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Residential Medication Management Reviews and continuous polypharmacy among older Australian women

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Abstract

Background Polypharmacy is an important consideration for the provision of Residential Medication Management Reviews (RMMRs) among older women given their enhanced risk of medication-related problems and admission to residential aged care (RAC). Objectives To determine the prevalence of the use of RMMRs among older women in RAC, and the association between RMMRs and polypharmacy, medications, and costs. Setting Older Australian women aged 79–84 years in 2005 who had at least one Medicare Benefits Schedule and Pharmaceutical Benefits Scheme record, received a service in aged care, and consented to data linkage. Methods Generalised estimating equations were used to determine the association between polypharmacy and RMMRs, while adjusting for confounding variables. Main outcome measures Prevalence of the use of RMMRs among older women in RAC, association between RMMRs and polypharmacy, medications, and costs. Results Most participants did not have continuous polypharmacy and did not receive RMMRs from 2005 [451 (67.4%)] until 2017 [666 (66.6%)]. Participants with continuous polypharmacy were 17% more likely to receive a RMMR (risk ratio 1.17; 95% confidence interval 1.11, 1.25). Participants in their final year of life and residing in outer regional/remote/very remote Australia were less likely to receive RMMRs. Out-of-pocket medication costs increased over time, and alendronate and aspirin were common contributors to polypharmacy among participants who received RMMRs. Conclusion Polypharmacy was associated with receiving RMMRs and around two-thirds of women who are entitled to a RMMR never received one. There is potential to improve the use of medicines by increasing awareness of the service among eligible individuals, their carers and health care professionals.

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Availability of data and material

Use of the ALSWH dataset is subject to strict ethical conditions due to the personal nature of the data collected. The ethics committees that oversee the ALSWH are the Australian Government Department of Health Human Research Ethics Committee and the Human Research Ethics Committees at the University of Queensland and the University of Newcastle. Ethical approval of the ALSWH specifies that de-identified data are only available to collaborating researchers where there is a formal request to make use of the material, and that each request has to be approved by the ALSWH Data Access Committee. Further details can be found at http://alswh.org.au/for-researchers.

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Acknowledgements

The authors thank Natasha Weaver (School of Medicine and Public Health, University of Newcastle), Dominic Cavenagh (Priority Research Centre for Generational Health and Ageing, University of Newcastle) and Desalegn Markos Shifti (University of Newcastle) for their statistical input and assistance. The authors also thank Sharmila Prasad (University of Newcastle) for her input as an Accredited Pharmacist registered with the Australian Association of Consultant Pharmacy. The research on which this study is based was conducted as part of the Australian Longitudinal Study on Women’s Health by the University of Queensland and the University of Newcastle. We are grateful to the Australian Government Department of Health for funding and to the women who provided the survey data. The authors acknowledge the Departments of Health and Veterans’ Affairs, and Medicare Australia, for providing PBS data, and the Australian Institute of Health and Welfare (AIHW) as the integrating authority.

Funding

The Australian Government Department of Health fund the Australian Longitudinal Study on Women’s Health and permit use of Study data for research purposes. The Department have no other role with respect to this research paper.

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Authors and Affiliations

  1. University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia

    Kaeshaelya Thiruchelvam, Julie Byles, Syed Shahzad Hasan, Nicholas Egan & Therese Kairuz

  2. International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia

    Kaeshaelya Thiruchelvam & Therese Kairuz

  3. Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia

    Julie Byles & Nicholas Egan

  4. University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK

    Syed Shahzad Hasan

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  1. Kaeshaelya Thiruchelvam
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Correspondence to Kaeshaelya Thiruchelvam.

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Consent to participate

For the ALSWH survey data, all participants consented to joining the study and are free to withdraw or suspend their participation at any time with no need to provide a reason. For the linked data (PBS), ALSWH participants who decline health record linkage are excluded from linked data requests. Over 80 percent of all ALSWH participants have explicitly consented to record linkage. Since 2005, the responsible Human Research Ethics Committees have approved opt-out consent; in addition, a waiver applies to unconsented participants who were deceased or lost to follow up before 2005.

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Thiruchelvam, K., Byles, J., Hasan, S.S. et al. Residential Medication Management Reviews and continuous polypharmacy among older Australian women. Int J Clin Pharm 43, 1619–1629 (2021). https://doi.org/10.1007/s11096-021-01294-3

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