Home' Australian Pharmacist : Australian Pharmacist May 2012 Contents 366 Australian Pharmacist May 2012 I ©Pharmaceutical Society of Australia Ltd.
gure interstate or overseas was closer
to the 50% mark, with poor access to
medicines within the community being a
big contributor to the lower rate.
'Home Medicines Reviews (HMRs) also
could play a much greater role. At present
the number of HMRs for palliative patients
is limited. There is a great opportunity for
us to change that,' Mr Tait said.
The problem has been more at the
prescriber end where many people
don't understand the value of HMRs
for palliative patients. Some palliative
patients may be on 10 or more palliative
medicines, over and above medicines for
an underlying condition. This presents
huge risk for medicines misadventure and
so the bene t of HMRs is clear.
An expanded role for
Professor Jiwa said the role of pharmacists
in palliative care was one of growing
importance, particularly as the
'Pharmacists have a huge role to play
in the palliative area. Most people say
they want to die at home and if we are
to facilitate that then clearly community
pharmacists are going to have a major role,'
Professor Jiwa said.
'In our study [see Australian Pharmacist
January 2012, Field testing a protocol to
facilitate the involvement of pharmacists in
community based palliative care, page 72]
the people we spoke to had at least seven
palliative care problems and many of these
require prescription medicines, often in
strange doses or medicines that need to be
administered in strange ways and so on.
'As a GP myself I recognise there is an
enormous role pharmacists can play if we
can facilitate this.'
Dr Luxford said she saw many roles
for pharmacists above the traditional
'HMRs are one tool I think we should
utilise far more in palliative care. More
and more people want to die at home so
HMRs play an important part in facilitating
this by providing better support at home
and developing better links between the
pharmacists and primary care providers
such as community care nurses.'
Another pharmacist working on the SA
Health program, Belinda Morris, says the
importance of pharmacists in palliative
care is a lot about access to medicines and
up-skilling community based sta so that
they can better look after palliative care
patients in the community.
'As demand for palliative care increases,
we need to lift the capacity of
community-based care,' she said.
'Access to medicines is a very big area.
Palliative care medicines are often not
generally stocked so we are developing
a formulary to help pharmacists plan.
There may be the need for pharmacies
to establish networks so they can help
each other out in the supply of the less
commonly used drugs.'
The South Australian initiative
A unique collaboration between health
professionals, as well as local and
national health reform, has resulted
in South Australia implementing the
ground-breaking Palliative Care Pharmacy
The expansion and reshaping of palliative
care services in South Australia, outlined
in its Palliative Care Service Plan 2009--
2016, is predicated on establishing new
advanced practice roles and optimising
all existing disciplinary contributions to
palliative care team practice.
The Statewide Palliative Care Pharmacy
Network project is managed by pharmacist
Debra Rowett and administered through
the Drug and Therapeutics Information
Service (DATIS). The project aims to
develop a model which builds a sustainable
community-based palliative care pharmacy
It will achieve this by linking key
stakeholders and services to support and
enhance the network, increase the capacity
to deliver Medication Management Review
services to patients in their homes and
provide timely and responsive access
Ms Rowett said the project provided the
opportunity to develop a sustainable
community-based palliative care pharmacy
network which aims to improve access
to medicines in metropolitan and rural
communities. It aims to achieve this within
a quality use of medicines framework
to support the ability of palliative care
services to provide palliative care in the
place of the patient's choice. The network
and the advanced practice roles were
only possible by having collaboration
between health professionals and good
health and palliative care policies working
'This is the result of many years of
cooperation between nurses, doctors
and pharmacists, the SA Palliative Care
Network, and funding and commitment for
the project provided through the Central
Northern Adelaide Health Service,' Ms
'There are a lot of people in the palliative
care eld doing exceptional work.
These include pharmacists who have
played an important clinical role in
palliative care for a very long time. The
project seeks to further engage community
pharmacists in a more collaborative way
along the continuum of care and at the
primary care/tertiary care interface.'
Ms Rowett said the network was
underpinned by research which showed
the need to improve the timely access
to medicines to improve the delivery
of palliative care in the place of the
'As the Advanced Practice Palliative Care
Pharmacist positions are new roles it is
acknowledged that there needs to be
careful consideration of how these roles
t with the new national frameworks for
advanced practice in pharmacy and the
need to align these positions within this
broader framework,' she said.
'To ensure the positions are developed
to achieve the goals and realise the
opportunities a orded these new roles
we have established an advisory group to
de ne the roles and to provide support
'The advanced practice pharmacist role
was supported by other members of the
health care team who recognised the
need for pharmacists to be involved, and
advocated for the role and funding for
these positions. It was recognition by other
health professionals of what pharmacists
have been doing for a very long time!'
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