Investigating the safe use of medicines among older residents of Australian retirement villages and supported residential services

This thesis describes research investigating medication use and pharmacist-led medication reviews among older residents of Australian retirement villages and Supported Residential Services (SRSs). Background: Medication-related problems (MRPs) are common in older Australians and sometimes lead to poor health outcomes and increased healthcare costs. About one in five unplanned hospitalisations in this group are due to MRPs. Home Medicines Review (HMR) is a pharmacist-conducted medication review service funded by the Australian Government for community patients who are at risk of MRPs to reduce medication misadventure and optimise medication use in this group. Older Australians living in retirement villages and SRSs may be at risk of experiencing MRPs and hence may benefit from a HMR, but limited information is available on medication use and the uptake of HMRs in these groups. The aims of this research were to investigate medication use and the uptake of HMRs in these populations and explore strategies to increase HMR uptake and evaluate their effectiveness. Methods: In Phase 1, cross-sectional mail surveys were carried out among a convenience sample of retirement village and SRS residents (n = 2,116 and 77, respectively) to determine their medication use, medication-related risk factors and uptake of HMRs. In Phase 2, in-depth interviews and focus groups were carried out with a purposive sample of stakeholders (n = 32 retirement village residents and 20 health professionals) to explore their views on the HMR service and issues affecting uptake in retirement village residents. In Phase 3, a cluster randomised controlled trial (cRCT) was carried out among a convenience sample of retirement village residents (n = 161 [92 intervention; 69 control]) to assess whether a multi-faceted intervention would increase their uptake of HMRs. All studies were undertaken in Victoria, Australia. Key findings: The surveys found that 1,374/2,116 (65%) retirement village and 56/77 (73%) SRS residents had medication-related risk factor(s), and hence would meet the eligibility criteria for a HMR. However, only 76/1,374 (6%) at-risk retirement village and 3/56 (5%) at-risk SRS residents had received a HMR in the previous 12 months. During the stakeholder interviews and focus groups, reasons for the poor uptake of HMRs and strategies for increasing the uptake in retirement village residents were identified. A strategy recommended by stakeholders for increasing HMR uptake was to use a multi-faceted intervention targeting residents and their health professionals. When the intervention was tested in the cRCT (involving 161 retirement village residents), no significant increase was seen in the uptake of HMRs. Reasons for the ineffectiveness of the intervention have been proposed along with practice implications and future research directions. Conclusions: The research has identified important issues which require the attention of healthcare providers. These include: the majority of retirement village and SRS residents are at risk of experiencing MRPs but the uptake of HMRs in these groups is very low; the poor uptake in retirement village residents is due to a range of patient, health professional and system factors; and there is a need for strategies to increase HMR uptake in retirement village and SRS residents