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National trial of RedUSe program achieves 13 per cent drop in use of psychotropics


Inappropriate prescribing of psychotropic medications in residential aged care facilities can be reduced using proven intervention strategies, according to new University of Tasmania research.

Researchers found a significant reduction (13 per cent) in the use of psychotropic medication among residents following the introduction of the Reducing Use of Sedatives program (RedUSe) in 150 aged care facilities nationally.

The study, which involved 12,157 residents taking part in a six-month intervention between April 2014 and March 2016, builds on the findings of the longitudinal study published in March and in 2015 (read more here).

Almost 40 per cent of residents who were initially prescribed antipsychotics at the beginning of the study had ceased medication use or had reduced doses by the six-month intervention period, the research found.

Wicking Dementia Research Education Centre lead researcher Dr Juanita Westbury said there was a “significant reduction” in psychotropic use across the 150 aged care facilities.

Dr Juanita Westbury

“Out of 150 homes, 99 reduced the use of both agents [antipsychotic and benzodiazepines] in their facility and then we had another 48 homes that reduced the use of either one of the sedative agents,” Dr Westbury told Australian Ageing Agenda.

“We had the small number of homes, eight in total, that didn’t record a reduction,” she said.

Dr Westbury said the reduction of psychotropic medications was greater in the national project than in the 2010 pilot.

The success of the RedUSe program can be linked back to high attendance of training sessions, a large interest towards the topic, awareness from staff and organisations on the issue, having three healthcare professionals involved with the study and nurses being a part of the decision-making process on medication.

“Involvement of nurses is key, because they’re the people on the ground, they know the residents better than anyone, and they know at that point in time what behaviours they may have,” Dr Westbury said.

Providing structured activities for people with changed behaviours was a challenge reported during the implementation of the program, where “more training and more communication between a lot of the staff” were among the ways to address these difficulties, Dr Westbury said.

Dr Westbury compared the study with similar programs in the UK and the US, both having achieved lesser results than the RedUSe initiative in the six-month period.

“In the UK for instance, there’s been a big public awareness campaign, but no specific strategies or structures to do anything, so they didn’t really show much difference in some of their studies,” Dr Westbury said.

“In the US there’s public reporting and a lot more legislation has been adopted. But without structured education, they have reduced use, but it’s been a lot slower than our project.”

Call to implement RedUSe in all facilities

Key recommendations of research include making RedUSe available to all Australian aged care facilities and offering it as part of the federally-funded Quality Use of Medicines program for community pharmacists.

The research also recommends providing training to aged care staff nationally on managing behavioural and psychological symptoms of dementia, and particularly on non-medication alternatives.

Dr Westbury said she would like to see a structured program that regularly measures results every three-months implemented.

“We would love to be able to offer the program to homes that are really wanting education about these medications, but also perhaps targeting homes with really high use of antipsychotic medications,” Dr Westbury said.

Educational materials from the intervention will be made available on the Department of Health website mid-year.

The study, which has been published in the Medical Journal of Australia this month, is available here.

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