Simplifying medication regimens for residents of aged care facilities: Pharmacist and physician use of a structured five-step medication simplification tool

Sluggett JK 1 , Stasinopoulos J 2 , Sylvester C 3 , Wong WJ 4 , Hillen J 5 , Hughes GA 6 Show all authors , Yu S 7 , Clark M 8 , Bell JS 9 , Corlis M 10 , Teng LS 11 , Newton L 12 , Piovezan RD 7 , Yu D 13 , Carter L 14 , Soulsby N 14

Affiliations 

  • 1 University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia. Electronic address: janet.sluggett@unisa.edu.au
  • 2 University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
  • 3 University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
  • 4 School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya, Selangor, Malaysia
  • 5 Ward Medication Management, Melbourne, Victoria, Australia; University of South Australia, UniSA Clinical and Health Sciences, Adelaide, South Australia, Australia
  • 6 Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; University of South Australia, UniSA Clinical and Health Sciences, Adelaide, South Australia, Australia
  • 7 Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
  • 8 Department of General Practice, University of Melbourne, Parkville, Victoria, Australia; IPN Medical Centres, Camberwell, Victoria, Australia
  • 9 Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
  • 10 Australian Nursing and Midwifery Federation (SA Branch), Adelaide, South Australia, Australia
  • 11 General Practitioner, Narre Warren, Victoria, Australia
  • 12 IPN Medical Centres, Camberwell, Victoria, Australia
  • 13 The Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
  • 14 Ward Medication Management, Melbourne, Victoria, Australia
Res Social Adm Pharm, 2024 Apr 09.
PMID: 38693035 DOI: 10.1016/j.sapharm.2024.04.008

Abstract

BACKGROUND: Pharmacist-led medication regimen simplification using a structured approach can reduce unnecessary medication regimen complexity in residential aged care facilities (RACFs), but no studies have investigated simplification by different health professionals, nor the extent to which simplification is recommended during comprehensive medication reviews.

OBJECTIVES: To compare medication regimen simplification opportunities identified by pharmacists, general medical practitioners (GPs), and geriatricians and to determine if pharmacists identified simplification opportunities during routinely conducted comprehensive medication reviews in RACFs for these same residents.

METHODS: Three pharmacists, three GPs and three geriatricians independently applied the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) to medication data for 83 residents taking medications at least twice daily. Interrater agreement was calculated using Fleiss's kappa. Pharmacist medication review reports for the same 83 residents were then examined to identify if the pharmacists conducting these reviews had recommended any of the simplification strategies.

RESULTS: Overall, 77 residents (92.8 %) taking medications at least twice daily could have their medication regimen simplified by at least one health professional. Pharmacists independently simplified 53.0-77.1 % of medication regimens (Κ = 0.60, 95%CI 0.46-0.75, indicating substantial agreement), while GPs simplified 74.7-89.2 % (Κ = 0.44, 95%CI 0.24-0.64, moderate agreement) and geriatricians simplified 41.0-66.3 % (Κ = 0.30, 95%CI 0.16-0.44, fair agreement). No simplification recommendations were included in the reports previously prepared by pharmacists as part of the comprehensive medication reviews undertaken for these residents.

CONCLUSION: Pharmacists, GPs, and geriatricians can all identify medication regimen simplification opportunities, although these opportunities differ within and between professional groups. Although opportunities to simplify medication regimens during comprehensive medication reviews exist, simplification is not currently routinely recommended by pharmacists performing these reviews in Australian RACFs.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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