Complex disease management and RMMR Flashcards
What is the medication review process?
Evaluation of patient’s medcines with the aim of optimising medicines use and improving health outcomes
> collect information –> identify issues –> resolve issues
How is funding for residents allocated? What are the three domains that appraises residents’ care needs?
Aged Cared Funding Instrument (ACFI)
- activities of daily living
- cognition and behaviour
- complex health care
What are some properties of RACF resident profile?
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
What are some common medical conditions seen in RACF patients from most to least?
- Hypertension
- Dementia
- Depression
- Cerebrovascular disease
- Diabetes
- Ischaemic heart disease
- High cholesterol
- Malnutrition
What are some common medications that RACF patients use from most to least?
- 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
What are the implications for RMMRs?
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
What does deprescribing involve?
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
What are some information sources?
The referral
Resident records
> GP notes
> Care notes
> Hospital admissions and discharges
> Asessments an charts
Interviews
> care-givers
- carers, nurses, allied health
- GP
> resident or family members
Why are documents important in RACF?
- Industry regulation
- ACFI purposes
- Multidisciplinary care teams
- Staff turnovewr
What systems are being used that replaces paper?
- iCare, LeeCare, eCase, and others
> optimising efficiency, reducing errors, risks and costs, and improving the quality of care.
What is the report format for RMMR?
- 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
Key messages
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
