(146) Variation in The Potentially Inappropriate Use of Antipsychotic Medications in Australian Long Term Care Facilities

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 820

Presenting Author(s)

Danijela Gnjidic
– Associate Professor, University of Sydney, The University Of Sydney, New South Wales, Australia

Co-Author(s)

Mouna J. Sawan
– The University of Sydney, Sydney Pharmacy School, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
Alexander Clough
– Research assistant, Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Camperdown, New South Wales, Australia
Jodie Hillen, BPharm, M Clin Med, PhD
– Research Fellow, University of South Australia, Prospect, South Australia, Australia
Andrew R. Zullo, PharmD, PhD
– Associate Professor, Brown University School of Public Health, Brown University, Providence, Rhode Island, United States
Daniela Moga, MD, PhD
– Associate Professor, University of Kentucky College of Pharmacy, Lexington, Kentucky, United States

Background: Antipsychotic medication use in long term care facilities (LTCFs) continues to be widely reported despite increased risk of harms and lack of efficacy. However, data on the influence of LTCF and resident characteristics on potentially inappropriate (PI) use of antipsychotics in Australian residents is limited.

Objectives: The aim of this study is to examine how LTCF and resident characteristics influence facility-level PI antipsychotic use.

Methods: Our cross-sectional, retrospective analysis used data from 15,442 residents of 342 LTCFs in Australia who had a medication review during 2019. Data on residents’ medication use and medical history (matched to ICD-10 codes) at the time of medication review was extracted from medical records by pharmacists. Descriptive analyses were conducted to report on LTCF (e.g., size, location by remoteness and socioeconomic index), and resident (e.g., age, gender, Charlson Comorbidity Index (CCI), cognitive status) characteristics, and the prevalence of PI antipsychotic use per the 2019 Beers Criteria. The proportion of residents receiving ≥1 PI antipsychotic medication in individual LTCFs was classified into quartiles from lowest to highest proportion of residents. Pearson’s chi-square tests were used to compare facility characteristics and independent sample t-tests to compare resident characteristics across quartiles.

Results: Among 15,442 participants, 42% (n = 6455) had dementia, 43% were female, the median age was 85 (95%CI 84 - 85) and the mean CCI score was 1.4 (95%CI 1.35 – 1.45). The majority of LTCFs were large in size (90-120 beds) (34%), located in major cities (81%), and 28% were in most socioeconomically advantaged areas of Australia. The median facility-level rate of PI use of antipsychotics ranged from 0% to 13.6% in Q1 (n = 68 LTCFs) to 31.14% to 100% in Q5 (n = 68 LTCFs). There was significant variation between the highest (Q5) and lowest rates (Q1) of PI use of antipsychotics based on remoteness (p=0.03) and socio-economic status (p < 0.01). LTCFs in major cities (Q1 74% vs Q5 88%) were more likely to use PI antipsychotic medications than those in regional and remote areas. Facilities in the highest prescribing quintile had a significantly higher proportion of residents with dementia (53% v 26%, p < 0.001) and a higher mean CCI score (1.58 v 0.93, p < 0.001) than residents in Q1 LTCFs.

Conclusions: There is a significant variation in the rate of PI use of antipsychotics across LTCFs. Dementia, remoteness, and socioeconomic status appear to be highly predictive of this variation. Further research into other factors including staff levels/mix, training provided and organizational culture, is needed to explain the high rate of PI use of antipsychotics in LTCFs.