Volume 201 - Issue 8
The hidden issues of anticipatory medications in community palliative care
Author: Gerard F Gill
Med J Aust 2014; 201 (8): 450-451. || doi: 10.5694/mja14.00805
Published online: 20 October 2014
Published online: 20 October 2014
Keeping the doctor’s bag relevant to needs
To the Editor: I support reform for providing anticipatory palliative care medication under Pharmaceutical Benefits Scheme (PBS) arrangements, as identified by O'Connor et al.1 There is merit in providing emergency and anticipatory medications under PBS prescriber bag supply arrangements to community-based palliative care.
There has been a decline in the provision of after-hours care and home visits by general practitioners.2 Many GPs, fearful of assault by drug-dependent individuals, no longer carry potentially dangerous injectable medications such as narcotics and benzodiazepines.3 As it is illegal for unused medications to be returned to pharmacies for resupply, supplies currently provided to terminally ill patients by GPs, to assist community palliative care teams, often remain unused on the patient's death and must be destroyed.
Prescriber bag supplies allow medical and nurse practitioners to provide essential drugs to patients at public expense.4 However, the current formulary mostly includes injectable drugs and few oral medications.5 Modernising the formulary to include small quantities of oral antibiotics, antipsychotics and benzodiazepines would allow patients access to earlier treatment where emergency pharmacy services are restricted. Currently supplied emergency medications have an excessive pack size and often a short therapeutic life. By using smaller pack sizes, the pharmaceutical industry could help to reduce wastage and the risk of diversion.
By limiting the costs to taxpayers and patients of unused PBS medication while increasing community access, these measures are more likely to deliver savings and appeal to GPs and the community.
Competing interests
Margaret O'Connor is my sister-in-law. She retired in June 2014 and gains no benefit from my endorsement of her letter to the Journal.1
References
- O'Connor M, Gatens S, Le BH. The hidden issues of anticipatory medications in community palliative care [letter]. Med J Aust 2014; 200: 578-580. 1
- Joyce C, Piterman L. Trends in GP home visits. Aust Fam Physician 2008; 37: 1039-1042. 2
- Magin PJ, Adams J, Sibbritt DW, et al. Effects of occupational violence on Australian general practitioners' provision of home visits and after-hours care: a cross-sectional study. J Eval Clin Pract 2008; 14: 336-342. 3
- Department of Health. Schedule of Pharmaceutical Benefits. Effective 1 June 2014 – 30 June 2014. Canberra: Commonwealth of Australia, 2014. http://www.pbs.gov.au/publication/schedule/2014/06/2014-06-01-general-schedule.pdf (accessed Aug 2014).
- Holmes JL. Time to restock the doctor's bag. Aust Prescr 2012; 35: 7-9. http://www.australianprescriber.com/magazine/35/1/7/9 (accessed Aug 2014).