The groups representing Australia’s pharmacists and community pharmacies have backed the aged care royal commission’s calls to strengthen the medication review program.
But the government has yet to confirm what it will or won’t commit to, and experts say additional measures are needed to address the cultural change needed.
In their interim report released last week, Commissioners Richard Tracey and Lynelle Briggs called on the Government to take immediate action to respond to the significant over-reliance on chemical restraint in aged care including through the seventh Community Pharmacy Agreement now being negotiated.
The commissioners suggest the Australian Government, the Pharmacy Guild of Australia and the Pharmaceutical Society of Australia review the effectiveness of the Residential Medication Management Review program and make it stronger and more accessible (read more here).
The program provides for pharmacists to examine and advise on the use of prescribed medications for aged care residents.
The commissioner’s suggestions include lifting the cap on funding to enable more frequent reviews, improving quality, and additional government-subsidised processes to support pharmacists to follow up on review recommendations.
Minister for Health Greg Hunt, who is the minister responsible for this area, announced on Friday that the health ministers’ agreement to make medication safety the 10th national priority was in response to the interim report (read more here).
However, he has not responded to the recommendations regarding the Community Pharmacy Agreement and RMMR program or to questions Australian Ageing Agenda sent on Monday about government’s support for the royal commissioners recommendations.
Pharmacists welcome RC’s recommendations
The Pharmacy Guild of Australia, which represents community pharmacies, and the Pharmaceutical Society of Australia, the peak national professional organisation representing all pharmacists, welcomed the commissioners’ recommendations.
Pharmacy Guild of Australia national president George Tambassis said he welcomed the Commissioners’ acknowledgement that pharmacists and the Community Pharmacy Agreement had a pivotal role in addressing the over-reliance on chemical restraint in aged care.
“We stand ready to take part in the proposed review of Residential Medication Management Reviews with the aim of ensuring the rules and eligibility requirements for these medication reviews are designed to achieve the best possible health outcomes for aged care residents,” Mr Tambassis said.
On how effective changes to the program will be, a spokesperson told AAA The Pharmacy Guild of Australia supported the review as recommended, but couldn’t pre-empt what that review may find or recommend.
Pharmaceutical Society of Australia national president Associate Professor Chris Freeman said it was clear the absence of regular pharmacist services in aged care facilities was causing harm.
“PSA members have told us they feel handcuffed by lack of funding and regulatory barriers which prevent them from protecting residents from the harms caused when medicines are not used in a safe and effective way,” Associate Professor Freeman said.
“PSA will act on the suggestions directed to us by the royal commission in the interim report. We will do everything we can to ensure residents are protected from the harms medicines are causing in aged care.”
Experts call for additional measures
Dr Juanita Breen, who led University of Tasmania’s successful Reducing Use of Sedatives program (RedUSe) in residential aged care, welcomed the commission’s early recommendations to reduce chemical restraint.
She said they could help in to address some aspects of the overuse of sedatives.
“It is a start and it’s certainly better than what is being done now. Because there are people making a lot of money out of doing really poor quality reviews and nobody is checking,” Dr Breen told AAA.
“The caps were put in there because of the poor quality,” she said.
Professor Joseph Ibrahim, head of the Health Law and Ageing Research Unit at Monash University, said the commissioners recommendations to strengthen the RMMR program were worthy.
However, they would have little impact on reducing the use of chemical restraint, he said.
In an article published in The Conversation, he said it would be of limited benefit because it failed to address the key contributing factors, such as acceptable cultures of practice and a lack of adequately trained and skilled staff.
“We can’t reduce the use of restraint with money alone; it will require a cultural shift in clinical and aged care practice. This includes having staff who understand the unique needs of a person with dementia and are trained to respond appropriately,” he wrote.
Dr Breen reiterated recent calls that the RedUse program provided a readymade and cost-effective program to improve education and culture within facilities (read more here).
“Elements of our program could be easily introduced into the pharmacy programs. They are proven,” she said.
“It just requires materials to be updated and you need to train the pharmacists to deliver them.
“We costed it. We could provide it to every aged care home in the next three years for under $2 million.”
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