Pharmacy vital but overlooked in palliative care

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Pharmacists represent an enormous untapped potential in end-of-life care, says Palliative Care Australia’s CEO

Liz Callaghan is encouraging Australia’s pharmacists to take an interest in palliative care, including not only providing services, but also helping patients break down barriers to accessing care.

Palliative Care Australia has talked with the Pharmacy Guild and PSA to discuss ways in which the skills of pharmacists can be used to improve end-of-life care for patients with life-limiting illnesses, she says, particularly outside the metropolitan areas.

“We’ve talked about what I believe is the key role that community pharmacists play in end-of-life-care,” she says. “If you think about primary health care, the pharmacist is a key part of that team but they’re often not considered in the whole equation.

“Regional and rural towns are not where specialist palliative care doctors tend to live. So GPs rely on pharmacists to assist them in working together as part of that primary care team to ensure people at the end of their lives receive appropriate care,” Ms Callaghan told the AJP.

“Some of that is about reducing polypharmacy, some is about ensuring there aren’t adverse reactions from drugs, and most of it is around dosing and appropriate use of medicines to relieve symptoms.”

The call comes during National Palliative Care Week, and as new AIHW figures were released showing that a greater proportion of people are accessing palliative care services in hospital.

Between 2010–11 and 2014–15, palliative care-related hospitalisations rose by about 19%. This is greater than the 15% increase recorded for hospitalisations for all reasons over the same period.

Australia’s growing and ageing population—paired with a rise in chronic and incurable illnesses—has broadened the type of patients requiring palliative care, an AIHW spokesperson said.

In 2014–15, about 155,600 people died in Australia, and almost half of these died as an admitted patient in hospital.

Of these, about 46% had been a palliative care patient during their final hospitalisation, up from 37% in 2010–11.

More than half (54%) of all palliative care-related hospitalisations in 2014–15 ended with the patient’s death. 

“We know there’s over 155,000 deaths a year, people are living with complex chronic diseases and the issue of polypharmacy is a big problem for people aged 65 and over,” says Ms Callaghan.

“The AIHW data also shows 90% of all palliative care prescriptions are written by general practitioners, so they’re not the specialised palliative medicines, they’re things like laxatives and painkillers.

“So there’s a key role for pharmacy. And health professionals like pharmacists also have a really clear role to play around what palliative care is, and how it can help.

“It’s not just for the last few days and weeks of life: it’s an approach that can improve quality of life for people and families through prevention and relief of suffering, and treating pain.”

Ms Callaghan says that most Australians still do not know what palliative care is, and so myths abound, such as the idea that it means shortening a person’s life, or refusing to let a person die. Pharmacists can help break down these myths.

“As a primary care provider, they have a role where they can get to know the people that live in their community and do it really well, and so members rely on them to help manage their health.

“So pharmacists can see when things change for people,” she says, encouraging pharmacists to put suggest “non-threatening” resources on advanced care plans, ways to engage with family members about end-of-life care, and so on.

“Pharmacy has an untapped potential to connect with the community on this.”

Ms Callaghan also points out that pharmacists are instrumental in many residential aged care settings.

“More than half of aged care clients said, in the survey we did this year, that provision of palliative care was a factor in choosing an aged care service.

“Seventy per cent of Australians consistently say they want to die in their own home. And for people in residential aged care, that is their home.”

Both community and hospital pharmacists are key in navigating the complexities of issues such as accessing S8 medications which cannot be stored on-site in residential aged care facilities, and accessing non-PBS drugs, she says.

“It’s about managing their symptoms well to ensure they have as comfortable a death as possible, and to keep interacting with their family as long as they can.

“That relies on holistic care, and part of that is pharmacy.”

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