Managing medicines in aged care with the PHARMA-Care National Quality Framework

Older adults living in residential aged care homes (RACHs) often experience multimorbidity and complex medication regimens, which can increase the risk of medicines-related adverse events and harms. The Aged Care Royal Commission emphasised the need for greater focus on quality use of medicines (QUM) in RACHs, recommending increased access to comprehensive medicines reviews, improved review quality, and embedding pharmacists within RACHs.

Currently, clinical pharmacist services are provided in RACHs through various government-funded initiatives:

1. Residential Medication Management Review (RMMR): conducted by credentialed pharmacists on referral from a GP.
2. Quality Use of Medicines program: facilitate pharmacists’ contributions to education and continuous improvement activities.
3. Aged Care On-site Pharmacist (ACOP) Measure: On-site credentialed pharmacists are funded to work in RACHs up to 0.2 FTE/50 beds, to contribute to clinical governance, medicines reviews and other resident-focused clinical interventions, interprofessional collaboration, residents/families communication, education, and quality improvement.

RACHs can choose to either implement the ACOP program (commenced July 2024) or maintain the longstanding RMMR/QUM programs. The ACOP program is still in an early implementation phase, with 12% of RACHs implementing an ACOP within 12-months of program commencement. Primary Health Networks can help RACHs engage an ACOP.

The PHARMA-Care National Quality Framework

Establishing the PHarmacists Actioning Rational use of Medicines in Aged Care (PHARMA-Care) Program is a four-year MRFF-funded project to establish an evidence-based quality monitoring program, support RACH teams to evaluate QUM and pharmacist services, and improve care and outcomes for residents. 

Our ACOP program logic model outlines the need for a quality framework and monitoring program to evaluate program impact and support refinements/scale-up. The recent Pharmacy Programs Cost Effectiveness Review also recommended mechanisms to support quality monitoring of pharmacy programs be established.

How it was developed

As part of PHARMA-Care, a National Quality Framework has been developed, which articulates an aspirational vision for monitoring QUM in RACHs. It outlines the desired actions, roles, and responsibilities for those who plan, implement, and evaluate these services. To develop this framework, relevant Australian and international frameworks were reviewed. A working group advised on development, and a national stakeholders’ workshop was held to finalise the framework, which included quality indicators (QIs).

What the framework includes

The framework comprises five domains: 

1. person-centred;
2. governance, leadership, and culture;
3. safety and quality; 
4. communication and collaboration; and 
5. access and equity. 

These domains help stakeholders to consider how their actions will improve residents' medicines-related experiences and outcomes. 

Domains are surrounded by six enablers: 

1. data, information systems and digital technology; 
2. skilled workforce; 
3. national policies and regulations; 
4. resources;
5. monitoring and evaluation; and
6. research.

Enablers refer to the broader policies, systems, resources, and infrastructure needed to successfully apply key domains. 

Through a rigorous and consultative process (systematic review, qualitative study, Delphi survey, national workshop), we identified 10 high-priority QIs to monitor QUM in RACHs. These QIs can help monitor activities relevant to the five framework quality domains, highlighting what is functioning well and potential improvements.

How the framework can help

The PHARMA-Care National Quality Framework supports: 

• The RACH team, including Medication Advisory Committees, with strategic planning, monitoring, and evaluation to embed consistent processes and support QUM. 
• Credentialed pharmacists to identify gaps, plan, implement, and monitor service provision and resident outcomes, and enhance communication/collaboration with GPs, nurses and other health professionals.
• Residents and/or supporters to be empowered and involved in medicines-related decisions and enhance understanding of the scope of pharmacist services in RACHs.  
• GPs, geriatricians and other medical practitioners to enhance their collaboration with credentialed pharmacists and understanding of QUM activities in RACHs.
• Researchers, program planners/evaluators and policy makers to monitor medicines management and inform future policy, practice, and funding support. 

The PHARMA-Care Framework and its associated QIs are designed to provide meaningful insights into resident care, supporting ongoing learning, benchmarking, and continuous improvement. It is designed to ensure work to optimise QUM in RACHs is measurable, visible and sustainable. Implementation of the framework will support the sector in consistently delivering high-quality medicines management and ultimately improve residents’ experiences and health outcomes. 

The Framework is endorsed by: Ageing Australia, Pharmaceutical Society of Australia, Advanced Pharmacy Australia, Australian Nursing & Midwifery Federation (SA Branch).

Dr Sara Javanparast is a medical practitioner and Senior Research Fellow in the School of Allied Health and Human Performance, Adelaide University. She has over 18 years of experience in primary health care and aged care research, and research implementation and translation.

Associate Professor Malcolm Clark is a GP and a Clinical Associate Professor at the Department of General Practice, University of Melbourne. He has been a GP in his local area for >25 years with special interests in aged care medicine, teaching, and GP research.

Professor Janet Sluggett is a pharmacist and Professor in Pharmacy & Pharmacoepidemiology, Enterprise Fellow, and NHMRC EL2 Fellow at Adelaide University, and the lead investigator on the PHARMA-Care project.

The PHARMA-Care project is funded by the MRFF 2022 Quality, Safety and Effectiveness of Medicine Use by Pharmacists (MRFMMIP000019) and an NHMRC Investigator grant (GNT2016277). Prof Sluggett is a Non-Executive Director of Southern Cross Care SA, NT, VIC.