Abstract:The study findings have been used to develop an evidence-based action plan for the Macmillan Pharmacist Facilitators. This program of work is due for completion by December 2012.
“…This perception was influenced by GPs’ negative attitudes towards pharmacists (Agomo, Ogunleye, & Portlock, 2016b; Campion et al., ; Evans et al., ; George et al., 2006b; Latif et al., ; Urban et al., ; Wilcock & Harding, ), GPs being suspicious of pharmacists’ financial motives (Urban et al., ) and competition for services (Agomo et al., 2016b; Evans et al., ; Latif et al., ; Wilcock & Harding, ). Examples of poor engagement included lack of GP availability (Mackridge, Beynon, McVeigh, Whitfield, & Chandler, ; Savage et al., ), patient referrals (Latif et al., ; Lucas & Blenkinsopp, ; Pumtong et al., ) and feedback (Akram et al., ; Urban et al., ).The only way I think everything could improve would be to have some way of getting the GPs back into the loop and stressing to them how important it is that patients know about any new medications they've been put on… For any service to work you need to have everybody engaged with the actual service and it's just this problem that the lack of responses from GPs. (Pharmacist, Lucas & Blenkinsopp, )…”
There has been a strong policy emphasis over the past decade on optimising patient-centred care and reducing general practitioners' (GPs') workload by extending community pharmacy services and collaboration between pharmacists and GPs. Our aim was to review current evidence of pharmacists' and GPs' views of extended community pharmacy services and pharmacists' roles in the United Kingdom (UK). A systematic review was undertaken looking at UK studies investigating pharmacists' and/or GPs' views of community pharmacy services or roles from 2005 to 2017. A range of databases were searched including EMBASE, PubMed, Scopus, Web of Science, International Pharmaceutical Abstracts (IPA), PsycINFO, Science Direct and The Cumulative Index to Nursing and Allied Health Literature (CINAHL). In addition, reference lists of included studies were screened and grey literature was searched. Following the application of inclusion/exclusion criteria, the quality of papers was critically analysed, findings were extracted into a grid and subjected to narrative synthesis following thematic analysis. The search strategy yielded a total of 4,066 unique papers from which 60 were included. Forty-seven papers covered pharmacists' views, nine combined both pharmacists' and GPs' views and four covered GPs' views. Study designs included interviews (n = 31, 52%), questionnaire surveys (n = 17, 28%) and focus groups (n = 7, 12%). Three main themes emerged from the data: "attitudes towards services/roles", "community pharmacy organisations" and "external influences". Pharmacists and GPs perceived a number of barriers to successful implementation and integration of pharmacy services. Moreover, collaboration between pharmacists and GPs remains poor despite the introduction of extended services. Overall, extending community pharmacy services require quality-driven incentives and joint working between community pharmacists and GPs to achieve better integration within the patient's primary care pathway.
“…This perception was influenced by GPs’ negative attitudes towards pharmacists (Agomo, Ogunleye, & Portlock, 2016b; Campion et al., ; Evans et al., ; George et al., 2006b; Latif et al., ; Urban et al., ; Wilcock & Harding, ), GPs being suspicious of pharmacists’ financial motives (Urban et al., ) and competition for services (Agomo et al., 2016b; Evans et al., ; Latif et al., ; Wilcock & Harding, ). Examples of poor engagement included lack of GP availability (Mackridge, Beynon, McVeigh, Whitfield, & Chandler, ; Savage et al., ), patient referrals (Latif et al., ; Lucas & Blenkinsopp, ; Pumtong et al., ) and feedback (Akram et al., ; Urban et al., ).The only way I think everything could improve would be to have some way of getting the GPs back into the loop and stressing to them how important it is that patients know about any new medications they've been put on… For any service to work you need to have everybody engaged with the actual service and it's just this problem that the lack of responses from GPs. (Pharmacist, Lucas & Blenkinsopp, )…”
There has been a strong policy emphasis over the past decade on optimising patient-centred care and reducing general practitioners' (GPs') workload by extending community pharmacy services and collaboration between pharmacists and GPs. Our aim was to review current evidence of pharmacists' and GPs' views of extended community pharmacy services and pharmacists' roles in the United Kingdom (UK). A systematic review was undertaken looking at UK studies investigating pharmacists' and/or GPs' views of community pharmacy services or roles from 2005 to 2017. A range of databases were searched including EMBASE, PubMed, Scopus, Web of Science, International Pharmaceutical Abstracts (IPA), PsycINFO, Science Direct and The Cumulative Index to Nursing and Allied Health Literature (CINAHL). In addition, reference lists of included studies were screened and grey literature was searched. Following the application of inclusion/exclusion criteria, the quality of papers was critically analysed, findings were extracted into a grid and subjected to narrative synthesis following thematic analysis. The search strategy yielded a total of 4,066 unique papers from which 60 were included. Forty-seven papers covered pharmacists' views, nine combined both pharmacists' and GPs' views and four covered GPs' views. Study designs included interviews (n = 31, 52%), questionnaire surveys (n = 17, 28%) and focus groups (n = 7, 12%). Three main themes emerged from the data: "attitudes towards services/roles", "community pharmacy organisations" and "external influences". Pharmacists and GPs perceived a number of barriers to successful implementation and integration of pharmacy services. Moreover, collaboration between pharmacists and GPs remains poor despite the introduction of extended services. Overall, extending community pharmacy services require quality-driven incentives and joint working between community pharmacists and GPs to achieve better integration within the patient's primary care pathway.
