Aged care residents with dementia who change to new general practitioner upon entry are more likely to be prescribed psychotropic medications for the first time than residents with their usual or known GP, a dementia conference as heard.
The University of New South Wales study examined whether a change in GP upon entering residential care impacted the number of medicines dispensed generally and the number of antipsychotics, benzodiazepines and antidepressants specifically.
It included data from 2,250 new residents with a dementia diagnosis prior to entering residential care between January 2010 and June 2014 from the Sax Institute’s 45 and Up Study on health and ageing study in New South Wales.
It found that 44 per cent of new residents changed to a new GP, 28 per cent retained their usual GP and 28 per cent changed to a known GP, which refers to someone they have seen before but not their usual GP.
UNSW research fellow Heidi Welberry told the Australian Dementia Forum 2021 the study identified a relationship between changing GPs and an increase in medicines.
“A large proportion of psychotropic initiation occurs in a group of [residents] with dementia who are under the care of a GP that they have never seen before,” Ms Welberry told the Australian Dementia Forum.
The study found residents with a new GP were more likely to have a higher increase in new medications after six months (1.6 medicines on average) compared to residents with their usual GP (0.7) or known GP (0.8).
“The flow on effect of that was the new GP group had more people with polypharmacy and hyper polypharmacy, and the difference was particularly marked in the hyper polypharmacy measure,” Ms Welberry said.
This finding was consistent across antipsychotics, benzodiazepines and antidepressants too, the study found.
“The usual GP group had a lower proportion who were initiating [antipsychotics] medicine for the first time, which increased across the known group and was highest amongst the new GP group, and this was repeated for benzodiazepines and antidepressants,” she said.
Ms Welberry said there should be better processes to support the transfer of care between GPs and more support for GPs to retain their patients when a resident moves into aged care to help reduce prescribing rates.
“We suggest that any new model of primary care should consider the transition into care as an important part of establishing and maintaining high quality care,” Ms Welberry said.
The study received funding through the Australian Government Research Training Program scholarship and Maintain Your Brain, which is funded through the NHMRC Boosting Dementia Research Team Grant.
The research paper has been provisionally accepted for publication in the Medical Journal of Australia.
The Australian Dementia Forum 2021 took place on 31 March – 1 June.
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