Variation in the potentially inappropriate use of antipsychotic and benzodiazepine medications among individuals receiving residential medication management reviews

Objectives: To describe the variation in the use of potentially inappropriate antipsychotic and benzodiazepine medications in residents who have received a medication review and to evaluate the extent to which this variation is associated with aged care home (ACH) and resident characteristics.

Methods: This cross-sectional, retrospective study used pharmacist-extracted data from 15,442 residents across 342 Australian ACHs who had a medication review during 2019. The proportion of residents receiving ≥1 potentially inappropriate antipsychotic and benzodiazepine medication according to Beers criteria were classified into quintiles by facility usage (Q1-Q5). Quintile characteristics were compared using descriptive analysis of facility and resident data. Logistic regression was used to compare individual usage between residents in each quintile adjusting for facility and resident characteristics.

Key findings: The cohort had mean age 85 years (SD ±9), with less than 14% of residents in Q1 (n = 68), and >31% of residents in Q5 (n = 68) using an antipsychotic. For benzodiazepines, these proportions were <19% in Q1 (n = 68) and >45% in Q5 (n = 67). Facilities in major cities were significantly more likely to report antipsychotic (Q1:74% vs Q5:88%, P =. 03) and benzodiazepine use (Q1:69% vs Q5:87%, P =. 015). Residents in Q5 were seven times more likely to be prescribed an antipsychotic (aOR:7.22, 95% CI:5.93-8.79) than residents in Q1, and eight times more likely to be prescribed a benzodiazepine (aOR:8.57, 95% CI 7.33-10.01, P <. 001) than residents in Q1.

Conclusions: Significant variation exists in potentially inappropriate antipsychotic and benzodiazepine use among ACH residents receiving a medication review highlighting the need for further research to reduce prescribing of these high-risk medications.