Major win on aged care prescribing

In a win for GPs and their aged care patients, the Federal Government has rejected an Aged Care Royal Commission recommendation to restrict prescribing of antipsychotics to nursing home residents.

The recommendation to limit initial prescribing to psychiatrists and geriatricians was made amid concerns that over-worked nursing home staff were pressuring GPs to chemically restrain dementia patients.

But the AMA advocated furiously against cutting the change, calling it a simplistic solution that ignored the environmental factors that have driven the use of antipsychotics, including a lack of appropriately-trained and experienced aged care staff.

“It is the environment in which antipsychotics are prescribed that needs to change, as opposed to the imposition of ill-considered restrictions on prescribing,” the AMA submission to the Pharmaceutical Benefits Advisory Committee (PBAC) said.

The PBAC has decided against the recommendation, citing the “substantial risk of unintended consequences”.

The AMA believes restrictive practices should only be used as a last resort – where any potential risk or harm caused by the restraint itself is less than the risk of the patient not being restrained.

However, the patient’s regular GP, along with the aged care provider and the patient’s family, should be involved in any decision to prescribe a restraint.

“GPs know their patients in aged care and are best informed to decide when prescribing of certain medication is warranted. Visiting geriatricians and psychiatrists lack that connection with the patient that the GP has. This is a position universally expressed by AMA geriatrician and psychiatrist members,” the AMA submission said.

The AMA has called for greater involvement of geriatricians and psychiatrists in aged care. However, non-GP specialist services in aged care are already limited and this recommendation would have overburdened them further, potentially putting patients at risk.

The AMA is continuing to call for residential aged care facilities to have registered nurses available on-site 27/7 under minimum staff-to-resident ratios that reflect the needs of residents, and for aged care staff, including personal care attendants and nurses, to have access to dementia management and behavioural training.

You can read the AMA submission here.

More information about the November 2021 PBAC meeting outcomes is available here.