Characterising the growth in palliative care prescribing 2011–2015: Analysis of national medical and non-medical activity

Ziegler, Lucy; Bennett, Mike; Mulvey, Matt; Hamilton, Tim; Blenkinsopp, Alison

doi:10.1177/0269216317739805

Cited by 8 publications

(7 citation statements)

References 14 publications

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“…107 However, CPs reportedly remain uncertain about their role in direct patient care and communication. 108 Indeed, Ziegler et al 109 report that half of all qualified non-medical prescribers, including pharmacists, who work in palliative care do not prescribe. The current impact of non-medical prescribing in palliative care remains minimal.…”

Section: Diversity and Disadvantagementioning

confidence: 99%

“…This is in accordance with wider findings that the practice of non-medical prescribing among CPs and other HCPs who have completed training is low, especially in palliative and end-of-life care. 102,109 Patients and FCGs preferred independently owned or smaller-branch community pharmacies, as well as those attached to general practices, which were more convenient. Home deliveries were valued by most participants who received these, particularly when access would otherwise have been difficult.…”

Section: The Role Of the Community Pharmacistmentioning

confidence: 99%

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Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study

Pollock

Wilson

Caswell

et al. 2021

Health Serv Deliv Res

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Background More effective ways of managing symptoms of chronic and terminal illness enable patients to be cared for, and to die, at home. This requires patients and family caregivers to manage complex medicines regimens, including powerful painkillers that can have serious side effects. Little is known about how patients and family caregivers manage the physical and emotional work of managing medicines in the home or the support that they receive from health-care professionals and services. Objective To investigate how patients with serious and terminal illness, their family caregivers and the health-care professionals manage complex medication regimens and routines of care in the domestic setting. Design A qualitative study involving (1) semistructured interviews and group discussions with 40 health-care professionals and 21 bereaved family caregivers, (2) 20 patient case studies with up to 4 months’ follow-up and (3) two end-of-project stakeholder workshops. Setting This took place in Nottinghamshire and Leicestershire, UK. Results As patients’ health deteriorated, family caregivers assumed the role of a care co-ordinator, undertaking the everyday work of organising and collecting prescriptions and storing and administering medicines around other care tasks and daily routines. Participants described the difficulties of navigating a complex and fragmented system and the need to remain vigilant about medicines prescribed, especially when changes were made by different professionals. Access to support, resilience and coping capacity are mediated through the resources available to patients, through the relationships that they have with people in their personal and professional networks, and, beyond that, through the wider connections – or disconnections – that these links have with others. Health-care professionals often lacked understanding of the practical and emotional challenges involved. All participants experienced difficulties in communication and organisation within a health-care system that they felt was complicated and poorly co-ordinated. Having a key health professional to support and guide patients and family caregivers through the system was important to a good experience of care. Limitations The study achieved diversity in the recruitment of patients, with different characteristics relating to the type of illness and socioeconomic circumstances. However, recruitment of participants from ethnically diverse and disadvantaged or hard-to-reach populations was particularly challenging, and we were unable to include as many participants from these groups as had been originally planned. Conclusions The study identified two key and inter-related areas in which patient and family caregiver experience of managing medicines at home in end-of-life care could be improved: (1) reducing work and responsibility for medicines management and (2) improving co-ordination and communication in health care. It is important to be mindful of the need for transparency and open discussion about the extent to which patients and family caregivers can and should be co-opted as proto-professionals in the technically and emotionally demanding tasks of managing medicines at the end of life. Future work Priorities for future research include investigating how allocated key professionals could integrate and co-ordinate care and optimise medicines management; the role of domiciliary home care workers in supporting medicines management in end-of-life care; patient and family perspectives and understanding of anticipatory prescribing and their preferences for involvement in decision-making; the experience of medicines management in terminal illness among minority, disadvantaged and hard-to-reach patient groups; and barriers to and facilitators of increased involvement of community pharmacists in palliative and end-of-life care. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 14. See the NIHR Journals Library website for further project information.

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Section: Diversity and Disadvantagementioning

confidence: 99%

Section: The Role Of the Community Pharmacistmentioning

confidence: 99%

Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study

Pollock

Wilson

Caswell

et al. 2021

Health Serv Deliv Res

View full text Add to dashboard Cite

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“…In the area of palliative care, drugs are also prescribed by some members of the palliative care team other than physicians. The purpose of developing non-medical prescribing (NMP) in this area is to improve patient care, patient safety, and the better use of professional and teamwork skills (28). However, giving drugs in Iran is considered as one of the nursing practices done only based on doctors' prescriptions.…”

