What Is the Community Pharmacists’ Role in Supporting Older Australians with Palliative Care Needs?
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design and Sampling
- Section 1: Socio-demographic and role characteristics of the respondents;
- Section 2: Practice characteristics;
- Section 3: Scope of services provided.
2.2. Ethical Consideration
2.3. Data Collection
2.4. Data Items
2.5. Data Analysis
3. Results
3.1. Respondents
3.1.1. Socio-Demographic and Role Characteristics of the Respondents
3.1.2. Practice Characteristics
3.1.3. Scope of Services Provided
- Having a formal relationship with an RAC Home or a hospice;
- Working in areas with a high proportion of older people;
- Overcoming delays in accessing stock due to rural location;
- Providing a public service—knowing that carrying these medicines reduces the stress for the individual, their carer, and the prescriber;
- Responding to prescribing patterns in the area.
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Domain No. | Domain Name | Domain Description |
---|---|---|
1 | Advance Care Planning | Documenting how a person would prefer (including wishes) to be cared for at the end of life |
2 | Recognise End of Life | Proactively considering whether the person could have changes indicating that death is foreseeable |
3 | Assess Palliative Care Needs | Comprehensive identification and planning of palliative care and addressing a person’s needs at the end of life |
4 | Provide Palliative Care | Delivering palliative care, reassessing needs, and monitoring for changes |
5 | Work Together | Working with a team of multidisciplinary professionals and services to provide coordinated palliative care |
6 | Respond to Deterioration | Identifying changing needs, caring for a person who is quickly approaching death, and updating care plans |
7 | Manage Dying | Having an appropriate plan in place to manage the last days of life |
8 | Bereavement | Supporting family, friends, residents, and staff with grief and loss after a death |
Characteristics: (N) | All Respondents | ||
---|---|---|---|
n | % | ||
Gender: (51) | Female | 39 | 76.5 |
Male | 12 | 23.5 | |
Age: (50) | <40 years | 30 | 60.0 |
>40 years | 20 | 40.0 | |
Postgraduate qualification: (51) | No | 41 | 80.4 |
Yes | 10 | 19.6 | |
Experience as pharmacists: (50) | 10 years or less | 23 | 46.0 |
>10 years | 27 | 54.0 | |
Employment status: (44) | Part-time-Casual | 18 | 40.9 |
Full-time | 26 | 59.1 | |
Work in a dispensing role: (51) | Yes | 27 | 52.9 |
No | 24 | 47.1 | |
Accredited to provide Commonwealth funded medication reviews: (44) | Yes | 20 | 45.5 |
No | 24 | 54.5 |
Characteristics: (N) | All Respondents | ||
---|---|---|---|
n | % | ||
Do you provide daily services for older Australians? (41) | Yes | 35 | 85.4 |
No | 6 | 14.6 | |
How many specific population groups are you aware of using your services (ten examples offered)? (40) | 0–5 | 17 | 33.3 |
6–10 | 34 | 66.6 | |
Are you aware of older Australians receiving at least one Federal Government funded aged care service? (40) | Yes | 39 | 97.5 |
No | 1 | 2.5 | |
In your opinion, will at least 25% of the older Australians using your service die in next 12 months? (41) | Yes | 18 | 44.0 |
No | 23 | 56.0 | |
Are you aware of any people using your services in the previous 12 months experiencing at least 4 indicators of clinical deterioration (six examples offered)? (40) | Yes | 39 | 97.5 |
No | 1 | 2.5 | |
Are you aware of people with palliative care needs using your services? (34) | Yes | 29 | 85.3 |
No | 5 | 14.7 |
Characteristics: (N) | Respondents in Dispensing Role | Respondents in Non-Dispensing Role | All Respondents | ||||
---|---|---|---|---|---|---|---|
n | % | n | % | n | % | ||
Do you provide ACP information to patients and their carers? (34) | Yes | 11 | 32.4 | 4 | 11.8 | 15 | 44.1 |
No | 6 | 17.6 | 13 | 38.2 | 19 | 55.9 | |
Have you witnessed or countersigned an Advance Care Directive? (34) | Yes | 2 | 5.9 | 4 | 11.8 | 6 | 17.6 |
No | 15 | 44.1 | 13 | 38.2 | 28 | 82.4 | |
Have you recommended, to a prescriber, that a medicine be deprescribed? (34) | Yes | 13 | 38.2 | 15 | 44.1 | 28 | 82.4 |
No | 4 | 11.8 | 2 | 5.9 | 6 | 17.6 | |
Have you involved the individual’s carer when providing advice, education and/or resources for older Australians, most of the time (i.e., often or always)? (32) | Yes | 12 | 37.5 | 10 | 31.3 | 22 | 68.7 |
