Sarita Y Lo1,2, Emily Reeve3,4, Amy T Page5,6,7, Syed Tabish R Zaidi8, Sarah N Hilmer9, Christopher Etherton-Beer5, Andrew McLachlan10, Lisa Pont11, Vasi Naganathan12. 1. Centre for Education and Research on Ageing, Concord Repatriation General Hospital and Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. Sarita.Lo@health.nsw.gov.au. 2. Laboratory of Ageing and Pharmacology, Royal North Shore Hospital and Northern Clinical School, Faculty of Medicine and Health, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia. Sarita.Lo@health.nsw.gov.au. 3. Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia. 4. Geriatric Medicine Research, Faculty of Medicine, and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada. 5. Western Australian Centre for Health and Ageing, University of Western Australia, Perth, WA, Australia. 6. Pharmacy Department, Alfred Health, Melbourne, VIC, Australia. 7. Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia. 8. School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK. 9. Laboratory of Ageing and Pharmacology, Royal North Shore Hospital and Northern Clinical School, Faculty of Medicine and Health, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia. 10. Sydney School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. 11. Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia. 12. Centre for Education and Research on Ageing, Concord Repatriation General Hospital and Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Abstract
BACKGROUND: Residential aged care facility (RACF) staff are well placed to identify opportunities for more appropriate prescribing. However, little is known about their views of polypharmacy, deprescribing and specific medications. OBJECTIVE: The objective of this study was to establish the beliefs and attitudes of RACF staff towards polypharmacy and medication use in residents. METHODS: A cross-sectional survey was conducted on RACF staff in metropolitan New South Wales, Australia using a self-administered questionnaire. The questionnaire was drafted based on the available literature and research team expertise and then piloted by a mixed group of 13 RACF staff. The final version of the questionnaire consisted of 28 questions. A total of 38 RACFs were contacted about the study. The questionnaire was distributed to eligible RACF staff between October 2017 and October 2019. The RACF staff were eligible if they provided direct patient care to residents or worked as a facility manager. Participants were excluded if they had insufficient English language skills. The results were presented in two groups, the nursing and care staff, using descriptive statistics. RESULTS: A total of 176 individuals from nine RACFs completed the questionnaire of whom 160 were eligible for study inclusion. Most considered polypharmacy to be five or more different tablets and capsules per day (95% nursing and 82% care staff respectively). A wide range of beliefs about medication use and deprescribing that centred on what constitutes appropriate polypharmacy was identified. Most thought that preventive medications were essential for residents. Most nurses agreed that sleeping tablets and pharmacological management of verbal aggression and wandering behaviours should be used less frequently whilst most care staff agreed that medications should be used more frequently to manage physical aggression. CONCLUSIONS: To successfully and sustainably optimise medication use in RACF residents, it is important to consider the variation in views of nurses and care staff.
BACKGROUND: Residential aged care facility (RACF) staff are well placed to identify opportunities for more appropriate prescribing. However, little is known about their views of polypharmacy, deprescribing and specific medications. OBJECTIVE: The objective of this study was to establish the beliefs and attitudes of RACF staff towards polypharmacy and medication use in residents. METHODS: A cross-sectional survey was conducted on RACF staff in metropolitan New South Wales, Australia using a self-administered questionnaire. The questionnaire was drafted based on the available literature and research team expertise and then piloted by a mixed group of 13 RACF staff. The final version of the questionnaire consisted of 28 questions. A total of 38 RACFs were contacted about the study. The questionnaire was distributed to eligible RACF staff between October 2017 and October 2019. The RACF staff were eligible if they provided direct patient care to residents or worked as a facility manager. Participants were excluded if they had insufficient English language skills. The results were presented in two groups, the nursing and care staff, using descriptive statistics. RESULTS: A total of 176 individuals from nine RACFs completed the questionnaire of whom 160 were eligible for study inclusion. Most considered polypharmacy to be five or more different tablets and capsules per day (95% nursing and 82% care staff respectively). A wide range of beliefs about medication use and deprescribing that centred on what constitutes appropriate polypharmacy was identified. Most thought that preventive medications were essential for residents. Most nurses agreed that sleeping tablets and pharmacological management of verbal aggression and wandering behaviours should be used less frequently whilst most care staff agreed that medications should be used more frequently to manage physical aggression. CONCLUSIONS: To successfully and sustainably optimise medication use in RACF residents, it is important to consider the variation in views of nurses and care staff.
Authors: Kaisu H Pitkälä; Anna-Liisa Juola; Hannu Kautiainen; Helena Soini; U Harriet Finne-Soveri; J Simon Bell; Mikko Björkman Journal: J Am Med Dir Assoc Date: 2014-05-10 Impact factor: 4.669
Authors: Amy T Page; Rhonda M Clifford; Kathleen Potter; Darren Schwartz; Christopher D Etherton-Beer Journal: Br J Clin Pharmacol Date: 2016-06-13 Impact factor: 4.335