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Improving community access to terminal phase medicines through the implementation of a ‘Core Medicines List’ in South Australian community pharmacies
  1. Paul Tait1,2,
  2. Chris Horwood3,
  3. Paul Hakendorf3 and
  4. Timothy To1
  1. 1 Southern Adelaide Palliative Services, Repatriation General Hospital, Adelaide, South Australia, Australia
  2. 2 Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
  3. 3 Clinical Epidemiology Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
  1. Correspondence to Paul Tait, Southern Adelaide Palliative Services, Repatriation General Hospital, 700 Goodwood Road, Adelaide, SA 5041, Australia; Paul.Tait{at}health.sa.gov.au

Abstract

Objectives Difficulties accessing medicines in the terminal phase hamper the ability of patients to die at home. The aim of this study was to identify changes in community access to medicines for managing symptoms in the terminal phase throughout South Australia (SA), following the development of a ‘Core Medicines List’ (the List) while exploring factors predictive of pharmacies carrying a broad range of useful medicines.

Methods In 2015, SA community pharmacies were invited to participate in a repeat survey exploring the availability of specific medicines. Comparisons were made between 2012 and 2015. A ‘preparedness score’ was calculated for each pharmacy, scoring 1 point for each medicine held from the following 5 classes: opioid, benzodiazepine, antiemetic, anticholinergic and antipsychotic.

Results The proportion of pharmacies carrying all items from the List rose from 7% in 2012 to 18% in 2015 (p=0.01). Multiple linear regression demonstrated that a monthly online newsletter subscription (p=0.04) and provision of a clinical service to aged care facilities (p=0.02) were predictors of pharmacies carrying all items on the List. Furthermore, multiple linear regression demonstrated that the provision of an afterhours service (p=0.02) and clinical services to aged care facilities (p=0.04) were predictors of pharmacies with a high ‘preparedness score’. In responding to issues with supply of medicines at end of life, respondents were more likely to contact the prescriber if aware of palliative patients (p=0.03).

Conclusions These results suggest that there is value in developing and promoting a standardised list of medicines, ensuring that community palliative patients have timely access to medicines in the terminal phase.

  • Formularies
  • Quality Improvement
  • Ambulatory Care
  • Terminal care
  • General Practitioners
  • Pharmacists

https://doi.org/10.1136/bmjspcare-2016-001191

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    Footnotes

    • Contributors PT contributed to the planning, conduct and reporting of the work described in the article. CH and PH contributed to the statistical analysis of the data and reporting of the work described in the article. TT contributed to the planning, conduct and reporting of the work described in the article.

    • Competing interests None declared.

    • Ethics approval Ethics approval for the study was obtained from the Southern Adelaide Clinical Human Research Ethics Committee (SAC HREC).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The authors are prepared to make unit record data available to share with anyone who is interested in comparing regional differences.