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Background: Hip fracture impacts on quality of life and may lead to premature death. In Australia, the extent of use of medicines that increase risk of falls or hip fracture in at-risk older people is not known. Aim: To determine the use of medicines associated with falls or hip fracture before hip fracture and whether medicine use changed after hip fracture. Method: Data from the Australian Department of Veterans' Affairs healthcare claims database were used. The cohort included patients aged > 65 years who were hospitalised for hip fracture in 2009. Percentages of patients using medicines associated with falls or hip fracture were calculated in the 6 weeks before hospitalisation for hip fracture. McNemar's test was used to assess changes in medicines used before admission and after discharge from hospital. Results: 2235 patients with a median age of 87 years had hip fractures in 2009. At least 1 medicine that increases risk of falls or hip fracture was used by 84% of patients before admission. Of the drug classes that increase risk of falls or hip fracture, the 4 most commonly dispensed before admission were antihypertensives (63%), antidepressants (29%), benzodiazepines (26%) and opioids (19%). After discharge, the use of antipsychotics (p < 0.0001), opioids (p < 0.0001), benzodiazepines (p = 0.0009) and antidepressants (p = 0.01) increased significantly. Conclusion: Most older patients used at least 1 medicine that increases the risk of falls or hip fracture before and after hip fracture. Antipsychotic, opioid, benzodiazepine and antidepressant use increased significantly after hospital discharge. [ABSTRACT FROM AUTHOR]

Aim: To identify the characteristics of patients who receive home medicines reviews (HMRs). Method: A retrospective analysis was conducted of the Department of Veterans’ Affairs administrative claims data. Veterans living in the community on 30 June 2009 were included if they had ≥ 1 medicines dispensed in the previous 12 months. The main outcome measure was the number of veterans who received an HMR. Log binomial regression analysis compared characteristics of HMR recipients and non-recipients – age and gender; number of medicines, prescribers, dispensing pharmacies and hospitalisations in the previous year; and conditions where medicine use is potentially problematic, e.g. dementia. Results: Of the 175 572 veterans included in the study, 6236 (3.6%) had received an HMR. The likelihood of having an HMR increased with age, number of medicines and number of GP visits. Women were 12% more likely to receive an HMR than men. Veterans who had received an HMR previously were 4 times more likely to have another HMR. Veterans with 1 to 4 hospitalisations were 10% more likely to receive an HMR than those who had not been hospitalised. The likelihood of having an HMR decreased with the number of dispensing pharmacies and specialist visits. Conclusion: Patients who received HMRs had characteristics that placed them at risk of medication-related problems. The uptake of HMRs was appropriate in our study population. [ABSTRACT FROM AUTHOR]

Since 2004, the Department of Veterans' Affairs (DVA) has funded the Veterans' Medicines Advice and Therapeutics Education Services (MATES) program. The main intervention of the program is quarterly targeted patient-specific prescriber feedback. The feedback comprises a list of relevant medications dispensed to each patient and notes about potential medicationrelated problems specific to the intervention. Supportive educational material is provided to assist general practitioners (GPs) resolve these medication-related problems. Veterans identified in the GP mailing are sent an educational brochure highlighting medication issues and encouraging them to speak with their doctor. To enable pharmacists to support this practice change, educational material is also provided to all pharmacies and accredited pharmacists. The most recent of the 28 interventions implemented to date have addressed osteoporosis, opioid-induced constipation and urinary incontinence. Overall, program materials have been mailed to 249 454 veterans, 34 527 GPs and around 8000 pharmacies and accredited pharmacists. Evaluation has demonstrated a doubling of home medicines review (HMR) rates in the veteran population. Analyses of the DVA data have reported a 45% reduction in hospitalisation for heart failure following HMR among veterans with heart failure (adjusted hazard ratio [HR] 0.6; 95% confidence interval [CI] 0.4-0.8), and a 79% reduction in hospitalisation for haemorrhage (HR 0.2; 95%CI 0.05-0.9) 2 to 6 months after an HMR in veterans dispensed warfarin. Veterans' MATES has resulted in clinically significant improvements in medication and health service use. [ABSTRACT FROM AUTHOR]