Factors affecting access to subcutaneous medicines for people dying in the community

Abstract

Objectives: Common terminal phase symptoms include pain, dyspnoea, anxiety, terminal restlessness, nausea and noisy breathing. This study identified the proportion of community pharmacies across two Australian states stocking medicines useful in managing terminal phase symptoms, while exploring factors considered predictive of pharmacies carrying these medicines.

Methods: Community pharmacies from across the states of New South Wales (NSW) and South Australia (SA) were concurrently mailed a survey. Respondents were asked questions relating to medicines stocked, expiry date of stock, awareness of people with palliative care needs and demographic characteristics of the pharmacy. A ‘prepared pharmacy’ was defined as a pharmacy that held medicines useful in the management of terminal phase symptoms.

Results: The proportion of prepared pharmacies across NSW and SA was 21.9%. Multiple logistic regression demonstrated eight predictors of prepared pharmacies, of which awareness of people with palliative needs using their service was the strongest.

Conclusions: One-fifth of community pharmacies carry formulations useful in managing terminal phase symptoms. The main factor associated with this was awareness of people with palliative needs using the pharmacy. Strategies that engage with pharmacists in anticipation of the terminal phase are critical, supporting people with palliative needs to remain at home to die, if desired.

Keywords:

• Pharmacists
• Terminal care
• Pharmaceutical preparations
• Signs and symptoms

Supplemental data

Supplemental data for this article can be accessed at https://doi.org/10.1080/09699260.2020.1746033.

Acknowledgements

The authors would like to thank Debra Rowett and John Gray for their valuable assistance in developing the original ‘Community Pharmacy Survey’, and the staff of the responding community pharmacies for their cooperation.

Disclaimer statements

Contributors Substantial contribution to the concept or design of the work – KS, NM, PT. Acquisition, analysis or interpretation of data – all authors. Drafted the article or revised it critically for important intellectual content – all authors. Approved the version to be published – all authors. Have participated sufficiently in the work to take public responsibility for appropriate portions of the content – all authors.

Funding The distribution of the Community Pharmacy Survey to NSW pharmacies was funded by the NSW Ministry of Health. The distribution of the Community Pharmacy Survey to SA pharmacies was funded by the Southern Adelaide Palliative Services.

Conflict of interest None.

Ethics approval The Southern Adelaide Clinical Human Research Ethics Committee (SAC HREC) reviewed the project and determined it does not require ethical review or approval, as this is a quality improvement project. Ethics for conducting the study in NSW was obtained from the South Eastern Sydney Local Health District Human Ethics Committee in accordance with NSW Health Guideline GL2007_020 Human Research Ethics Committees – Quality Improvement and Ethics Review: A Practice Guide for NSW.