Home' Australian Pharmacist : Australian Pharmacist May 2013 Contents 78 Australian Pharmacist May 2013 I ©Pharmaceutical Society of Australia Ltd.
to build the relationship with other
palliative healthcare providers.
Despite mailed surveys still being superior
to web-based alternatives,16 the response
rate to our study was low (23.7%).
A postal survey was deemed appropriate
because gathering information on
stock levels and expiry dates would
have required the respondent to move
around the dispensary. A second mail
out was deemed unnecessary as the data
were reflective of a wide distribution of
socioeconomic areas with an expected
proportion of rural postcodes. These data
however, probably represent the best
The medicines selected for this survey
were based on prescription data for
patients discharged from a large
metropolitan inpatient palliative care
unit. While this should indicate usual
palliative care practice, there may be
a bias towards specific strengths of
medicines that are more commonly
required for complex hospital patients
than the more straightforward patient
observed in the community. For example,
the 10 mg/mL hydromorphone injection,
included in this survey, is five times the
potency of the 10 mg/mL morphine
injection. This probably indicates a more
complex patient mix for the specialist
unit discharged from a hospital rather
than being reflective of community
Palliative care organisations should
support consistency in prescribing
through the development of prescribing
guidance that includes a published list of
core medicines for pharmacies to stock.
Prescribers and supporting staff should
routinely identify the patient's regular
community pharmacy early in the
patient's illness and communicate
with them as a member of the
Pharmacists should be proactive
in contacting the health care team,
when they identify individual palliative
patients in their practice, to establish the
range of symptoms they can anticipate
and therefore the likely medicines they
Pharmacy managers should engage with
palliative care providers in their region to
establish the range of medicines that they
could anticipate for patients in the last few
days of life to ensure immediate access to
Pharmacy owners should establish regional
pharmacy cooperatives that guarantee
consistent access to medicines where there is
a risk of medicines expiring.
The role of the hospice is well established in
providing quality care for the dying. With the
push for greater emphasis on community
based palliative care, there is a need to
transfer elements of the hospice model to
the community environment. Our study
illustrates the current inability of pharmacies
to hold the entire range of medicines that
could be prescribed at the end of life.
Changes in timely access to important
medicines and the ability of pharmacists to
anticipate the specific medicines to stock
hinges on community pharmacies being
part of the palliative team.
1. World Health organization. WHO Definition of Palliative Care.
Geneva, 2012. At: www.who.int/cancer/palliative/definition/en/
(accessed Jan 2013).
2. Hudson P. Home-based support for palliative care families: challenges
and recommendations. Med J Aust. 2003;179(6):S35--S37
3. Thorpe G. Enabling more dying people to remain at home. BMJ
4. Foreman, L.M., et al., Factors predictive of preferred place of death
in the general population of South Australia. Palliative Medicine,
5. Wowchuk SM, Wilson A, Embleton L, Garcia M, Harlos M, Chochinov
HM. The palliative Medication Kit: An Effective Way of Extending
Care in the Home for Patients Nearing Death. Journal of Palliative
6. Lucey M, McQuillan R, MacCallion A, Corrigan M, Flynn J, Connaire K.
Access to medications in the community by patients in a palliative
setting. A systems analysis. Palliat Med. 2008;22:185--9.
7. Rowett D, Ravenscroft PJ, Hardy J, Currow D: Using national Health
Policies to improve access to palliative care medicines in the
community. J Pain Sympt Manage 2009;37(3):395--402.
8. Palliative Care Expert Group. Terminal Care. In: Therapeutic
guidelines: palliative care. Version 3. Melbourne: Therapeutic
Guidelines; 2010. pp.357--61.
9. Glare P, Dickman A, Goodman M. Symptom control in care of the
dying. In: Ellershaw J, Wilkinson S, eds. Care of the dying. New York:
Oxford, 2011. pp. 33--61.
10. Palliative Care Australia. Palliative Care Service Provision in Australia: a
planning guide 2nd edition. Canberra: Palliative Care Australia; 2003.
11. Good PD, Cavenagh JD, Currow DC, Woods DA, Tuffin PH,
Ravenscroft PJ. What are the essential medications in palliative care?
A survey of Australian palliative care doctors. Aust Fam Physician
12. Hoddinott SN, Bass MJ. The Dillman Total Design Survey Method:
a sure-fire way to get high survey return rates. Can Fam Physician.
13. Statewide Service Strategy Division. Palliative Care Services Plan
2009-2016. Adelaide: Department of Health; 2009.
14. Murray SA, Kendall M, Boyd K, Sheikh A. illness trajectories and
palliative care. BMJ 2005; 330:1007--11.
15. Australian Pharmaceutical Advisory Council. Guiding principles
to achieve continuity in medication management. Canberra;
Commonwealth of Australia; 2005.
16. Kaplowitz MD, Hadlock TD, Levine R. A comparison of web and mail
survey response rates. Public Opin Q. 2012 Winter;68(1):94--101.
The role of the Community Service
Obligation (CSO) is being celebrated in
a new awareness campaign launched
At APP by the National Pharmaceutical
Services Association. At the heart of
the campaign is a documentary-style
video -- Going the Extra Mile -- which
demonstrates how the CSO helps
pharmacists to provide outstanding
levels of patient care. It features on
the new NPSA web site (www.npsa.
org.au), NPSA's YouTube channel and
is supported by a range of printed
collateral featuring pharmacists telling
their stories about how the CSO helps
them care for their community.
The Australian Self Medication
Industry (ASMI) has welcomed
reforms implemented following an
extensive review of the business
processes in relation to the
evaluation of over-the-counter
medicines (OTC) in Australia and New
Zealand. 'The decision to align the
administrative processes for evaluating
OTC medicines in Australia and New
Zealand in readiness for the joint
agency (ANZTPA) scheduled for 2016,
makes good sense,' ASMI Scientific
& Regulatory Affairs Director, Steve
Scarff said. The new administrative
procedures were implemented from
15 April 2013 and will be rolled out
over a period of 12 months.
The McKeon report sets out a decisive
blueprint for the future of health
and medical research in Australia
according to Medicines Australia (MA).
Chief Executive Dr Brendan Shaw
said recommendations to strengthen
intellectual property and accelerate
improvements to Australia's clinical
trials system would encourage global
investment in R&D and lead to a
better and more efficient healthcare
system. 'In particular, it reinforces the
importance of a strong, stable and
globally harmonised IP system.'
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