LASA Fusion Winter 2021

Page 60

MAKING HISTORY: THE ROAD TO A BETTER FUTURE

FURTHER RESTRICTIONS OF ANTIPSYCHOTICS IN RESIDENTIAL AGED CARE

POLICY CHANGES MAY BE HIT-AND-MISS

T

here is no one panacea for optimising treatment of Behavioural and Psychological Symptoms of Dementia (BPSD) in Australian aged care. New policies must be clinically relevant in terms of each medicine or class, the realities of prescribing in aged care, individual diagnoses, and existing industry standards. In response to public reports and research findings of overuse of antipsychotics in residential aged care and the associated harms, the Aged Care Royal Commission advocated for further restrictions on prescribing antipsychotics in aged care to treat BPSD. In its 65th recommendation, the Royal Commission suggested a specialist-restrictive model similar to that used for prescribing of antipsychotics for children with autism, to ensure that a specialist reviews people in residential aged care before antipsychotic medicines are prescribed. In its response, the Government agreed in principle to this recommendation and referred the matter to the Pharmaceutical Benefits Advisory Committee for consideration.

Is this good policy?

Prima Facie this step seems reasonable, as the policy implies improved appropriateness of prescribing through specialist knowledge and collaboration with primary care prescribers. However, in Australia and the US, policies that restrict access to medicines have shown mixed outcomes, and there is no evidence that restriction of antipsychotic prescribing to specialists will improve collaborative care and outcomes for residents. In addition, a one-year timeframe for exposure seems generous without requiring regular review for effectiveness and safety. The Royal Australian College of General Practitioners recommends three-monthly reviews for opportunities to deprescribe.

Insufficient specialists

Management of BPSD is a constant challenge for carers, which requires flexible access to medical practitioners and in many cases, immediate access.

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In 2017, there were approximately 800 geriatricians (400-560 FTE) in Australia, which fell short of the 925 FTE required to meet service requirements with significant shortfalls predicted for regional areas. There are approximately 180,000 Australians living in aged care of which 50 per cent have a diagnosis of dementia. At some point in the disease course, people with dementia will have at least one experience of BPSD. These data suggest that there will be challenges with accessing a suitable specialist to initiate medication in a timely manner. Research has shown barriers to optimising prescribing in Australian aged care include the following, which will not be solved with proposed policy changes: • Lack of support for GPs to make medication changes especially if the initial prescription was written by another prescriber and/or specialist. • Pressure for GPs to switch to alternative medicines or prescribe ‘off-label’ (use without an approved diagnosis) due to multiple competing interests from aged care staff, families and prescribing restrictions.


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Articles inside

Redefining aged care and

4min
pages 86-87

Fresh Ideas

11min
pages 88-90

From little things big things grow

3min
pages 84-85

Revolutionary virtual reality

3min
page 83

Find your passion for a happy life

3min
page 82

Unique industry awards for

2min
pages 77-78

How uniforms help unit remote teams and promote your brand

2min
page 76

Technology successfully supporting home care

3min
page 75

Is your ICT up to scratch?

3min
pages 70-71

A ‘tonic’ for the times Collaborative, social (group) practice

3min
pages 72-74

Victorian council adopts client facing technology to improve

2min
pages 68-69

Further restrictions of antipsychotics in residential aged care

4min
pages 60-61

Thinking green

5min
pages 62-64

Country wise supports aged care in regional Australia

6min
pages 56-59

Support for building workforce capacity

3min
pages 54-55

A gateway to providing quality palliative care

3min
pages 52-53

Older Australians deserve good oral care

5min
pages 49-51

Young aged care leaders and the federal budget

4min
pages 36-38

Embracing innovation and technology

3min
pages 44-46

Why do all age services look alike?

4min
pages 34-35

The new age of director skill requirements

3min
page 43

Our mob, our health, our way

4min
pages 39-40

The measure of our industry

3min
pages 30-31

CEO’s Column

4min
pages 7-9

Key insights for future policy directions

5min
pages 22-24

Royal Commission wrapped-up

4min
pages 17-21

Minister’s Column

3min
pages 10-11

Thanks for caring

4min
pages 27-29

Guest Column: Grattan Institute

4min
pages 15-16

Vaccination is essential to our COVID-19 recovery

3min
pages 25-26
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