Home' Australian Pharmacist : Australian Pharmacist May 2013 Contents 74 Australian Pharmacist May 2013 I ©Pharmaceutical Society of Australia Ltd.
The end-of-life: A community pharmacist's
Objectives: This paper examines the availability of medicines from community
pharmacies for the controlling of symptoms in the terminal phase of life. It provides an
objective measure of the problem, with the view of identifying opportunities for greater
community pharmacy involvement.
Methods: A Terminal Phase Medicines (TPM) list was created using discharge data from
a metropolitan inpatient palliative care unit. This list comprised of 13 medicines by name
and formulation used for managing terminal symptoms. A survey was then developed
to determine which of these 13 medicines were stocked by community pharmacies,
the expiry date of this stock, pharmacy awareness of palliative patients and basic
demographic characteristics of the community pharmacies. The survey was mailed to all
455 registered community pharmacies across South Australia. 105 responded (23.1%).
Key results: 91/105 (86.7%) responders were aware of at least one palliative patient using
their pharmacy over the previous 12 months. However, 22 acknowledged learning of the
palliative status of patients from another health service.
The median number of medicines stocked by community pharmacies from the TPM
list was 3 (range 0 to 12). The most likely of these medicines were: metoclopramide 10
mg/2mL injection, morphine sulphate 10 mg/mL injection and morphine hydrochloride
10 mg/mL oral mixture.
Conclusions: This study identified that while a majority of community pharmacists could
identify palliative patients using their pharmacy, there was likely to be limitations for carers
obtaining the range of medicines commonly prescribed for end of life symptoms in a timely
manner. Initiatives which support the timely supply of terminal phase medicines through
community pharmacies are required. If community pharmacists are to anticipate the stock
required in their dispensaries for end-of-life care, they must be informed in a timely manner
of the needs of their patients as part of the multidisciplinary palliative care team.
Palliative care is provided to those
with advanced, life limiting illnesses.
It concentrates on optimising function
and comfort, with a focus on quality of
life, through the prevention and relief of
suffering.1 This is achieved through early
recognition, evaluation and treatment
of physical, psychosocial and spiritual
concerns in the face of progressive and
Improving timely access to palliative
care in the community in a cost-effective
manner is an important challenge for
healthcare organisations worldwide.
Palliative care at home is reported
to produce the feeling of normality,
choice, and comfort whilst being more
economical for health systems than
hospital based care.2 Home-based
care however shifts financial and work
burden to the family. Whilst the majority
of palliative patients and their families
choose their home as their preferred
place to die, only a small number actually
achieve this.3,4 There are a number of
reasons for this, including the absence
of an informal caregiver, change of
preference as death approaches and
variable access to community resources,
including access to appropriate
medicines where and when they are
needed.5,6 Much has been accomplished,
Paul Tait,* Southern Adelaide Palliative
Services, Repatriation General Hospital,
Adelaide, South Australia.
Bel Morris, Central Adelaide Palliative
Care Service, The Queen Elizabeth
Hospital, Adelaide, South Australia.
David Currow, Discipline of Palliative and
Supportive Services, Flinders University,
Adelaide, South Australia
Debra S Rowett, Drug and Therapeutics
Information Service, Repatriation General
Hospital, Adelaide, South Australia
*Author for correspondence: Paul.Tait@
The authors wish to acknowledge the
support of Mr John Gray and Dr Paul
Hakendorf for their constructive input in
the development of this survey. We would
also like to thank Mrs Anne Friedman for
her valuable assistance in distributing the
survey and the staff of the responding
community pharmacies for their
Con icts of Interest
The authors declare that they have
no conflicts of interest in relation to
No funding was provided for this study.
in Australia, to improve access to
medicines through the development
of a Palliative Care Section within the
Pharmaceutical Benefits Scheme (PBS).7
This has resulted in increasing the
quantity of stock that can be prescribed
as well as broadening the range of
medicines available through the PBS.
Despite the palliative literature
recognising the need to enhance timely
access to medicines in the community,
no studies have established benchmarks
for the actual availability of medicines for
palliative symptoms through community
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