“…Subcutaneous infusion or injection of morphine and hydromorphone can be performed by placement of a narrow butterfly catheter inserted under the skin which can be left in place for a week or more [39]. Before choosing other drugs for subcutaneous injections or infusions, pharmaceutical counseling is deemed mandatory [40]. If applied as a baseline opioid, morphine or hydromorphone can either be administered every 4 h (according to their average duration of action) or continuously via a syringe driver [41].…”
Breast cancer patients with bone metastases often suffer from cancer pain. In general, cancer pain treatment is far from being optimal for many patients. To date, morphine remains the gold standard as first-line therapy, but other pure µ agonists such as hydromorphone, fentanyl, or oxycodone can be considered. Transdermal opioids are an important option if the oral route is impossible. Due to its complex pharmacology, methadone should be restricted to patients with difficult pain syndromes. The availability of a fixed combination of oxycodone and naloxone is a promising development for the reduction of opioid induced constipation. Especially bone metastases often result in breakthrough pain episodes. Thus, the provision of an on-demand opioid (e.g., immediate-release morphine or rapid-onset fentanyl) in addition to the baseline (regular) opioid therapy (e.g., sustained-release morphine tablets) is mandatory. Recently, rapid onset fentanyls (buccal or nasal) have been strongly recommended for breakthrough cancer pain due to their fast onset and their shorter duration of action. If available, metamizole is an alternative non-steroid-anti-inflammatory-drug. The indication for bisphosphonates should always be checked early in the disease. In advanced cancer stages, glucocorticoids are an important treatment option. If bone metastases lead to neuropathic pain, coanalgetics (e.g., pregabalin) should be initiated. In localized bone pain, radiotherapy is the gold standard for pain reduction in addition to pharmacologic pain management. In diffuse bone pain radionuclids (such as samarium) can be beneficial. Invasive measures (e.g., neuroaxial blockage) are rarely necessary but are an important option if patients with cancer pain syndromes are refractory to pharmacologic management and radiotherapy as described above. Clinical guidelines agree that cancer pain management in incurable cancer is best provided as part of a multiprofessional palliative care approach and all other domains of suffering (psychosocial, spiritual, and existential) need to be carefully addressed (‘total pain’).
“…9 One barrier community pharmacists face is the lack of training in palliative care. [9][10][11] Community pharmacists from urban and rural communities in Australia reported that they deliver palliative care services infrequently and consequently lack knowledge in this area. 12 Further, community pharmacists who dispense medications to home-based palliative care patients are often unfamiliar with uncommon palliative care medications 13 and often have misconceptions about opioid use.…”
Background: Pharmacists are among the most accessible health care professionals in the community, yet are often not involved in community palliative care teams. Objective: We investigated community pharmacists' attitudes, beliefs, feelings, and knowledge about palliative care as a first step towards determining how best to facilitate the inclusion of community pharmacists on the palliative care team. Method: A cross-sectional descriptive survey design was used. Subjects: Community pharmacists around Australia were invited to participate; 250 completed surveys were returned. Measurements: A survey was constructed to measure pharmacists' knowledge and experience, emotions and beliefs about palliative care. Results: Pharmacists were generally positive about providing services and supports for palliative care patients, yet they also reported negative beliefs and emotions about palliative care. In addition, pharmacists had good knowledge of some aspects of palliative care, but misconceptions about other aspects. Pharmacists' beliefs and knowledge about palliative care predicted-and therefore underpinned-a positive attitude towards palliative care and the provision of services and supports for palliative care patients.
Conclusion:The results provide evidence that pharmacists need training and support to facilitate their involvement in providing services and supports for palliative care patients, and highlight areas that training and support initiatives should focus on.
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