Home' Australian Pharmacist : Australian Pharmacist January 2012 Contents 76 Australian Pharmacist January 2012 I ©Pharmaceutical Society of Australia Ltd.
needs, a sophisticated knowledge
of medical ethics, and excellence in
communication skills.18 These issues
were extensively reviewed in the full
report on this project.19 Although
many of these skills are addressed in
medical and pharmaceutical training,
research indicates that many health care
professionals are poorly prepared for
the complexities of palliative care.
Exemplary health systems assimilate
the input of physicians, pharmacists,
nurses and psychosocial carers in a
holistic framework and foster increased
confidence in delivering excellent
palliative care.20 At the same time it
is important to acknowledge that in
Australia the fee for service model
of care that is an integral part of the
primary care service is extended to
include all members of the team. To
facilitate the PCMMR it may also be that
the process would be better supported
if both nurses and GPs were able to
claim a fee for making the referral.7
This is not currently permitted under
In addition, there needs to be a
mechanism for actively encouraging
referrals and closer collaboration
among palliative care doctors, GPs
and accredited pharmacists. There was
limited evidence for this in our study.
This might be expected given the short
duration of the study; collaboration is
built on a shared understanding which
may develop over time. There is also
a need for accredited pharmacists to
be formally inducted as members of a
multidisciplinary palliative care team.20
Overall pharmacists are capable of
providing this service and, with training
and further support, implementation of
this service is viable. Patients have found
this service beneficial. However the study
identified a number of problems with the
protocol used; some were unique to the
delivery of the PCMMR service and others
are generic to medication management
review models operating in Australia. There
needs to be support at the organisational
and policy levels to ensure that the process
is simple and efficient, and also at the
individual level to nurture collaboration
between all health professionals involved in
care at the end of life.
1. WHO definition of palliative care [online].
2. Currow DC, Stevenson JP, Abernethy AP, et al. Prescribing in
palliative care as death approaches. J Am Geriatr Soc. 2007;
3. Needham DS, Wong ICK, Campion PD. Evaluation of the
effectiveness of UK community pharmacists' interventions in
community palliative care. Palliat Med. 2002; 16:219--25.
4. Gilbar P, Stefaniuk K. The role of the pharmacist in palliative care:
results of a survey conducted in Australia and Canada. J Palliat
Care. 2002; 18:287--92.
5. Austwick EA, Brown LC, Goodyear KH, et al. Pharmacists' input
into a palliative care clinic. Pharm J. 2002; 268:404--6.
6. The Pharmacy Guild of Australia. Medication Management
Review Program [online]. [Accessed 9 Sep 2010].
7. Glasziou P, Haynes B. The paths from research to improved
health outcomes. Evid Based Med. 2005; 10;4--7. doi:10.1136/
8. Medical Research Council. Developing and evaluating
complex interventions [online]. [Accessed Aug 2011].
9. Sheikh A, Smeeth L, Ashcroft R. Randomised controlled trials
in primary care: scope and application. Br J Gen Pract. 2002;
10. Waldrop MM. Complexity: the emerging science at the edge
of order and chaos. Harmondsworth, UK: Penguin; 1994. ISBN
11. Hardeman W, Sutton S, Griffin S, et al. A causal modelling
approach to the development of theory-based behaviour
change programmes for trial evaluation. Health Educ Res.
2005; 20: 676--87.
12. Oakley A, Strange V, Bonell C, et al. RIPPLE Study Team.
Process evaluation in randomised controlled trials of complex
interventions. BMJ. 2006; 332: 413--6.
13. Carl ord S, Lindberg M, Bendtsen P, et al. Key factors
influencing adoption of an innovation in primary health
care: a qualitative study based on implementation theory.
BMC Fam Pract. 2010; 11:60.
14. Brett TD, Arnold-Reed DE, Hince DA, et al. Retirement
intentions of general practitioners aged 45--65 years. Med J
Aust. 2009; 20;191:75--7.
15. Kitson AL, Rycroft-Malone J, Harvey G, et al. Evaluating the
successful implementation of evidence into practice using
the PARiHS framework: theoretical and practical challenges.
Implement Sci. 2008; 3:1. DOI:10.1186/1748-5908-3-1.
16. Rogers EM. Diffusion of Innovations. 5th ed. New York:
Free Press; 2003.
17. Needham DS, Wong ICK, Campion PD. Evaluation of the
effectiveness of UK community pharmacists' interventions
in community palliative care. Palliative Medicine. 2002;
18. McDonough, RP. Interventions to improve patient
pharmaceutical care outcomes. American Pharmaceutical
Association Continuing Education. 1996; 7:253--67.
19. The role of the pharmacist in the provision of palliative care
[online]. [Accessed Oct 2011]. At: www.guild.org.au/sites/
20. Forbes JF. Toward an optimal teaching programme for
supportive care. Supportive Care in Cancer. 1994; 2:7--15.
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