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Community Pharmacists: A Forgotten Resource for Palliative Care. Paul Tait , John Gray, Paul Hakendorf, Bel Morris, David Currow & Debra Rowett. Aim. Identify likelihood of community pharmacies having medicines for symptom control in the terminal p hase

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community pharmacists a forgotten resource for palliative care

Community Pharmacists: A Forgotten Resource for Palliative Care

Paul Tait, John Gray, Paul Hakendorf, Bel Morris, David Currow & Debra Rowett

slide2
Aim
  • Identify likelihood of community pharmacies having medicines for symptom control in the terminal phase
  • Identify community pharmacy’s level of awareness of palliative patients/carers
  • Understand the demographics of the community pharmacies
  • Develop a distribution list of community pharmacies

Building a platform for improved access to palliative medicines in the community

terminal phase medicines tpm list
Terminal Phase Medicines (TPM) List
  • Symptoms:
    • Dyspnoea
    • Pain
    • Nausea
    • Delirium ± agitation; and
    • Noisy secretions.
  • Physical ability
    • decreased energy levels;
    • reduced ability to swallow; and
    • impaired mental state

Building a platform for improved access to palliative medicines in the community

terminal phase medicines tpm list1
Terminal Phase Medicines (TPM) List

Building a platform for improved access to palliative medicines in the community

tpm list
TPM List
  • Clonazepam 1mg inj*
  • Clonazepam 2.5mg/mL oral drops*
  • Dexamethasone 4mg/mL inj*
  • Fentanyl 100mcg/2mL inj
  • Haloperidol 5mg/mL inj*
  • Hydromorphone 10mg/mL inj*
  • Hyoscine Butylbromide 20mg/mL inj*
  • Hyoscine Hydrobromide 400mcg/mL inj
  • Metoclopramide 10mg/2mL inj*
  • Midazolam 5mg/mL inj
  • Morphine 10mg/mL inj*
  • Morphine 10mg/mL oral mixture*
  • Oxycodone 10mg/mL inj

Building a platform for improved access to palliative medicines in the community

the survey
The Survey
  • Demographics of the pharmacy
    • Role of the person completing the survey;
    • Postcode (→socioeconomic scales, rural/metro);
    • Pharmacist FTEs;
    • Usual opening hours; and
    • Clinical and supply services offered.
  • Awareness of palliative patients
    • How many palliative patients had used pharmacy over the previous 12 months;
    • How they became aware of palliative status; and
    • The range of issues affecting timely access to these medicines.

Building a platform for improved access to palliative medicines in the community

the survey1
The Survey
  • Access to stock
    • Date of completing the survey;
    • Existence of medicines from the TPM List in their dispensary; and
    • Shortest expiry date of each item held within the pharmacy.
  • Willingness to be part of an email distribution list

Building a platform for improved access to palliative medicines in the community

methodology
Methodology
  • Southern Adelaide Clinical Human Research Ethics Committee (SAC HREC)
  • Each community pharmacy was allocated an individual code.
  • Survey was mailed with a cover letter to 455 pharmacies across SA
  • All responding pharmacies were allocated to a decile of the Seifa Index
  • No reminders were sent out

Building a platform for improved access to palliative medicines in the community

likelihood of having stock
Likelihood Of Having Stock

Building a platform for improved access to palliative medicines in the community

likelihood of having stock1
Likelihood Of Having Stock

Building a platform for improved access to palliative medicines in the community

likelihood of having stock2
Likelihood Of Having Stock

Building a platform for improved access to palliative medicines in the community

likelihood of having stock3
Likelihood Of Having Stock

Building a platform for improved access to palliative medicines in the community

likelihood of having stock4
Likelihood Of Having Stock

Building a platform for improved access to palliative medicines in the community

likelihood of having stock5
Likelihood Of Having Stock

Building a platform for improved access to palliative medicines in the community

awareness
Awareness

Building a platform for improved access to palliative medicines in the community

awareness1
Awareness

Building a platform for improved access to palliative medicines in the community

expiry d ate data
Expiry Date Data

Building a platform for improved access to palliative medicines in the community

recommendations
Recommendations
  • Prescribers:
    • Involve community pharmacists in discussions about care planning
  • Palliative Care Organisations:
    • Develop a core medicines list to guide prescribers and community pharmacists alike
  • Policy Makers:
    • Create incentives for community pharmacies to hold a small range of medicines

Building a platform for improved access to palliative medicines in the community

reflections
Reflections

What Worked Well

What We’d Do Differently

Enquiring about a single strength for each medicine may have skewed data

  • Sending survey in paper form with reply paid envelope
  • Surveying all pharmacies across SA
  • Asking about expiry dates
  • Choice of medicines matched the WA essential medicines document

Building a platform for improved access to palliative medicines in the community

community pharmacists a forgotten resource for palliative care1

Community Pharmacists: A Forgotten Resource for Palliative Care

Paul Tait, John Gray, Paul Hakendorf, Bel Morris, David Currow & Debra Rowett

core medicines
Core Medicines

For noncomplex adult patients

  • Clonazepam 1mg injection;
  • Morphine 10mg/mL injection;
  • Haloperidol 5mg/mL injection;
  • Metoclopramide 10mg/2mL injection;
  • Hyoscine butylbromide 20mg/mL injection.

Building a platform for improved access to palliative medicines in the community

demographics
Demographics

Building a platform for improved access to palliative medicines in the community

issues
Issues

Building a platform for improved access to palliative medicines in the community