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Issues affecting supply of palliative medicines into community pharmacy: A qualitative study of community pharmacist and pharmaceutical wholesaler/distributor perspectives

Issues affecting supply of palliative medicines into community pharmacy: A qualitative study of community pharmacist and pharmaceutical wholesaler/distributor perspectives
Issues affecting supply of palliative medicines into community pharmacy: A qualitative study of community pharmacist and pharmaceutical wholesaler/distributor perspectives

Background: Patient access to medicines in the community at end-of-life (pertaining to the last year of life) is vital for symptom control. Supply of such medicines is known to be problematic, but despite this, studies have failed to examine the issues affecting community pharmacy access to palliative medicines.

Objective: To identify community pharmacists' and pharmaceutical wholesalers'/distributors' views on supply chain processes and challenges in providing access to medicines during the last year of life, to characterise supply in this UK context.

Methods: Qualitative design, with telephone interviews analysed using Framework Analysis. Coding frames were developed iteratively with data analysed separately and then triangulated to examine differences in perspectives.

Findings: Thirty-two interviews (24 community pharmacists and 8 wholesalers/distributors) were conducted. To ensure appropriate palliative medicines were available despite occasional shortages, community pharmacists worked tirelessly. They navigated a challenging interface with wholesalers/distributors, the Drug Tariff to ensure reimbursement, and multiple systems. IT infrastructures and logistics provided by wholesalers/distributors were often helpful to supply into community pharmacies resulting in same or next day deliveries. However, the inability of manufacturers to predict operational issues or accurately forecast demand led wholesalers/distributors to encounter shortages with manufactured stock levels, reducing timely access to medicines.

Conclusions: The study identifies for the first time how palliative medicines supply into community pharmacy, can be improved. A conceptual model was developed, illustrating how influencing factors affect responsiveness and speed of medicines access for patients. Work is required to strengthen this supply chain via effective relationship-building and information-sharing, to prevent patients facing disruptions in access to palliative medicines at end-of-life.

2667-2766
100132
Campling, Natasha
0e0410b0-a9cd-486d-a51f-20d80df04791
Breen, Liz
516211de-dbb6-4381-be29-cdfb0652a58d
Miller, Elizabeth
180cf79e-2de5-4cc4-bba4-c1610d5b5036
Birtwistle, Jacqueline
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Richardson, Alison
3db30680-aa47-43a5-b54d-62d10ece17b7
Bennett, Michael
6df5585a-3d93-4870-8797-389759fc82c7
Latter, Susan
83f100a4-95ec-4f2e-99a5-186095de2f3b
Campling, Natasha
0e0410b0-a9cd-486d-a51f-20d80df04791
Breen, Liz
516211de-dbb6-4381-be29-cdfb0652a58d
Miller, Elizabeth
180cf79e-2de5-4cc4-bba4-c1610d5b5036
Birtwistle, Jacqueline
584beb99-2f59-4762-a936-e00c9945e0aa
Richardson, Alison
3db30680-aa47-43a5-b54d-62d10ece17b7
Bennett, Michael
6df5585a-3d93-4870-8797-389759fc82c7
Latter, Susan
83f100a4-95ec-4f2e-99a5-186095de2f3b

Campling, Natasha, Breen, Liz, Miller, Elizabeth, Birtwistle, Jacqueline, Richardson, Alison, Bennett, Michael and Latter, Susan (2022) Issues affecting supply of palliative medicines into community pharmacy: A qualitative study of community pharmacist and pharmaceutical wholesaler/distributor perspectives. Exploratory Research in Clinical and Social Pharmacy, 6, 100132, [100132]. (doi:10.1016/j.rcsop.2022.100132).

Record type: Article

Abstract

Background: Patient access to medicines in the community at end-of-life (pertaining to the last year of life) is vital for symptom control. Supply of such medicines is known to be problematic, but despite this, studies have failed to examine the issues affecting community pharmacy access to palliative medicines.

Objective: To identify community pharmacists' and pharmaceutical wholesalers'/distributors' views on supply chain processes and challenges in providing access to medicines during the last year of life, to characterise supply in this UK context.

Methods: Qualitative design, with telephone interviews analysed using Framework Analysis. Coding frames were developed iteratively with data analysed separately and then triangulated to examine differences in perspectives.

Findings: Thirty-two interviews (24 community pharmacists and 8 wholesalers/distributors) were conducted. To ensure appropriate palliative medicines were available despite occasional shortages, community pharmacists worked tirelessly. They navigated a challenging interface with wholesalers/distributors, the Drug Tariff to ensure reimbursement, and multiple systems. IT infrastructures and logistics provided by wholesalers/distributors were often helpful to supply into community pharmacies resulting in same or next day deliveries. However, the inability of manufacturers to predict operational issues or accurately forecast demand led wholesalers/distributors to encounter shortages with manufactured stock levels, reducing timely access to medicines.

Conclusions: The study identifies for the first time how palliative medicines supply into community pharmacy, can be improved. A conceptual model was developed, illustrating how influencing factors affect responsiveness and speed of medicines access for patients. Work is required to strengthen this supply chain via effective relationship-building and information-sharing, to prevent patients facing disruptions in access to palliative medicines at end-of-life.

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Issues Affecting Supply of Palliative Medicines into Community Pharmacy - Accepted Manuscript
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Accepted/In Press date: 28 March 2022
e-pub ahead of print date: 4 April 2022
Published date: June 2022
Additional Information: © 2022 The Authors.

Identifiers

Local EPrints ID: 457094
URI: http://eprints.soton.ac.uk/id/eprint/457094
ISSN: 2667-2766
PURE UUID: 4d9674a0-d8ad-41b7-a1ce-3bbe387aeeb3
ORCID for Natasha Campling: ORCID iD orcid.org/0000-0002-4158-7894
ORCID for Alison Richardson: ORCID iD orcid.org/0000-0003-3127-5755
ORCID for Susan Latter: ORCID iD orcid.org/0000-0003-0973-0512

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Date deposited: 24 May 2022 16:32
Last modified: 04 Oct 2022 01:48

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Contributors

Author: Liz Breen
Author: Elizabeth Miller
Author: Jacqueline Birtwistle
Author: Michael Bennett
Author: Susan Latter ORCID iD

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