Improving community access to terminal phase medicines through the implementation of a 'Core Medicines List' in South Australian community pharmacies.
OBJECTIVE
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.
Southern Adelaide Palliative Services, Repatriation General Hospital, Adelaide, South Australia, Australia.|Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia.
Paul
P
Tait
Clinical Epidemiology Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.
Chris
C
Horwood
Clinical Epidemiology Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.
Paul
P
Hakendorf
Southern Adelaide Palliative Services, Repatriation General Hospital, Adelaide, South Australia, Australia.
Timothy
T
To
D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003157:Community Pharmacy Services / Q000331:legislation & jurisprudence*; D005260:Female; D006284:Health Plan Implementation / Q000379:methods*; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000331:legislation & jurisprudence / Q000379:methods*; D013021:South Australia; D011795:Surveys and Questionnaires
D000701:Analgesics, Opioid; D000932:Antiemetics; D014150:Antipsychotic Agents; D018680:Cholinergic Antagonists; D001569:Benzodiazepines
Ambulatory Care; Formularies; General Practitioners; Pharmacists; Quality Improvement; Terminal care