Section: Discussionmentioning

confidence: 99%

The Feasibility of Home Palliative Care for Cancer Patients: The Perspective of Iranian Nurses

et al. 2018

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Background: Cancer is one of the major health challenges that requires palliative care. Home care is one of the most desirable palliative care models. The implementation of any model of care requires the assessment of the views of the service providers and as nurses represent most of the manpower providing home care, their point of view should be considered.Objectives: This research aimed at investigating nurses' views on the feasibility of home palliative care in Iran. Methods: In this descriptive study, 196 nurses were selected purposefully from all over Iran and filled out demographic information and the Global Home Health Nursing Care Assessment questionnaires. Data analysis was performed, using SPSS software version 20. Results:According to the opinion of the nurses, in order to provide home palliative care for patients with cancer, there is social acceptability and relative satisfaction regarding access to medications, equipment, and pain management. However, lack of access to end-of-life services and hospices as well as achieving educational opportunities are amongst the most important obstacles to the implementation of this kind of care.Conclusions: By having proper planning to promote home palliative care, using the existing potentials as well as applying functional changes to the nursing curriculum at Bachelor's level, home palliative care can be developed for patients with cancer.

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“…We estimated the number of patients requiring palliative care services to be 239,822 based on the CCG prevalence estimates. 63 The total number (n = 1,591,156) of prescriptions required by this population was taken from Ziegler et al 66 The Handbook of Practice Management 67 states that 80% of all prescriptions are repeats and we assumed that this would apply to a palliative care context. From this information, we estimated that there are 318,231 new prescriptions and 1,272,925 repeat prescriptions per annum.…”

Section: Budget Impact Analysismentioning

confidence: 99%

Patient and carer access to medicines at end of life: the ActMed mixed-methods study

Latter

Campling

Birtwistle

et al. 2022

Health Soc Care Deliv Res

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Background Patient access to medicines at home during the last 12 months of life is critical for effective symptom control, prevention of distress and unplanned admission to hospital. The limited evidence suggested problems with different components of service delivery and, to the best of our knowledge, the impact of innovations in end-of-life service delivery has remained unevaluated. Objective To provide an evaluation of patient and carer access to medicines at end of life within the context of models of service delivery. Design and data sources The study used a multiphase mixed-methods design, comprising (1) a systematic literature review; (2) an online questionnaire survey of health-care professionals delivering end-of-life care; (3) evaluative mixed-method case studies of service delivery models, including cost and cost-effectiveness analysis; (4) interviews with community pharmacists and pharmaceutical wholesalers and distributors; and (5) an expert consensus-building workshop. Setting Community and primary care end-of-life services in England. Participants Health-care professionals delivering end-of-life care and patients living at home in the last 12 months of life and their carers. Results A systematic review identified a lack of evidence on service delivery models and patient experiences of accessing medicines at end of life. A total of 1327 health-care professionals completed an online survey. The findings showed that general practitioners remain a predominant route for patients to access prescriptions, but nurses and primary care-based pharmacists are also actively contributing. However, only 42% of clinical nurse specialists and 27% of community nurses were trained as prescribers. The majority (58%) of prescribing nurses and pharmacists did not have access to an electronic prescribing system. Health-care professionals’ satisfaction with access to shared patient records to facilitate medicines access was low, with 39% of health-care professionals either not at all or only slightly satisfied. Respondents perceived that there would be a significant improvement in pain control if access to medicines was greater. Case studies (n = 4) highlighted differences in speed and ease of access to medicines between service delivery models. Health-care professionals’ co-ordination facilitated the access process. The work of co-ordination was frequently burdensome, for example because general practitioner services were hard to access or because the stock of community pharmacy medicines was unreliable. Prescription cost differentials between services were substantial when accounting for the eligible population over the medium term. The supply chain generally ensured stocks of palliative medicines, but this was underpinned by onerous work by community pharmacists navigating multiple complex systems and wholesaler interfaces. Limitations Patient records lacked sufficient detail for timelines to be constructed. Commissioners of community pharmacy services and wholesalers and distributors were difficult to recruit. Conclusions Accessing medicines required considerable co-ordination work. Delays in access were linked to service delivery models that were over-reliant on general practitioners prescribing, unreliable stocks of community pharmacy medicines and clinical nurse specialists’ lack of access to electronic prescribing. Key issues were relationships and team integration, diversifying the prescriber workforce, access to shared records and improved community pharmacy stock. Future work Further research should consider policy and practice action for nursing and pharmacy services to fulfil their potential to help patients access medicines, together with attention to improving co-ordination and shared electronic records across professional service interfaces. Study registration This study is registered as CRD42017083563 and the trial is registered as ISRCTN12762104. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 20. See the NIHR Journals Library website for further project information.

show abstract

Characterising the growth in palliative care prescribing 2011–2015: Analysis of national medical and non-medical activity

Cited by 8 publications

References 14 publications

Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study

Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study

The Feasibility of Home Palliative Care for Cancer Patients: The Perspective of Iranian Nurses

Patient and carer access to medicines at end of life: the ActMed mixed-methods study

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