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Access to palliative care medicines in the community: an evaluation of practice and costs using case studies of service models in England

Access to palliative care medicines in the community: an evaluation of practice and costs using case studies of service models in England
Access to palliative care medicines in the community: an evaluation of practice and costs using case studies of service models in England

Background: good patient access to medicines at home during the last 12 months of life is critical for effective symptom control, prevention of distress and avoidance of unscheduled and urgent care. 

Objectives: to undertake an evaluation of patient and carer access to medicines at end-of-life within the context of models of service delivery. 

Design: evaluative, mixed method case studies of service delivery models, including cost analysis. The unit of analysis was the service delivery model, with embedded sub-units of analysis. 

Setting: (i) General Practitioner services (ii) Palliative care clinical nurse specialist prescribers (iii) a 24/7 palliative care telephone support line service. Participants: Healthcare professionals delivering end-of-life care; patients living at home, in the last 12 months of life, and their carers. 

Methods: within each case: Patients/carers completed a structured log on medicines access experiences over an 8-week period. Logs were used as an aide memoire to sequential, semi-structured interviews with patients/carers at study entry, and at four and eight weeks. Healthcare professionals took part in semi-structured interviews focused on their experiences of facilitating access to medicines, including barriers, and facilitating factors. Data on prescribed medicines were extracted from patient records. Detailed contextual data on each case were also collected from a range of documents. Patient, carer and healthcare professional interview data were analysed using Framework Analysis to identify main themes. We estimated prescription costs and budget impact analysis of the different service models. Data were triangulated within each case. Cross-case comparison and logic models were employed to enable systematic comparisons across service delivery types. 

Findings: accessing medicines is a process characterised by complexity and systems inter-dependency requiring considerable co-ordination work by patients, carers and healthcare professionals. Case studies highlighted differences in speed and ease of access to medicines across service delivery models. Key issues were diversifying the prescriber workforce, the importance of continuity of relationships and team integration, access to electronic prescribing systems, shared records and improved community pharmacy stock. Per patient prescription cost differentials between services were modest but were substantial when accounting for the eligible population over the medium term. 

Conclusions: experiences of medicines access would be improved through increasing numbers of nurse and pharmacist prescribers, and improving shared inter-professional access to electronic prescribing systems and patient records, within care delivery systems that prioritise continuity of relationships. Community pharmacy stock of palliative care medicines also needs to become more reliable.

Case study, Community, Cost analysis, Costs, Drugs, General practitioners, Nurses, Palliative care, Qualitative research, Telephone
0020-7489
Campling, Natasha
0e0410b0-a9cd-486d-a51f-20d80df04791
Birtwistle, Jacqueline
584beb99-2f59-4762-a936-e00c9945e0aa
Richardson, Alison
3db30680-aa47-43a5-b54d-62d10ece17b7
Bennett, Michael I.
6df5585a-3d93-4870-8797-389759fc82c7
Meads, David
394bf351-3283-47a6-8bc0-61d54a960b45
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Latter, Sue
83f100a4-95ec-4f2e-99a5-186095de2f3b
Campling, Natasha
0e0410b0-a9cd-486d-a51f-20d80df04791
Birtwistle, Jacqueline
584beb99-2f59-4762-a936-e00c9945e0aa
Richardson, Alison
3db30680-aa47-43a5-b54d-62d10ece17b7
Bennett, Michael I.
6df5585a-3d93-4870-8797-389759fc82c7
Meads, David
394bf351-3283-47a6-8bc0-61d54a960b45
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Latter, Sue
83f100a4-95ec-4f2e-99a5-186095de2f3b

Campling, Natasha, Birtwistle, Jacqueline, Richardson, Alison, Bennett, Michael I., Meads, David, Santer, Miriam and Latter, Sue (2022) Access to palliative care medicines in the community: an evaluation of practice and costs using case studies of service models in England. International Journal of Nursing Studies, 132, [104275]. (doi:10.1016/j.ijnurstu.2022.104275).

Record type: Article

Abstract

Background: good patient access to medicines at home during the last 12 months of life is critical for effective symptom control, prevention of distress and avoidance of unscheduled and urgent care. 

Objectives: to undertake an evaluation of patient and carer access to medicines at end-of-life within the context of models of service delivery. 

Design: evaluative, mixed method case studies of service delivery models, including cost analysis. The unit of analysis was the service delivery model, with embedded sub-units of analysis. 

Setting: (i) General Practitioner services (ii) Palliative care clinical nurse specialist prescribers (iii) a 24/7 palliative care telephone support line service. Participants: Healthcare professionals delivering end-of-life care; patients living at home, in the last 12 months of life, and their carers. 

Methods: within each case: Patients/carers completed a structured log on medicines access experiences over an 8-week period. Logs were used as an aide memoire to sequential, semi-structured interviews with patients/carers at study entry, and at four and eight weeks. Healthcare professionals took part in semi-structured interviews focused on their experiences of facilitating access to medicines, including barriers, and facilitating factors. Data on prescribed medicines were extracted from patient records. Detailed contextual data on each case were also collected from a range of documents. Patient, carer and healthcare professional interview data were analysed using Framework Analysis to identify main themes. We estimated prescription costs and budget impact analysis of the different service models. Data were triangulated within each case. Cross-case comparison and logic models were employed to enable systematic comparisons across service delivery types. 

Findings: accessing medicines is a process characterised by complexity and systems inter-dependency requiring considerable co-ordination work by patients, carers and healthcare professionals. Case studies highlighted differences in speed and ease of access to medicines across service delivery models. Key issues were diversifying the prescriber workforce, the importance of continuity of relationships and team integration, access to electronic prescribing systems, shared records and improved community pharmacy stock. Per patient prescription cost differentials between services were modest but were substantial when accounting for the eligible population over the medium term. 

Conclusions: experiences of medicines access would be improved through increasing numbers of nurse and pharmacist prescribers, and improving shared inter-professional access to electronic prescribing systems and patient records, within care delivery systems that prioritise continuity of relationships. Community pharmacy stock of palliative care medicines also needs to become more reliable.

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Accepted/In Press date: 22 April 2022
e-pub ahead of print date: 29 April 2022
Published date: 1 August 2022
Additional Information: Funding Information: This study is funded by the National Institute for Health Research (NIHR) [Health Services & Delivery Research programme] (project number 16/52/23). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: © 2022 The Author(s)
Keywords: Case study, Community, Cost analysis, Costs, Drugs, General practitioners, Nurses, Palliative care, Qualitative research, Telephone

Identifiers

Local EPrints ID: 467928
URI: http://eprints.soton.ac.uk/id/eprint/467928
ISSN: 0020-7489
PURE UUID: 4b45af02-4a38-4842-9e55-f72495ed1b25
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 Miriam Santer: ORCID iD orcid.org/0000-0001-7264-5260
ORCID for Sue Latter: ORCID iD orcid.org/0000-0003-0973-0512

Catalogue record

Date deposited: 26 Jul 2022 16:34
Last modified: 27 Jul 2022 01:47

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Contributors

Author: Jacqueline Birtwistle
Author: Michael I. Bennett
Author: David Meads
Author: Miriam Santer ORCID iD
Author: Sue Latter ORCID iD

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