No | 4 | 12.5 | 6 | 18.8 | 10 | 31.3 | |
What is the main pharmacy software program used in practice? (32) | Fred dispense | 7 | 21.9 | 3 | 9.4 | 10 | 31.3 |
Minfos | 4 | 12.5 | 1 | 3.1 | 5 | 15.6 | |
Z software | 3 | 9.4 | 1 | 3.1 | 4 | 12.5 | |
Other | 1 | 3.1 | 5 | 15.6 | 6 | 18.7 | |
None | 1 | 3.1 | 6 | 18.8 | 7 | 21.9 | |
Have you ever participated in a case conference? (31) | Yes | 6 | 19.4 | 5 | 16.1 | 11 | 35.5 |
No | 10 | 32.3 | 10 | 32.3 | 20 | 64.5 | |
Have bereaved clients discussed their loss with you? (31) | Yes | 16 | 51.6 | 9 | 29.0 | 25 | 80.6 |
No | 0 | 0.0 | 6 | 19.4 | 6 | 19.4 | |
Have you ever referred a bereaved client for psychological support? (31) | Yes | 15 | 48.4 | 4 | 12.9 | 19 | 61.3 |
No | 1 | 3.2 | 11 | 35.5 | 12 | 38.7 | |
Dispensing Pharmacist Specific Questions | |||||||
What range of supportive equipment is hired or sold by the pharmacy? (15) | 0–4 | 9 | 60.0 | n.a. | n.a. | 9 | 60.0 |
5–8 | 6 | 40.0 | n.a. | n.a. | 6 | 40.0 | |
Which medication review services are offered by the pharmacy you work in? (15) | MedsCheck | 14 | 93.3 | n.a. | n.a. | 14 | 93.3 |
Medication review Services offered by an accredited pharmacist | 12 | 80.0 | n.a. | n.a. | 12 | 80.0 | |
How many ways do you communicate with GPs or nurse practitioners about patient specific information (eight examples offered)? (15) | 0–4 ways | 4 | 26.7 | n.a. | n.a. | 4 | 26.7 |
5–8 ways | 11 | 73.3 | n.a. | n.a. | 11 | 73.3 | |
How Many medicines from the “Palliative Care Symptom Management Medicines List for Australians living in the community” are stocked by the pharmacy? (15) | 0–5 medicines | 5 | 33.3 | n.a. | n.a. | 5 | 33.3 |
6–10 medicines | 10 | 66.7 | n.a. | n.a. | 10 | 66.7 | |
Are you aware of the National “Palliative Care Symptom Management Medicines” list? (14) | Yes | 6 | 42.9 | n.a. | n.a. | 6 | 42.9 |
No | 8 | 57.1 | n.a. | n.a. | 8 | 57.1 | |
Does the pharmacy have an arrangement to stock a range of subcutaneous medicines based on discussions with prescribers in the area? (15) | Yes | 8 | 53.3 | n.a. | n.a. | 8 | 53.3 |
No or unsure | 7 | 46.7 | n.a. | n.a. | 7 | 46.7 |
Free Evidence-Based Palliative Care Resources | Yes | No | Unaware | |||
---|---|---|---|---|---|---|
n | % | n | % | n | % | |
Clinical Tools | 19 | 59.4 | 11 | 34.4 | 2 | 6.3 |
Experiential Training Programs | 8 | 25 | 14 | 43.8 | 10 | 31.3 |
Evidence Based Resources | 7 | 21.9 | 17 | 53.1 | 8 | 25.0 |
Advance Care Planning Resources | 11 | 34.4 | 15 | 46.9 | 6 | 18.8 |
Awareness of Care Needs for Patients Approaching End-Of-Life (n = 40) [22] * | Systems to Identify Patients for Predicting Medication Misadventure (n = 31) [23] | ||||
---|---|---|---|---|---|
Indicators | n | % | Indicators | n | % |
Persistent, troublesome symptoms | 40 | 100.0 | Previous adverse drug reaction | 23 | 74.2 |
Lives in a residential aged care home or needs care at home | 40 | 100.0 | Polypharmacy (more than 5 medicines) | 21 | 67.7 |
Two or more unplanned hospital admissions | 39 | 97.5 | Multimorbidity | 16 | 51.6 |
Needs help with personal care | 38 | 95.0 | Swallowing difficulty | 14 | 45.2 |
Requests supportive and palliative care or treatment withdrawal | 33 | 82.5 | Poor eyesight | 13 | 41.9 |
Weight loss (5–10%) and/or body mass index <20 | 30 | 75.0 | Poor renal function | 13 | 41.9 |
English as a second language | 12 | 38.7 | |||
Poor hearing | 12 | 38.7 | |||
Cognitive decline | 11 | 35.5 | |||
Heart failure | 11 | 35.5 | |||
Poor liver function | 11 | 35.5 | |||
Poor mobility | 11 | 35.5 | |||
Poor dexterity or poor fine manipulative skills | 10 | 32.3 | |||
Poor health literacy | 9 | 29.0 |
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Tait, P.; Chakraborty, A.; Jones, K.; Tieman, J. What Is the Community Pharmacists’ Role in Supporting Older Australians with Palliative Care Needs? Healthcare 2021, 9, 489. https://doi.org/10.3390/healthcare9050489
Tait P, Chakraborty A, Jones K, Tieman J. What Is the Community Pharmacists’ Role in Supporting Older Australians with Palliative Care Needs? Healthcare. 2021; 9(5):489. https://doi.org/10.3390/healthcare9050489
Chicago/Turabian StyleTait, Paul, Amal Chakraborty, Kelly Jones, and Jennifer Tieman. 2021. "What Is the Community Pharmacists’ Role in Supporting Older Australians with Palliative Care Needs?" Healthcare 9, no. 5: 489. https://doi.org/10.3390/healthcare9050489