25 September 2009

Deprescribing, opioid-phobia and disposal of unused medicines have been identified as significant issues in palliative care in a report prepared by the National Prescribing Service (NPS) and Palliative Care Australia (PCA).

The report, Achieving quality use of medicines in the community for palliative and end-of-life care, released today at the 10^th Australian Palliative Care Conference, is the first to document a shared understanding of the barriers to the best use of medicines during the end stages of life.

Informed by submissions from more than 70 healthcare organisations and individuals, the report describes medicines use issues in palliative care and documents ways in which it can be improved.

Palliative Care Australia CEO, Donna Daniell says the report has helped prioritise areas for change.

“While everyone involved in palliative care has a responsibility to help improve medicines use, Palliative Care Australia will be leading the way,” Ms Daniell said.

“We will be talking to stakeholders about ways to strengthen clinical skills and the application of the current and emerging evidence base for medicines use at end of life. We will be working with practitioners to ensure safe and effective use of opioids for end-of-life care.”

The report identifies quality use of medicines issues including the need for clearer guidelines around deprescribing - when medicines should cease being prescribed to a patient at the end stages of life because they are no longer contributing to quality of life.

“Deprescribing, or ceasing medication where the evidence does not support its use in the current context of the patient, can be very difficult for medical practitioners. Doctors need clearer guidelines in this area so they can assess whether the evidence supports the continuation of a medicine,” NPS CEO, Dr Lynn Weekes said.

Opioid-phobia was also identified as a barrier to adequate pain management, with some health professionals lacking full knowledge about opioids including when and how to initiate them, management of breakthrough pain and understanding new formulations.

The report also identifies the need for comprehensive guidelines for consumers and carers around the safe use, storage and disposal of medicines in the home.

“Thanks to advances in medicines use, more patients are able spend their last days in the comfort of their home. However, medicines regimens may change frequently during their last weeks which can result in large amounts of unused medicines. This means the burden of medicine disposal lies with the family, and they are often left with medicines requiring careful storage including sedatives and opiates,” Dr Weekes said.

Other key findings in the report included:

• effects of polypharmacy on quality of life: tablet burden, adverse interactions, over prescribing
• lack of guidance for medicines use where evidence is not clear or is still emerging
• low access and utilisation of the Palliative Care Schedule on the PBS
• use of complementary medicines is not well understood or documented in palliative care
• identification of clinical skills gaps.

To view the full report go to www.nps.org.au or www.palliativecare.org.au.

The National Prescribing Service Limited (NPS) is an independent, non-profit organisation for Quality Use of Medicines funded by the Australian Government Department of Health and Ageing.