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; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
J Am Med Dir Assoc. 2021 Jan;22(1):148-155.e1. doi: 10.1016/j.jamda.2020.10.027. Epub 2020 Dec 4.
Residential medication management reviews (RMMRs) are comprehensive medication reviews conducted by clinical pharmacists and general medical practitioners. RMMRs are the primary government-funded service to optimize medication management in Australian residential aged care facilities (RACFs) and are recommended for all new residents. This study investigated resident characteristics associated with timely RMMR provision within 90 days of RACF entry and national intrafacility variation in timely RMMR provision.
National retrospective cohort study.
Individuals aged ≥65 years who first entered permanent residential aged care in Australia between January 1, 2012, and December 31, 2015, received at least 1 medication in the previous year, and were alive at 90 days post-RACF entry.
Resident characteristics associated with timely RMMR provision were determined using multivariate logistic regression. Crude and risk-adjusted funnel plots were used to examine intrafacility variation in timely RMMR provision.
Of the 143,676 residents from 2799 RACFs included, 30,883 (21.5%) received an RMMR within 90 days. Resident characteristics associated with timely provision included dementia (adjusted odds ratio [aOR] 1.05, 95% confidence interval [CI] 1.02-1.08), primary language other than English (aOR 1.04, 95% CI 1.01-1.09), number of unique prescriptions dispensed in the previous year (aOR [per additional 5 prescriptions] 1.02, 95% CI 1.01-1.03), need for medication administration assistance (aORs ranged from 1.35 to 1.42, compared with residents self-managing) and facility remoteness (aORs ranged from 0.67 to 0.75 for residents outside major cities). The proportion of new residents receiving a timely RMMR ranged from 0% (n = 303 RACFs) to 100% (n = 4 RACFs). There were 174 RACFs (6.2%) in which ≥50% of new residents received a timely RMMR.
Although there was some evidence that RMMRs are targeted to individuals with a greater burden of medication use and those living with dementia, considerable variation in provision exists nationally. This flagship medication review service is generally underutilized among residents of Australian RACFs.
住宅药物管理审查（RMMR）是临床药师和普通内科医生进行的全面药物审查。RMMR 是优化澳大利亚住宅老年护理设施（RACF）中药物管理的主要政府资助服务，建议为所有新居民提供。本研究调查了与入住 RACF 后 90 天内及时提供 RMMR 相关的居民特征，并调查了全国范围内及时提供 RMMR 的院内差异。
全国回顾性队列研究。
2012 年 1 月 1 日至 2015 年 12 月 31 日期间首次进入澳大利亚永久性住宅老年护理的年龄≥65 岁的个人，在过去一年中至少服用过一种药物，并且在入住 RACF 后 90 天内仍存活。
使用多变量逻辑回归确定与及时提供 RMMR 相关的居民特征。使用未经调整和风险调整的漏斗图检查及时提供 RMMR 的院内差异。
在来自 2799 家 RACF 的 143676 名居民中，有 30883 名（21.5%）在 90 天内接受了 RMMR。与及时提供相关的居民特征包括痴呆症（调整后的优势比[OR] 1.05，95%置信区间[CI] 1.02-1.08）、非英语母语（OR 1.04，95% CI 1.01-1.09）、前一年开具的独特处方数量（OR[每增加 5 个处方] 1.02，95% CI 1.01-1.03）、需要药物管理协助（OR 范围为 1.35-1.42，与自行管理的居民相比）和设施偏远程度（OR 范围为居住在大城市以外的居民为 0.67-0.75）。及时接受 RMMR 的新居民比例从 0%（n=303 家 RACF）到 100%（n=4 家 RACF）不等。有 174 家 RACF（6.2%）的新居民中有≥50%及时接受了 RMMR。
尽管有证据表明 RMMR 主要针对药物使用负担更大和患有痴呆症的个人，但全国范围内的供应情况存在很大差异。澳大利亚 RACF 居民对这种主要药物审查服务的使用率普遍较低。
