Community access to palliative care medicines-patient and professional experience: systematic review and narrative synthesis

Abstract

Background: Providing palliative care patients living at home with timely access to medicines is critical to enable effective symptom management, minimise burden and reduce unplanned use of healthcare services. Little is known about how diverse community-based palliative care models influence medicine access.

Objective: To produce a critical overview of research on experiences and outcomes of medicine access in community-based palliative care models of service delivery through a systematic review and narrative synthesis.

Methods: MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library databases and grey literature were systematically searched for all types of studies. Study quality was assessed using the Mixed Methods Appraisal Tool; a narrative synthesis was used to integrate and summarise findings.

Results: 3331 articles were screened; 10 studies were included in the final sample. Studies included a focus on community pharmacy (n=4), hospice emergency medication kits (HEMKs) in the home (n=3), specialist community nurse prescribers (n=1), general practice (n=1) and one study included multiple service delivery components. Community pharmacy was characterised by access delays due to lack of availability of medicine stock and communication difficulties between the pharmacy and other healthcare professionals. HEMKs were perceived to reduce medicine access time out of hours and speed symptom control. However, the majority of studies comprised small, local samples, largely limited to self-reports of health professionals. There was a lack of data on outcomes, and no comparisons between service delivery models.

Conclusions: Further research is required to understand which models facilitate rapid and efficient access to medicines for community-based palliative care patients.

Keywords: home care; service evaluation; symptoms and symptom management.

Figure 1. Phase 1 study inclusion and exclusion criteria. EoL, end of life.

Figure 2. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 flow diagram. *1Database; MEDLINE: 1306+CINAHL: 167+PsycINFO: 968+EMBASE: 1186. *2The reason for reduction; sources were not accessible: 10. *3Two papers reporting the same study were counted as one study.