Campling Natasha, Breen Liz, Miller Elizabeth, Birtwistle Jacqueline, Richardson Alison, Bennett Michael, Latter Susan
School of Health Sciences, University of Southampton, Building 67, Highfield, Southampton SO17 1BJ, England, UK.
University of Bradford School of Pharmacy and Medical Sciences, M27a Richmond Building, Richmond Road, Bradford BD7 1DP, England, UK.
Explor Res Clin Soc Pharm. 2022 Apr 4;6:100132. doi: 10.1016/j.rcsop.2022.100132. eCollection 2022 Jun.
Patient access to medicines in the community at end-of-life (pertaining to the last year of life) is vital for symptom control. Supply of such medicines is known to be problematic, but despite this, studies have failed to examine the issues affecting community pharmacy access to palliative medicines.
To identify community pharmacists' and pharmaceutical wholesalers'/distributors' views on supply chain processes and challenges in providing access to medicines during the last year of life, to characterise supply in this UK context.
Qualitative design, with telephone interviews analysed using Framework Analysis. Coding frames were developed iteratively with data analysed separately and then triangulated to examine differences in perspectives.
Thirty-two interviews (24 community pharmacists and 8 wholesalers/distributors) were conducted. To ensure appropriate palliative medicines were available despite occasional shortages, community pharmacists worked tirelessly. They navigated a challenging interface with wholesalers/distributors, the Drug Tariff to ensure reimbursement, and multiple systems. IT infrastructures and logistics provided by wholesalers/distributors were often helpful to supply into community pharmacies resulting in same or next day deliveries. However, the inability of manufacturers to predict operational issues or accurately forecast demand led wholesalers/distributors to encounter shortages with manufactured stock levels, reducing timely access to medicines.
The study identifies for the first time how palliative medicines supply into community pharmacy, can be improved. A conceptual model was developed, illustrating how influencing factors affect responsiveness and speed of medicines access for patients. Work is required to strengthen this supply chain via effective relationship-building and information-sharing, to prevent patients facing disruptions in access to palliative medicines at end-of-life.
患者在临终时（指生命的最后一年）在社区获取药物对于症状控制至关重要。已知此类药物的供应存在问题，但尽管如此，研究仍未考察影响社区药房获取姑息治疗药物的问题。
确定社区药剂师以及药品批发商/经销商对于临终前一年药品供应链流程及获取药物所面临挑战的看法，以描述英国背景下的供应情况。
采用定性设计，通过框架分析法对电话访谈进行分析。编码框架经反复开发，先分别分析数据，然后进行三角互证以检验观点差异。
共进行了32次访谈（24名社区药剂师和8名批发商/经销商）。为确保尽管偶尔出现短缺但仍能提供适当的姑息治疗药物，社区药剂师不懈努力。他们在与批发商/经销商、药品价格表以确保报销以及多个系统之间的具有挑战性的界面中周旋。批发商/经销商提供的信息技术基础设施和物流通常有助于向社区药房供货，实现当日或次日送达。然而，制造商无法预测运营问题或准确预测需求，导致批发商/经销商在成品库存水平方面遇到短缺，减少了药物的及时获取。
该研究首次确定了如何改善姑息治疗药物向社区药房的供应。开发了一个概念模型，说明影响因素如何影响患者获取药物的响应能力和速度。需要通过有效的关系建立和信息共享来加强这一供应链，以防止患者在临终时获取姑息治疗药物时面临中断。
