Challenges to timely access to out-of-hours end-of-life medications: a qualitative study in UK primary care.

Abstract

Timely, 24/7 access to medications in the community is essential for effective symptom management for people approaching the end of life. Little is known about current systems ensuring skilled and timely patient assessment, prescribing, and administration, and service gaps. To investigate out-of-hours access to end-of-life care medications in community settings, identifying gaps, challenges, and potential solutions. A qualitative study as part of a larger UK research programme concerning out-of-hours community palliative care services. Structured interviews with key stakeholders responsible for delivering or commissioning palliative care services in the community. In total, 71 interviews were conducted across 60 areas in the UK. Four key themes were identified: 1) patient assessment and medication prescribing - primary care services are heavily relied on out-of-hours but are often overburdened; 2) dispensing and collecting medications - collecting medications often falls to informal carers, posing challenges, especially in rural areas; in urban settings, safety concerns limit pharmacy opening hours for late-night dispensing of controlled medications; 3) administering medications - this is usually under the responsibility of primary care services, but delays often arise because of overburdened teams; and 4) anticipatory prescribing - the facilitation of timely medication dispensing and collection is limited to identified patients receiving palliative care and is dependent on overburdened community services for administration; concerns over potential drug misuse can occasionally delay anticipatory prescribing. Systemic challenges and safety concerns hinder timely access to out-of-hours medications for community-based palliative care. Improvements in community pharmacy services, the primary care workforce, and specialist palliative care support are needed.