Emergency supply of prescription-only medicines to patients by community pharmacists: a mixed methods evaluation incorporating patient, pharmacist and GP perspectives

Abstract

ObjectiveTo evaluate and inform emergency supply of prescription-only medicines by community pharmacists (CPs), including how the service could form an integral component of established healthcare provision to maximise adherence.DesignMixed methods. 4 phases: prospective audit of emergency supply requests for prescribed medicines (October–November 2012 and April 2013); interviews with CPs (February–April 2013); follow-up interviews with patients (April–May 2013); interactive feedback sessions with general practice teams (October–November 2013).Setting22 community pharmacies and 6 general practices in Northwest England.Participants27 CPs with experience of dealing with requests for emergency supplies; 25 patients who received an emergency supply of a prescribed medicine; 58 staff at 6 general practices.ResultsClinical audit in 22 pharmacies over two 4-week periods reported that 526 medicines were requested by 450 patients. Requests peaked over a bank holiday and around weekends. A significant number of supplies were made during practice opening hours. Most requests were for older patients and for medicines used in long-term conditions. Difficulty in renewing repeat medication (forgetting to order, or prescription delays) was the major reason for requests. The majority of medicines were ‘loaned’ in advance of a National Health Service (NHS) prescription. Interviews with CPs and patients indicated that continuous supply had a positive impact on medicines adherence, removing the need to access urgent care. General practice staff were surprised and concerned by the extent of emergency supply episodes.ConclusionsCPs regularly provide emergency supplies to patients who run out of their repeat medication, including during practice opening hours. This may aid adherence. There is currently no feedback loop, however, to general practice. Patient care and interprofessional communication may be better served by the introduction of a formally structured and funded NHS emergency supply service from community pharmacies, with ongoing optimisation of repeat prescribing.

Assessment of the rates and characteristics of the short-term supply of medication (Tider) from an integrated healthcare delivery system in the United States

“…O’Neil and colleagues reported that 67% of 243 pharmacists from Greater London and Southeast England who were surveyed responded receiving at least one request monthly for an emergency supply of a prescription medication in 1998 5. Morecroft and colleagues reported from their clinical audit of 22 pharmacies in Northwest England that 450 patients had requested an emergency supply of a prescription medication during a 4-week time period in 2013 4. Neither of these studies’ results readily are comparable to our findings as they do not report the denominator of prescriptions dispensed during the study period.…”

“…O’Neil and colleagues reported that patients most commonly requested an emergency supply of respiratory, cardiovascular, and central nervous system medications 5. Morecroft and colleagues reported that patients most commonly requested an emergency supply of cardiovascular, respiratory, and endocrine medications and a high proportion of requests around the weekend 4. While we identified high rates of cardiovascular and endocrine tider dispensing, we identified relatively few respiratory (i.e., decongestants) tider dispensing since these medications are not dispensed as tiders at Kaiser Permanente Colorado.…”

“…These studies reported the characteristics of patients who received a tider4,5, the tider medications dispensed4,5, and patients’ and pharmacists’ perceptions of tiders on medication adherence 6,7. These studies had either small sample sizes or were focused on the legal implications of providing a tider 4,5,6,7. Studies detailing the cost of tider medication dispensing and contrasting the characteristics of tider and non-tider patients and medications have not been reported.…”

DTB Select: 10 | October 2015

“…Although community pharmacists frequently provide emergency supplies of prescription medicines to patients who run out, there is limited published evidence on the scale and nature of such requests 3. A recently published paper provides some more detail on the number of requests and the experiences of patients, pharmacists and GP practice staff 3.…”

“…A recently published paper provides some more detail on the number of requests and the experiences of patients, pharmacists and GP practice staff 3. The four-phase study was designed to evaluate the provision of emergency supplies of medicine and to inform how this process could be used to support patient care.…”