Register      Login
Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Improving community access to terminal phase medicines in Australia: identification of the key considerations for the implementation of a ‘core medicines list’

Paul A. Tait A B D , Weng Hou Cheung C , Michael Wiese C and Kirsten Staff C
+ Author Affiliations
- Author Affiliations

A Southern Adelaide Palliative Services, Repatriation General Hospital, 700 Goodwood Road, Daw Park, SA 5041, Australia.

B Discipline of Palliative and Supportive Services, Flinders University, SA 5042, Australia.

C School of Pharmacy and Medical Sciences, University of South Australia, SA 5000, Australia.

D Corresponding author. Email: paul.tait@sa.gov.au

Australian Journal of Primary Health 23(4) 373-378 https://doi.org/10.1071/PY16153
Submitted: 24 November 2016  Accepted: 12 February 2017   Published: 11 May 2017

Abstract

During the terminal phase, access to medicines is critical for people wishing to spend their last days of life at home. Yet, access to medicines can be problematic. The aim of this study was to report the perspectives of specialist and generalist health professionals (HPs) on the issues of community access to medicines for this vulnerable group. A qualitative descriptive study design investigated the views of HPs working in palliative care roles in South Australia. Nurses, doctors and pharmacists described their experiences of accessing medicines for management of terminal phase symptoms during semi-structured focus group discussions. Content analysis identified six themes including: ‘Medication Supply’, ‘Education and Training’, ‘Caregiver Burden’, ‘Safety’, ‘Funding’ and ‘Clinical Governance’. Future projects should aim to address these themes when developing strategies for the management of people wishing to die at home.


References

Australian Institute of Health and Welfare (2014) Palliative care services in Australia 2014. Catalogue number HWI 128. AIHW, Canberra.

Bell CL, Somogyi-Zalud E, Masaki KH (2010) Factors associated with congruence between preferred and actual place of death. Journal of Pain and Symptom Management 39, 591–604.
Factors associated with congruence between preferred and actual place of death.Crossref | GoogleScholarGoogle Scholar |

Brisbane South Palliative Care Collaborative (2013) Workplace implementation guide: support for Managers, Link Nurses and Palliative Approach Working Parties, Queensland Health. Available at https://www.caresearch.com.au/Caresearch/Portals/0/PA-Tookit/Workplace_Implementation_Guide_1.pdf [Verified 24 November 2016]

Broad JB, Gott M, Kim H, Boyd M, Chen H, Connolly MJ (2013) Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. International Journal of Public Health 58, 257–267.
Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics.Crossref | GoogleScholarGoogle Scholar |

Ewing G, Grande G (2013) Development of a Carer Support Needs Assessment Tool (CSNAT) for end-of-life care practice at home: a qualitative study. Palliative Medicine 27, 244–256.
Development of a Carer Support Needs Assessment Tool (CSNAT) for end-of-life care practice at home: a qualitative study.Crossref | GoogleScholarGoogle Scholar |

Faull C, Windridge K, Ockleford E, Hudson M (2013) Anticipatory prescribing in terminal care at home: what challenges do community health professionals encounter? BMJ Supportive & Palliative Care 3, 91
Anticipatory prescribing in terminal care at home: what challenges do community health professionals encounter?Crossref | GoogleScholarGoogle Scholar |

Gomes B, Calanzani N, Curiale V, McCrone P, Higginson IJ (2013) Effectiveness and cost‐effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database of Systematic Reviews Issue 6, CD007760
Effectiveness and cost‐effectiveness of home palliative care services for adults with advanced illness and their caregivers.Crossref | GoogleScholarGoogle Scholar |

Hudson P (2013) Home-based support for palliative care families: challenges and recommendations. The Medical Journal of Australia 179, S35–S37.

Linge-Dahl L, Vranken M, Juenger S, North K, Scholten W, Payne S, Radbruch L (2015) Identification of challenges to the availability and accessibility of opioids in twelve European countries: conclusions from two ATOME six-country workshops. Journal of Palliative Medicine 18, 1033–1039.
Identification of challenges to the availability and accessibility of opioids in twelve European countries: conclusions from two ATOME six-country workshops.Crossref | GoogleScholarGoogle Scholar |

Lucey M, McQuillan R, MacCallion A, Corrigan M, Flynn J, Connaire K (2008) Access to medications in the community by patients in a palliative setting. A systems analysis. Palliative Medicine 22, 185–189.
Access to medications in the community by patients in a palliative setting. A systems analysis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1c3htlektA%3D%3D&md5=d5da4f92aed3fba7028e865857170adbCAS |

Malterud K (2012) Systematic text condensation: a strategy for qualitative analysis. Scandinavian Journal of Public Health 40, 795–805.
Systematic text condensation: a strategy for qualitative analysis.Crossref | GoogleScholarGoogle Scholar |

O’Connor M, Hewitt LY, Tuffin PH (2013) Community pharmacists’ attitudes toward palliative care: an Australian nationwide survey. Journal of Palliative Medicine 16, 1575–1581.
Community pharmacists’ attitudes toward palliative care: an Australian nationwide survey.Crossref | GoogleScholarGoogle Scholar |

Payne S, Turner M, Seamark D, Thomas C, Brearley S, Wang X, Blake S, Milligan C (2015) Managing end of life medications at home – accounts of bereaved family carers: a qualitative interview study. BMJ Supportive & Palliative Care 5, 181–188.
Managing end of life medications at home – accounts of bereaved family carers: a qualitative interview study.Crossref | GoogleScholarGoogle Scholar |

Rosenberg JP, Bullen T, Maher K (2015) Supporting family caregivers with palliative symptom management: a qualitative analysis of the provision of an emergency medication kit in the home setting. The American Journal of Hospice & Palliative Care 32, 484–489.
Supporting family caregivers with palliative symptom management: a qualitative analysis of the provision of an emergency medication kit in the home setting.Crossref | GoogleScholarGoogle Scholar |

Swerissen H, Duckett SJ (2015) What can we do to help Australians die the way they want to? The Medical Journal of Australia 202, 10–11.
What can we do to help Australians die the way they want to?Crossref | GoogleScholarGoogle Scholar |

Swetenham K, Grantham H, Glaetzer K (2014) Breaking down the silos: collaboration delivering an efficient and effective response to palliative care emergencies. Progress in Palliative Care 22, 212–218.
Breaking down the silos: collaboration delivering an efficient and effective response to palliative care emergencies.Crossref | GoogleScholarGoogle Scholar |

Tait PA, Gray J, Hakendorf P, Morris B, Currow DC, Rowett DS (2013) Community pharmacists: a forgotten resource for palliative care. BMJ Supportive & Palliative Care 3, 436–443.
Community pharmacists: a forgotten resource for palliative care.Crossref | GoogleScholarGoogle Scholar |

Tait P, Morris B, To T (2014) Core palliative medicines: meeting the needs of non-complex community patients. Australian Family Physician 43, 29–32.

Virdun C, Luckett T, Davidson PM, Phillips J (2015) Dying in the hospital setting: a systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important. Palliative Medicine 29, 774–796.
Dying in the hospital setting: a systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important.Crossref | GoogleScholarGoogle Scholar |

Walker KA, McPherson ML (2010) Perceived value and cost of providing emergency medication kits to home hospice patients in Maryland. The American Journal of Hospice & Palliative Care 27, 254–260.
Perceived value and cost of providing emergency medication kits to home hospice patients in Maryland.Crossref | GoogleScholarGoogle Scholar |