clinical focus
A SIMPLE FIX FOR A COMPLEX SYSTEM
Academics emphasise that there are many
unknowns as to whether the nudge method
is the best course of action in this case.
Dr Magda Raban, a senior research
fellow at Macquarie University’s Australian
Institute of Health Innovation, argues that
this approach by the Department of Health
may be too simplistic to use in a “complex
system” like aged care.
“The interim report from the aged care
royal commission also brings to light a lot of
evidence that facilities also make a lot of the
decisions around this.
“And the GP relies on the facilities in terms
of their decision-making about prescribing
as well. So, it’s a very complex system to be
putting this intervention in place,” Raban tells
Aged Care Insite.
These letters, she adds, may lead to
unforeseen consequences. GP visits to
RACFs are in decline, as some GPs feel they
are not compensated well enough. Further
scrutiny may affect whether GPs engage
with the aged care system at all, she says.
“There were similar letters sent about
opioid prescribing to GPs last year. And
there was anecdotal evidence that GPs were
saying, ‘Well, I’m not going to see these
high-risk patients anymore, or patients in
palliative care, because I don’t want to be
monitored for my prescribing of opioid use,
which is in my view appropriate because of
the cohort of patients I have’.”
Raban argues that nudge letters as part
of a wider strategy to fix the use of drugs
in aged care may work, but says the health
department should think about broadening
the list of players that it targets and how they
approach them, as a threatening approach
has been shown to negate any benefits a
nudge may have.
“It’s not necessarily that the nudge is not a
strategy or a part of a suite of strategies, but
we might be going about it the wrong way,”
she says.
“So, the people who are receiving these
letters, whether it be the facility or GP,
need to be confident about that data being
accurate, because that’s one of the other
concerns … So, there needs to be a certain
level of transparency about where the data
has come from, how it has been adjusted
for the cohort of patients or residents that
the person is treating. And it shouldn’t
come across as an aggressive strategy, but
obviously it’s one part of the fix.”
Last year the Pharmaceutical Society of
Australia (PSA) called for a national program
that would see pharmacists embedded in
aged care facilities.
A report by PSA showed that 98 per cent
of aged care residents have at least one
medicine-related incident and 50 per cent
are taking one inappropriate medicine.
PSA national president Dr Chris Freeman
argued that regular access to pharmacists
for residents and clinicians will help tackle
medical mismanagement and related harm.
“The health of the aged care sector
matters a great deal to pharmacists, and
many pharmacists already contribute to
activities and services to improve resident
safety and system changes impacting on
quality and safety in RACFs,” he said. ■
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agedcareinsite.com.au 31