Community pharmacists: a forgotten resource for palliative care

Abstract

Timely access to medicines within the community is important for palliative patients where their preferred place of care is the home environment. The objective of this observational study is to establish baseline data to quantify the issue of poor access to medicines for symptom control in the last few days of life. The list of 13 medicines was generated from medicine use within a metropolitan palliative care unit. A survey was designed to determine which of these 13 medicines community pharmacies stock, the expiry date of this stock, awareness of palliative care patients by community pharmacists and basic demographic characteristics of the community pharmacies. Surveys were distributed, by post, to all community pharmacies in South Australia. The response rate was 23.7%, and was representative of all socioeconomic areas. Each pharmacy stocked a median of 3 medicines (range 0-12) with 1 in 8 pharmacies having none of the 13 medicines listed in the survey. When the data was combined to identify the range of medicines from all pharmacies within a geographical postcode region, the median number of medicines increased to 5 medicines per postcode. Just over 1 in 5 pharmacies reported learning about the palliative status of a patient through another health practitioner. Community pharmacies remain an underused resource to support timely access to medicines for community-based palliative patients. Palliative care services and government agencies can develop new strategies for better access to medicines that will benefit community patients and their carers.

How timely is access to palliative care medicines in the community? A mixed methods study in a UK city

“…Legal errors on CD prescriptions played a much smaller role and had little impact on access to PMs in this study. Stock availability as a significant factor to support timely access has also been seen in previous studies 5 8 10 11…”

“…Pharmacies cannot stock every possible PM; local formularies, which provide lists of preferred medicines to support symptom management towards the end of life, help address this in the UK 7 8. However, knowledge on which PMs are listed in the formulary and those pharmacies holding stocks may be lacking among prescribers,7 8 which could lead to prescriptions being issued for ‘non-formulary’ items not on the local list and/or prescriptions being presented to pharmacies that do not routinely hold PMs 5–12. Delays may also be caused by legal errors on controlled drug (CD) prescriptions that do not comply with UK government legislation necessitating the pharmacist making professional and ethical judgements in supporting patient care especially in the out-of-hours period 5 7 8.…”

“…Australian research on a proposed core set of PMs found that pharmacies stocked on average three out of the list of 12,11 while a system analysis in Ireland found that not stocking PMs in the pharmacy was the most likely factor leading to delays10 and this has also been found in the UK 5 7 8 12. Reported contributory factors include: the unpredictable nature of PM prescription requests; national stock shortages; the prescription of PMs or strengths not on the recommended list; unlicensed medicines; errors on CD prescriptions and the inability to contact the prescriber, for instance, outside general practitioner (GP) (family doctor) practice opening hours 5 8 14…”

Medication management for community palliative care patients and the role of a specialist palliative care pharmacist: A qualitative exploration of consumer and health care professional perspectives

“…15 Palliative care patients frequently have multiple co-morbidities that require complex and dynamic therapeutic regimens. Pharmacists could play crucial roles in this setting by undertaking various clinical pharmacy functions including medication reviews, optimisation of therapy for symptom management, [16][17][18] monitoring and reporting adverse drug reactions and interactions, 19 counselling and education for patients and caregivers. 20,21 The pharmacist could also assist in facilitating access to medicines and medicines-related information to patients, carers and other health professionals.…”

Improving community access to terminal phase medicines through the implementation of a ‘Core Medicines List’ in South Australian community pharmacies

“…In 2012, we designed a ‘Community Pharmacy Survey’ to provide objective baseline data to describe the community pharmacy involvement in care for patients dying at home 13. We showed: Good awareness, by community pharmacists, of palliative patients using their business;Willingness of pharmacists to contact nearby pharmacies to access urgent medicines, in the event that the prescribed medicine was unavailable;Many community pharmacists continue to struggle to anticipate which medicines to stock; andMany formulations on the pharmacy shelf were imminently expiring, questioning the sustainability of ongoing supply of this range of products.…”