Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
School of Pharmacy and Medical Sciences, University of Bradford Faculty of Life Sciences, Bradford, UK.
BMJ Open. 2019 Nov 24;9(11):e029016. doi: 10.1136/bmjopen-2019-029016.
To investigate timely access to palliative medicines/drugs (PMs) from community pharmacies to inform palliative care service delivery.
Mixed methods in two sequential phases: (1) prospective audit of prescriptions and concurrent survey of patients/representatives collecting PMs from pharmacy and (2) interviews with community pharmacists (CPs) and other healthcare professionals (HCPs).
Five community pharmacies in Sheffield, UK and HCPs that deliver palliative care in that community.
Phase 1: five CPs: two providing access to PMs within a locally commissioned service (LCS) and three not in the LCS; 55 patients/representatives who completed the survey when accessing PMs and phase 2: 16 HCPs, including five phase 1 CPs, were interviewed.
The prescription audit collected information on 75 prescriptions (75 patients) with 271 individual PMs; 55 patients/representatives (73%) completed the survey. Patients/representatives reported 73% of PMs were needed urgently. In 80% of cases, patients/representatives received all PMs on the first pharmacy visit. One in five had to travel to more than one pharmacy to access PMs. The range of PMs stocked by pharmacies was the key facilitating factor. CPs reported practical issues causing difficulty keeping PMs in stock and playing a reactive role with palliative prescriptions. Confidentiality concerns were cited by other HCPs who were reluctant to share key patient information proactively with pharmacy teams. Inadequate information transfer, lack of CP integration into the care of palliative patients and poor HCP knowledge of which pharmacies stock PMs meant patients and their families were not always able to access PMs promptly.
Consistent routine information transfer and integration of pharmacy teams in the care of palliative patients are needed to achieve timely access to PMs. Commissioners of PM access schemes should review and monitor access. HCPs need to be routinely made aware and reminded about the service and its locations.
调查从社区药房获得姑息治疗药物（PMs）的及时情况，为姑息治疗服务的提供提供信息。
两个连续阶段的混合方法：（1）对处方进行前瞻性审核，同时对从药房获取 PM 的患者/代表进行调查，（2）对社区药剂师（CPs）和其他医疗保健专业人员（HCPs）进行访谈。
英国谢菲尔德的五家社区药房和在该社区提供姑息治疗的 HCPs。
第一阶段：五名 CPs：两名在当地委托服务（LCS）中提供 PM 服务，三名不在 LCS 中；55 名患者/代表在获取 PM 时完成了调查，第二阶段：16 名 HCPs，包括五名第一阶段的 CPs，接受了采访。
处方审核收集了 75 张处方（75 名患者）和 271 种 PM 的信息；55 名患者/代表（73%）完成了调查。患者/代表报告说，73%的 PM 是急需的。在 80%的情况下，患者/代表在第一次去药房时就收到了所有的 PM。五分之一的人不得不去多家药房才能获得 PM。药房库存 PM 的范围是关键的促进因素。CPs 报告了库存 PM 方面的实际问题，难以保持库存，并对姑息治疗处方采取被动反应。其他 HCPs 提出了保密性问题，他们不愿意主动与药房团队分享关键患者信息。信息传递不足、CP 未整合到姑息患者的护理中以及 HCP 对哪些药房库存 PM 的了解不足，意味着患者及其家属并不总是能够及时获得 PM。
为了实现 PM 的及时获取，需要对社区药房团队进行持续的常规信息传递和整合，使他们参与到姑息患者的护理中。PM 访问计划的制定者应审查和监测访问情况。应定期让 HCPs 了解并提醒他们有关该服务及其位置的信息。
