Module 5, RMMR & complex disease management Flashcards
1
Q
What is the medication review process?
A
- its a structured evaluation of patient’s medcines with the aim of optimising medicines use and improving health outcomes
- entails detecting drug related problems & recommending interventions
- collect information –> identify issues –> resolve issues
2
Q
What are the common characteristics of Australian aged care facility residents?
A
- over 215 000 Australians live in ~ 2700 RACFs
- range in size from about 12- 150 beds per site
- most (55%) are managed by non profit organisations
- funding is allocated as per Aged Cared Funding Instrument (ACFI)
- activities of daily living
- cognition and behaviour
- complex health care
- Average age 84 years and 62% feamle
- Multimorbidiity is common
- median number of medical conditions around 6
- Polypharmacy is the norm
- median number of medications is 10
- ALOS is aroudn 2.5 years
- 80% of exits from permanent residential care due to death
3
Q
What are some common medical conditions seen in RACF patients?
Most common to least common…
A
- Hypertension- 49.8%
- Dementia- 48.2%
- Depression- 33%
- Cerebrovascular disease- 24.2%
- Diabetes- 20.6%
- Ischaemic heart disease- 13.8%
- High cholesterol- 12.4%
- Malnutrition- 0.9%
4
Q
What are some common medications that RACF patients use from most common to least common?
A
- Laxatives
- Other analgesics and antipypretics
- Anthithrombotic agents
- Drugs for peptic ulcer and GORD
- High ceiling diuretics
- ACE inhibitors, plain
- Hypnotics and sedatives
- Antidepressants
- Vasodilators used in cardiac disease
- Antipsychotics
Opioids
5
Q
What are the implications for RMMRs?
A
- Aims of optimising medicines use and improving health outcomes with a greater emphassis on interventions that maintain quality of life
- only be done if the persons goals are understood
- and a plan can be evaluated appropriately (i.e. a medication review) knowing the person’s care goals
- aggressive preventative therapies tend to have less of a focus in RMMRs
6
Q
What does deprescribing involve?
A
- the systematic process of identifying and discontinuing drugs in instances in which existing or potential harms outweigh existing or potential benefits within context of an individual patient’s care goals, current level of functioning, life expectancy, values and preferences
- positive patient centred intervention, requiring shared decision making, informed patient consent, close monitoring of effects
- not about denying effective treatment to eligible patients
7
Q
What are some information sources?
A
- the referaal
- resident records
- GP notes
- care notes
- hospital admissions & discharges
- assessments & chats
- interviews
- care givers
- carers, nurses, allied health
- GP
- resident or family members
- care givers
8
Q
Why is documentation important in RACF?
A
- industry regulation
- ACFI purposes
- Multidisciplinary care teams
- Staff turnover
- icare, leeCare, ecase & others are advanced systems now available as paper based documentation is being replaced by software solutions
9
Q
What is the report format for RMMR?
A
- Residential details (name/DOB, ward/bed)
- Introduction (thank you for referring resident for a RMMR)
- Medication list (copy of medication chart)
- DRPs identified with evidence to support your findings
- Suggestions of actions to be taken
- Supporting literature (where appropriate)
- A caveat that recommendations were based on the available data
- Invitation for further discussion and contact details
10
Q
Summary of RMMR lecture
A
- RMMRs tend to be a complex activity
- Many recipients are very old with multiple morbidities and medications
- There is limited high quality literature to inform medication use
- Life expectancy and care goals also greatly influence outcomes of these reviews
- An enormous amount of information is avaliable about most residents
- Much of it is not valuable
- technology is making accessiblity of information easier
