Entering aged care with new GP linked to medication increase

The finding is based on a recently published study that analysed data from 2250 new residents with a dementia diagnosis prior to entering residential care between January 2010 and June 2014 from the Sax Institute’s 45 and Up Study in New South Wales.
 
‘We already knew … [that] there’s a big uptick in prescribing just after entry to residential aged care,’ lead author Dr Heidi Welberry said.
 
‘We also know anecdotally that many people change GP when they go into residential care. So, what we looked at was whether this increase in prescriptions was related to a change in their usual GP.’
 
But prior to the analysis, little was known about how many residents change their GP when entering residential aged care facilities (RACFs), or what effect this has on their care.
 
The research showed while 28% of the new RACF residents with dementia tracked in the study retained their usual GP, slightly more (29%) changed to another known GP (ie a GP they had seen before but was not their usual GP) and nearly half (44%) saw a new GP.
 
Residents seeing a new GP were dispensed more medicines – including antipsychotics and benzodiazepines – than residents who retained their usual or known GP. The percentage increase for medicines dispensed for residents with a new GP was 20%, twice as high as those who saw their usual GP (9%) or a known GP (10%).
 
According to the authors of the study, the expected benefit of antipsychotics and benzodiazepines for older people with dementia is small and the risk of adverse effects high.
 
 
‘There’s an increased risk in adverse events like stroke, and death among older people with dementia taking antipsychotics,’ co-author Professor Henry Brodaty said.
 
‘So generally, the recommendation is to try other strategies first to help manage changed behaviours and psychological symptoms associated with dementia. This could include diversion therapy and music therapy.’
 
However, Professor Louisa Jorm, another co-author, also acknowledged that a change in prescriptions for people entering residential care may simply reflect events that precipitated their entry or their adjustment to their new surroundings. She said a new environment can be distressing people with dementia, as can the impact of having an unfamiliar GP.
 
‘This study has raised a lot of questions about what may drive changes in prescribing patterns,’ Dr Welberry said.
 
‘The Australian Medical Association in 2018 examined barriers to GPs providing care in nursing homes. These included geographical relocation and financial barriers.
 
‘As it can be difficult and inefficient for GPs to just visit a single patient in a particular nursing home, especially one they don’t regularly visit, they may transfer care to another GP.’
 
Dr Welberry said the main recommendation from the research is to look at new models of GP care in residential aged care – a recommendation also made by the Royal Commission into Aged Care Quality and Safety.
 
‘The takeaway message is the importance of looking at the continuity of care for residents as they enter residential aged care,’ Dr Welberry said.
 
However, the RACGP has previously raised concerns about some of the recommendations stemming from the royal commission, in particular the call for a revamped primary care funding model.
 
Nonetheless, Dr Welberry said she hopes this study forms part of the discussion around what a high-quality model of GP care in aged care looks like.
 
‘We would also like to understand more about some of the drivers behind prescribing in terms of how these might differ among these different GP groups,’ she said.
 
‘For example, looking at particular aspects like how a GP may approach caring for a new patient that they haven’t seen before at that entry point?
 
‘I think there’s certainly a lot more that we can investigate in this regard. But hopefully, it raises discussion around what good quality GP care should be in this particular setting.’
 
The researchers said facilitating GP continuity of care and better support for GP handover processes could potentially prevent inappropriate psychotropic prescribing for aged care residents.
 
‘Anything that can provide a GP with greater support to spend more time in that transition period – and to really understand a new patient’s situation – will assist in establishing a higher level of care,’ Dr Welberry said.
 
‘This includes better organisation of GP care handover, including the medical history of the new patient.
 
‘There’s a lot of pressure on GPs to care for many people, so time pressure can be really difficult.’
 
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