specialty focus
How much is enough ?
Lack of accountability blamed for dangerous polypharmacy .
By Elise Hartevelt
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 .
Meanwhile , 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 wholeof-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 .
“
There are so many different competing bodies , and everybody ’ s so stretched .
“ 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-forprofit 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 .
22 agedcareinsite . com . au