The approach to end-of-life care: a community pharmacy’s perspective

Access to medicines in the last days of life can be difficult hampering efforts to support patients to  die at home. The development of a state-wide list of five core medicines in 2012 was seen as the first step towards improving access. The aim of this study was to identify changes in community access to injectable medicines throughout South Australia (SA) between 2012 and 2015 and explore factors predictive of pharmacies carrying a broad range of medicines useful in terminal care. SA community pharmacies were invited to participate in a survey in 2012, and again in 2015. The survey asked for pharmacy characteristics and the availability of specific medicines useful in terminal care. Comparisons were made between 2012 and 2015.  While pharmacies held a similar number of  medicines, the proportion of pharmacies carrying the five core medicines rose from 6.7% in 2012 to 18.4% in 2015. Multiple linear regression demonstrated that the provision of after-hours services (p=0.02) and awareness of at least one palliative patient in the previous year (p<0.01) were predictors of community pharmacies with a wider range of medicines useful in terminal care. In responding to issues with supply of medicines at end of life, respondents were more likely to contact the prescriber if aware of palliative patients (22.4%) compared with those unaware (4%).These results suggest there is value in engaging with local pharmacists to ensure community patients can access medicines in the last days of life.