Background Providing palliative care patients living at home with timely access to medicines is critical to enable effective symptom management, minimise burden and reduce unplanned use of healthcare services. Little is known about how diverse community-based palliative care models influence medicine access.
Objective To produce a critical overview of research on experiences and outcomes of medicine access in community-based palliative care models of service delivery through a systematic review and narrative synthesis.
Methods MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library databases and grey literature were systematically searched for all types of studies. Study quality was assessed using the Mixed Methods Appraisal Tool; a narrative synthesis was used to integrate and summarise findings.
Results 3331 articles were screened; 10 studies were included in the final sample. Studies included a focus on community pharmacy (n=4), hospice emergency medication kits (HEMKs) in the home (n=3), specialist community nurse prescribers (n=1), general practice (n=1) and one study included multiple service delivery components. Community pharmacy was characterised by access delays due to lack of availability of medicine stock and communication difficulties between the pharmacy and other healthcare professionals. HEMKs were perceived to reduce medicine access time out of hours and speed symptom control. However, the majority of studies comprised small, local samples, largely limited to self-reports of health professionals. There was a lack of data on outcomes, and no comparisons between service delivery models.
Conclusions Further research is required to understand which models facilitate rapid and efficient access to medicines for community-based palliative care patients.
- home care
- service evaluation
- symptoms and symptom management
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Contributors All authors (MO, NC, JB, AR, MIB, MS, SL) contributed to study design. MO performed the searches. MO, NC and SL contributed to data collection and data analysis. MO and SL drafted the article. NC contributed to writing of the article. All authors revised the article critically for important intellectual content and were responsible for approval of the final manuscript. SL is responsible for the overall content as guarantor.
Funding The review reported here formed part of a larger study evaluating ACcess To MEDicines (ActMed) for patients at end of life in the context of service delivery characteristics. ISRCTN: 12762104 | PROSPERO registration: CRD42017083563. Date of registration: 18 December 2017. Protocol: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/165223/%23/. This study was funded by the National Institute for Health Research (NIHR) (Health Services and Delivery Research Programme) (project number 16/52/23).
Disclaimer This study is funded by the National Institute for Health Research (NIHR) [Health Services & Delivery Research programme] (project number 16/52/23). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Professor Richardson is a National Institute for Health Research (NIHR) Senior Investigator. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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