Antipsychotic use not budging, may be higher

The latest quality indicator report in residential aged care indicates there has been no significant change in antipsychotic use since a national prevalence study was conducted seven years ago. 

The July-September 2021 report on the National Aged Care Mandatory Quality Indicator Program is the first to include quality indicators for medication management as it was added to the program last July.

The report, which is based on data collected from 2,410 aged care services, found that 21.6 per cent of residents used an antipsychotic during the seven-day assessment period in the quarter.

It’s a similar result to a 2014-15 University of Tasmania national study on antipsychotic prevalance, said Associate Professor Juanita Breen, who developed the successful Reducing Use of Sedatives (RedUSe) program to reduce antipsychotic and benzodiazepine use in residential aged care.

“We found 21.8 per cent of residents in each home were using these medications on a regular basis. This was using data from 150 homes in six states and one territory,” Dr Breen told Australian Ageing Agenda.

“Their sample was over 2,000 homes [in the second half] of 2021. And yet our prevalence of antipsychotic use was almost identical. There does not appear to have been a significant change in six or seven years.”

QIs can help improve practice

Dr Breen said the USA has been reporting on quality indicators for nearly 10 years and considers it has driven down antipsychotic use markedly. She suspects the Australian QIs will do the same. However, it is possible the actual rate in Australia is higher than revealed in this first report.

“There is a caveat to this data though; we need to appreciate that these QIs are self-reported by homes. Research in the US has shown that under-reporting occurs by over a percentage point on average so the actual rate of use is probably slightly higher.”

Dr Breen said her research has found that many providers are unaware of the extent of antipsychotic use in their home. She said these QI readings were an ideal way for homes to benchmark their prescribing, see how they compare to others and monitor how their own use changes over time.

“If rates are higher than 21 per cent – the national average – then the home needs to question why as a matter of priority. Ask how long a resident has been taking them, could they possibly reduce use, and most importantly, is staff training needed on managing behaviour by non-drug alternatives?”

Polypharmacy an issue for two in five

The medication management QI also measures polypharmacy, which records the number of residents who were prescribed nine or more medications at the collection date in the quarter. According to the report, just over two in five residents fit this category (41 per cent).

“Again, I think the real figure would probably be higher. An important next step would be to see the proportion of these residents who had a Residential Medication Management Review, with a view to deprescribing,” Dr Breen said.

“Do these residents still need treatment such as aggressive cholesterol lowering and blood pressure medications? Do they need to be taking antipsychotics?” Reviewing and reducing use would positively impact two measures in one swoop, she said.

“These two QIs have strong potential to improve the quality of medicines used in residential care as they provide valuable tangible data on use – data that can be used as a key measure in quality improvement initiatives. Also they build on awareness of what may be inappropriate medication use.”

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