Jodie B. Hillen

To date, access to appropriate and timely GP services for those in aged care has been described as limited, in part due to inadequate models of care and remuneration. As the Australian population ages and more Australians become dependent on aged-care services, the need for good quality medical care that meets the needs of residents will continue to grow. The purpose of this study was to provide a current analysis of trends in GP services in residents in Australian aged-care facilities. Longitudinal population data (2005–2014) was used to describe the changing population demographics and calculate annual rates for GP services specific to this population. Total population and age-group strata (<85 years and 85+ years) rates were calculated for standard consultations, after-hours consultations, contribution to a care plan and collaborative medication review. For the period 2005–2014 there was an increase of 1.5 million GP services to this population, which had simultaneously grown by 19 800 residents, aged (6% increase in residents aged 85+ years) and become more dependent (14% increase is high-care residents). Significant increases in all GP service rates were observed, with a shift towards after-hours consultations. Residents aged <85 years received significantly more services than residents aged 85+ years. GP service delivery to the whole aged-care population continues to be heavily weighted towards standard and after-hours consultations, while collaborative GP services remain a very small proportion of services accessed by this population. There is scope to increase collaborative GP services, which have been linked to improved outcomes for this population.

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.