Canaries in the coalmine: Stakeholder perspectives of medication management reviews for residents with dementia

Background: Residential medication management reviews (RMMRs) are the primary strategy enabling collaborative and individualised medication reviews in Australian residential aged care homes (RACHs). Residents with dementia often have complex health needs and care goals, which makes them a useful benchmark of health service efficacy. Objective: To analyse perspectives of pharmacists, general practitioners (GPs) and nurses on the suitability and delivery of the current RMMR model for residents with dementia; and to identify scope for improvement in medication review service delivery. Methods: Electronic surveys were distributed to the included health professions via professional agencies. Descriptive statistics and non-parametric tests were used to summarise quantitative variables. Qualitative data obtained from open-text responses underwent iterative thematic analysis. Two researchers independently conducted the thematic categorisation; data within responses was inductively coded, then codes were linked to identify emergent themes that described the data content. In a triangulated exploratory mixed method approach, the qualitative findings were used to explain the quantitative findings. Results: None of the participants agreed that the current program recommendation of a single RMMR every 24 months was suitable for the residents’ needs. Participants were more likely to use written, rather than verbal, means of communication during RMMRs. RMMRs were perceived to have minimal benefit if there was minimal face-to-face interaction between stakeholders. Individualised medicine management in relation to resident goals of care was the key benefit of RMMRs. Insufficient remuneration was the primary barrier to effective face-to-face collaboration and delivery of individualised resident care. Conclusions: Increasing support for stakeholder participation in face-to-face interactions during medication reviews may enable delivery of a more patient-centred service for residents with dementia and improve health professional satisfaction and engagement.