Abstract
Given the growing aged care population, the complexity of their medication-related needs and increased risk of adverse drug events, there is a necessity to systematically monitor and manage medication-related quality of care. The aim of this systematic review was to identify and synthesise medication-related quality of care indicators with respect to application to residential aged care. MEDLINE (Ovid), Psychinfo, CINAHL, Embase and Google® were searched from 2001 to 2013 for studies that were in English, focused on older people aged 65+ years and discussed the development, application or validation of original medication-related quality of care indicators. The quality of selected articles was appraised using the Critical Appraisal Skills Program and psychometric qualities extracted and synthesised using content analysis. Indicators were mapped to six medication-related quality of care attributes and a minimum indicator set derived. Thirty three articles describing 25 indicator sets met the inclusion criteria. Thirteen (52%) contained prescribing quality indicators only. Eight (32%) were developed specifically for aged care. Twenty three (92%) were validated and seven (28%) assessed for reliability. The most common attribute addressed was medication appropriateness (n = 24). There were no indicators for evaluating medication use in those with limited life expectancy, which resulted in only five of the six attributes being addressed. The developed minimum indicator set contains 28 indicators representing 22 of 25 identified indicator sets. Whilst a wide variety of validated indicator sets exist, none addressed all aspects of medication-related quality of care pertinent to residential aged care. The minimum indicator set is intended as a foundation for comprehensively evaluating medication-related quality of care in this setting. Future work should focus on bridging identified gaps.
Highlights
IntroductionSince 1970, the Australian population has aged significantly with a six-fold increase in the proportion of adults aged 85 years and older (Australian Institute of Health and Welfare 2010) with similar statistics reported in the UK, Europe and the USA
In Australia and other developed countries the population is ageing rapidly
The majority of indicator sets originated from Australia (n = 8) (Australian Institute of Health and Welfare 2009; Department of Health 2012; Campbell Research and Consulting (CR&C) 2006; Nay et al 2004; Courtney et al 2007; NSW Therapeutic Assessment Group 2007; Figure 1 Flowchart of the study selection process
Summary
Since 1970, the Australian population has aged significantly with a six-fold increase in the proportion of adults aged 85 years and older (Australian Institute of Health and Welfare 2010) with similar statistics reported in the UK, Europe and the USA Multimorbidity is associated with use of multiple medicines (polypharmacy) which in turn is linked to medication-related adverse outcomes including falls, death and hospitalisation (Wilson et al 2010; Milton et al 2008). This is compounded by the physiologic effects of ageing, such as altered clearance of medicines (Milton et al 2008). In the United States medication-related adverse events in residential aged care have been estimated to be between 1.19 to 7.26 incidents per 100 resident-months and for every $1 (US) spent on medicines in aged care it is estimated $1.33 is spent on treating adverse events (Bootman et al 1997)
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