Supporting carers to access palliative care medicines in the community in a timely way
An article written by Prof. Liz Reymond and Paul Tait
In Australia, many families and carers choose to look after a person, in the last weeks of their life, at home. For carers, it is a demanding and stressful role but one that is highly valued. An important part of this role is to help manage physical symptoms, like pain. Carers report a strong sense of achievement and satisfaction from being able to help keep the person comfortable and at home where they want to be.
People near the end of life are clinically unstable and severe symptoms can emerge rapidly at any time. If these symptoms are not managed quickly, unnecessary suffering and unwanted transfers to hospital can result.
Despite the degree of unpredictability, there are some things which clinicians can anticipate. For instance, in the terminal phase of a life-limiting illness, a standard set of symptoms is documented, including pain, shortness of breath, nausea, restlessness, anxiety, and rattly breathing. Additionally, the person loses the ability to swallow, necessitating giving medicines under the skin to manage symptoms at this point of their illness.
It is critical for those who wish to spend their last days at home to have timely access to the required medicines to enable effective symptom management, minimise burden and reduce unwanted transfers to inpatient services.
While using the patient's regular pharmacy may appear to be the best choice, evidence suggests that it may be difficult to access palliative care medicines as some pharmacies may not stock these medicines. This can create additional stress for families and carers. They may need to ring around to find a pharmacy that stocks the medicines prescribed by a doctor or a nurse practitioner or there may be a delay while the pharmacy sources a particular medicine.
To improve access to palliative care medicines, caring@home has developed a National Core Community Palliative Care Medicines List (the List). The four medicines on the List fulfil these requirements:
- evidence-based efficacy in management of common symptoms
- cost considerations (including PBS subsidy)
- common use across Australia
- efficacy in multiple symptoms
- community-friendly formulation for administration
- easy transport and storage.
The List guides prescribers on what medicines to prescribe and pharmacists on what medicines to stock. It also provides a foundation for communication and collaboration across the disciplines to enable a person to remain at home with good and responsive symptom management. The List will help community pharmacies anticipate the most likely medicines that will be prescribed and enable GPs and NPs to predict which medicines will be readily available in the pharmacies.
caring@home is promoting the List across Australia through a variety of communication strategies and provides education about the four medicines via palliMEDS. This is a free app to support the clinical knowledge of health professionals. Through this easy-to-search mobile reference tool, health professionals can search by symptom or medicine, view dosing considerations, access useful resources, and quickly see which medicines are TGA-approved and PBS listed.
Prescribers and community pharmacists, by considering this List, can assist in providing timely access to medicines for people with palliative care needs and facilitate them remaining in their setting of choice for end-of-life care.
Download the list here.
caring@home is a National Palliative Care Project, funded by the Australian Government Department and led by Brisbane South Palliative Care Collaborative.
Authors
Professor Liz Reymond
Director of the caring@home project
Paul Tait
Senior Program Manager
SA Virtual Care Service, Adelaide