Lack of accountability blamed for dangerous polypharmacy and preventable deaths   

New research suggests a rivalry between industry bodies as to who should be in charge of medication reviews is leading to preventable hospitalisations and deaths of people in aged care homes.

Up to 91 per cent of aged care residents are on five or more different medications and close to 75 per cent are taking over nine different types of drugs. 

Yet, almost half of the prescribed medication is considered inappropriate for the resident and causes one in five hospitalisations. 

Dr Amy Page from The University of Western Australia says regular medication reviews can prevent this issue but are not fully optimised in residential care due to industry bodies' reluctance to take responsibility.

"There are so many different competing bodies, and everybody's so stretched," Page says.

"A lot of different people think it's somebody else's responsibility.

"We must move to a situation where everybody is taking responsibility for reviewing medications regularly."

Calling it a "major public health concern", her recent research highlights the continuing issue of medication-induced harm and polypharmacy for people in residential aged care. 

Page says that each industry body is coming across different roadblocks when it comes to facilitating medication reviews.

"Pharmacists bemoan the fact that their recommendations to the GP aren't implemented," she says.

"The GPs feel like they can't implement these recommendations or have the courage of de-prescribing because they're medicines that the specialist has started or is perceived as managing. 

"And the specialist doesn't think that it sits with them, but with the GP, to have that whole-of-person view of the medicines regimen." 

Similarly, hospitals report that something should be done in the community because "they're only looking at the acute event", Page says.

Over 250,000 hospital admissions each year are caused by medicine-related harm, costing the healthcare sector more than $1.4 billion.

However, interventions to address the issue have been unsuccessful because of this reluctance to take responsibility. 

"So many people are affected by suboptimal medicine regimens," she says.

"It's vital when we've got so many people who are impacted that we do take action to try and reduce the potential for harm because medicines also have the potential for benefit."

She's a firm believer in empowering consumers to make it a priority with their healthcare professionals.

"Consumers need to know what questions to ask or have the resources or the tools to be able to question it," she says.

"But it's tough to ask questions when you don't know what questions to ask."

Page recommends the list of questions from the Australian not-for-profit organisation NPS MedicineWise, which was created to help reduce over-medicalisation. 

Dr Janet Sluggett from the University of South Australia agrees that frequent talks between consumers and health professionals are valuable.

She recently found that residents had a 5 per cent lower risk of death if they'd received a medication review every 12 months.

"We know these reviews can successfully identify and resolve some of these problems with medicines," Sluggett says.

"However, they are not being utilised in residential care, although it has been recommended for all people when they enter an aged care facility and when their clinical circumstances change."

Sluggett's study, funded by the Australian Association of Consultant Pharmacy, came in response to the Aged Care Royal Commission's recommendation to look closer at the evidence behind the medication review programme.

The study revealed that, on average, medication reviews identify between 2.7 and 3.9 medicine-related problems, yet, four out of five residents are missing out on those meet-ups despite being eligible. 

She emphasises that many factors are at play regarding polypharmacy and medication-induced harm.

"It's a very complex process where many barriers can arise across each step," she says.

"So that's very likely the reason why we're seeing limited uptake of the review service in residential care."

The "right" process starts with someone receiving a referral and then undertaking a review. They are then provided with recommendations before being incorporated into a medication management plan.

But complications and communication issues along the way can prevent people’s medications being reviewed.

Particularly when someone goes into residential aged care, Sluggett says, as many residents get a new GP and will receive care from new staff who may not have the resident's full medical background information.

"Or they might be receiving medicines dispensed from a new pharmacy or have been in hospital before they come into residential aged care," she explains.

"So, all of those factors can mean that medicines change on entry.

"And we know that when a person goes through a transition of care, it can be a riskier period in terms of medication use."

Sluggett is calling for better communication between the industry bodies to prevent medication-induced harm.

"A key component of this is building strong relationships between pharmacists, GPs and providers, together with residents and their families, so that all parties are on the same page," she says.

The government has announced funding for a new program to support pharmacists working onsite in aged care facilities, starting from January 2023.

Pharmacists will be able to work onsite more often in aged care homes while facilitating collaboration between the pharmacists and other care team members. 

Sluggett says she's looking forward to the implementation of the new program.

"Then they're on the ground to provide more resident care and improve health outcomes for residents," she says.

"But we're also still encouraging residents to ask for frequent medication reviews and for GPs, pharmacists and aged care providers to think about which of their residents could potentially benefit from a review."

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