Community Pharmacists: A Forgotten Resource for Palliative Care

1. Community Pharmacists: A Forgotten Resource for Palliative Care Paul Tait, John Gray, Paul Hakendorf, Bel Morris, David Currow & Debra Rowett

2. Aim • Identify likelihood of community pharmacies having medicines for symptom control in the terminal phase • Identify community pharmacy’s level of awareness of palliative patients/carers • Understand the demographics of the community pharmacies • Develop a distribution list of community pharmacies Building a platform for improved access to palliative medicines in the community

3. Terminal Phase Medicines (TPM) List • Symptoms: • Dyspnoea • Pain • Nausea • Delirium ± agitation; and • Noisy secretions. • Physical ability • decreased energy levels; • reduced ability to swallow; and • impaired mental state Building a platform for improved access to palliative medicines in the community

4. Terminal Phase Medicines (TPM) List Building a platform for improved access to palliative medicines in the community

5. TPM List • Clonazepam 1mg inj* • Clonazepam 2.5mg/mL oral drops* • Dexamethasone 4mg/mL inj* • Fentanyl 100mcg/2mL inj • Haloperidol 5mg/mL inj* • Hydromorphone 10mg/mL inj* • Hyoscine Butylbromide 20mg/mL inj* • Hyoscine Hydrobromide 400mcg/mL inj • Metoclopramide 10mg/2mL inj* • Midazolam 5mg/mL inj • Morphine 10mg/mL inj* • Morphine 10mg/mL oral mixture* • Oxycodone 10mg/mL inj Building a platform for improved access to palliative medicines in the community

6. The Survey • Demographics of the pharmacy • Role of the person completing the survey; • Postcode (→socioeconomic scales, rural/metro); • Pharmacist FTEs; • Usual opening hours; and • Clinical and supply services offered. • Awareness of palliative patients • How many palliative patients had used pharmacy over the previous 12 months; • How they became aware of palliative status; and • The range of issues affecting timely access to these medicines. Building a platform for improved access to palliative medicines in the community

7. The Survey • Access to stock • Date of completing the survey; • Existence of medicines from the TPM List in their dispensary; and • Shortest expiry date of each item held within the pharmacy. • Willingness to be part of an email distribution list Building a platform for improved access to palliative medicines in the community

8. Methodology • Southern Adelaide Clinical Human Research Ethics Committee (SAC HREC) • Each community pharmacy was allocated an individual code. • Survey was mailed with a cover letter to 455 pharmacies across SA • All responding pharmacies were allocated to a decile of the Seifa Index • No reminders were sent out Building a platform for improved access to palliative medicines in the community

9. Likelihood Of Having Stock Building a platform for improved access to palliative medicines in the community

10. Likelihood Of Having Stock Building a platform for improved access to palliative medicines in the community

11. Likelihood Of Having Stock Building a platform for improved access to palliative medicines in the community

12. Likelihood Of Having Stock Building a platform for improved access to palliative medicines in the community

13. Likelihood Of Having Stock Building a platform for improved access to palliative medicines in the community

14. Likelihood Of Having Stock Building a platform for improved access to palliative medicines in the community

15. Awareness Building a platform for improved access to palliative medicines in the community

16. Awareness Building a platform for improved access to palliative medicines in the community

17. Expiry Date Data Building a platform for improved access to palliative medicines in the community

18. Recommendations • Prescribers: • Involve community pharmacists in discussions about care planning • Palliative Care Organisations: • Develop a core medicines list to guide prescribers and community pharmacists alike • Policy Makers: • Create incentives for community pharmacies to hold a small range of medicines Building a platform for improved access to palliative medicines in the community

19. Reflections What Worked Well What We’d Do Differently Enquiring about a single strength for each medicine may have skewed data • Sending survey in paper form with reply paid envelope • Surveying all pharmacies across SA • Asking about expiry dates • Choice of medicines matched the WA essential medicines document Building a platform for improved access to palliative medicines in the community

20. Community Pharmacists: A Forgotten Resource for Palliative Care Paul Tait, John Gray, Paul Hakendorf, Bel Morris, David Currow & Debra Rowett

21. Core Medicines For noncomplex adult patients • Clonazepam 1mg injection; • Morphine 10mg/mL injection; • Haloperidol 5mg/mL injection; • Metoclopramide 10mg/2mL injection; • Hyoscine butylbromide 20mg/mL injection. Building a platform for improved access to palliative medicines in the community

22. Demographics Building a platform for improved access to palliative medicines in the community

23. Issues Building a platform for improved access to palliative medicines in the community

24. Building a platform for improved access to palliative medicines in the community