents are only visited every two years for RMMR.

One participant in a 2021 ReMinder study said that she'd "never seen a pharmacist since coming here, and I've been here for five years". 

Renly says that the study underscores the acute need for more in-house pharmacists to prevent harm in the aged care sector.

"Pharmacists have a very limited role in aged care," Renly says.

"Our data showed that only about 10% of the residents actually received the RMMR service. 

"So they are funded, but we know that it's very underutilised."

The Australian government recently set aside $345.7 million for on-site pharmacists to improve medication management, which is planned to commence from July 2023. 

Though Renly applauds the increase in funding, she recommends considering alternative options in aged care facilities.

"We put a lot of focus on medicines, but it's also important to think about better or nonpharmacological options that we can use to help with the resident's condition."

Renly hopes that they'll play a much more significant role in the future in reviewing and monitoring the effects of medicines in aged care.

"It's essential that we pay more attention to making sure medicines are used safely and effectively in aged care."

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