Supporting patient access to medicines in community palliative care: on-line survey of health professionals’ practice, perceived effectiveness and influencing factors

Abstract

Background Patient access to medicines at home during the last year of life is critical for symptom control, but is thought to be problematic. Little is known about healthcare professionals’ practices in supporting timely medicines access and what influences their effectiveness. The purpose of the study was to evaluate health professionals’ medicines access practices, perceived effectiveness and influencing factors. Methods On-line questionnaire survey of health care professionals (General Practitioners, Community Pharmacists, community-based Clinical Nurse Specialists and Community Nurses) delivering end-of-life care in primary and community care settings in England. Quantitative data were analysed using descriptive statistics. Results One thousand three hundred twenty-seven responses were received. All health professional groups are engaged in supporting access to prescriptions, using a number of different methods. GPs remain a predominant route for patients to access new prescriptions in working hours. However, nurses and, increasingly, primary care-based pharmacists are also actively contributing. However, only 42% (160) of Clinical Nurse Specialists and 27% (27) of Community Nurses were trained as prescribers. The majority (58% 142) of prescribing nurses and pharmacists did not have access to an electronic prescribing system. Satisfaction with access to shared patient records to facilitate medicines access was low: 39% (507) were either Not At All or only Slightly satisfied. Out-of-hours specialist cover was reported by less than half (49%; 656) and many General Practitioners and pharmacists lacked confidence advising about out-of-hours services. Respondents perceived there would be a significant improvement in pain control if access to medicines was greater. Those with shared records access reported significantly lower pain estimates for their caseload patients. Conclusions Action is required to support a greater number of nurses and pharmacists to prescribe end-of-life medicines. Solutions are also required to enable shared access to patient records across health professional groups. Coverage and awareness of out-of-hours services to access medicines needs to be improved.

Community access to palliative care medicines—patient and professional experience: systematic review and narrative synthesis

“…But one study (Kuruvilla et al) 19 highlighted that delivery systems are not free of charge and reduce contact time with the pharmacist, and a more recent survey highlighted electronic prescribing is far from universally available to prescribing nurses and pharmacists, suggesting further in-depth evaluation of these aspects of service delivery is required. 35 Community palliative care specialist nurse prescribers were also reported to provide out-of-hours support and quicker medicine access in times of crisis. This form of out-of-hours care delivery is also recommended as a quality improvement priority by Williams et al 36 following their review of community palliative care incidents reported on a national database.…”

Getting palliative medications right across the contexts of homes, hospitals and hospices: protocol to synthesise scoping review and ethnographic methods in an activity theory analysis

“…A better understanding of practices experienced, as distinct from intended processes, can identify targets for system change, new ways of working and new forms of practice 12–16. To address this, the multistep process of prescribing and medication use should be conceptualised as a series of socially constructed practices in which patients, informal carers and professionals are required to collaborate across locations and organisational boundaries 17–19…”

Patient and carer access to medicines at end of life: the ActMed mixed-methods study

“…Routes provided for access to new prescriptions during working hours43 Which of the following are you able to provide for patients to obtain new prescriptions during working hours? Please select all options you use:…”

“…Note that different numbers of 'NA' recorded throughout and so percentages have different denominators. Reproduced with permission from Latter et al43 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: https://creativecommons.org/ licenses/by/4.0/.…”