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Anticipatory prescribing in community end-of-life care in the UK and Ireland during the COVID-19 pandemic: online survey.
BMJ Support Palliat Care. 2020 Jun 16 [Online ahead of print]BS

Abstract

BACKGROUND

Anticipatory prescribing (AP) of injectable medications in advance of clinical need is established practice in community end-of-life care. Changes to prescribing guidelines and practice have been reported during the COVID-19 pandemic.

AIMS AND OBJECTIVES

To investigate UK and Ireland clinicians' experiences concerning changes in AP during the COVID-19 pandemic and their recommendations for change.

METHODS

Online survey of participants at previous AP national workshops, members of the Association for Palliative Medicine of Great Britain and Ireland and other professional organisations, with snowball sampling.

RESULTS

Two hundred and sixty-one replies were received between 9 and 19 April 2020 from clinicians in community, hospice and hospital settings across all areas of the UK and Ireland. Changes to AP local guidance and practice were reported: route of administration (47%), drugs prescribed (38%), total quantities prescribed (35%), doses and ranges (29%). Concerns over shortages of nurses and doctors to administer subcutaneous injections led 37% to consider drug administration by family or social caregivers, often by buccal, sublingual and transdermal routes. Clinical contact and patient assessment were more often remote via telephone or video (63%). Recommendations for regulatory changes to permit drug repurposing and easier community access were made.

CONCLUSIONS

The challenges of the COVID-19 pandemic for UK community palliative care has stimulated rapid innovation in AP. The extent to which these are implemented and their clinical efficacy need further examination.

Authors+Show Affiliations

Department of Public Health and Primary Care, University of Cambridge Primary Care Unit, Cambridge, Cambridgeshire, UK bc521@medschl.cam.ac.uk.Department of Public Health and Primary Care, University of Cambridge Primary Care Unit, Cambridge, Cambridgeshire, UK.Department of Public Health and Primary Care, University of Cambridge Primary Care Unit, Cambridge, Cambridgeshire, UK.Department of Public Health and Primary Care, University of Cambridge Primary Care Unit, Cambridge, Cambridgeshire, UK.Community Specialist Palliative Care Team, Arthur Rank Hospice Charity, Cambridge, UK. Palliative Medicine, Papworth Hospital NHS Foundation Trust, Cambridge, UK.School of Nursing, University of Nottingham, Nottingham, Nottinghamshire, UK.Department of Public Health and Primary Care, University of Cambridge Primary Care Unit, Cambridge, Cambridgeshire, UK.Department of Public Health and Primary Care, University of Cambridge Primary Care Unit, Cambridge, Cambridgeshire, UK.Palliative Medicine, North Manchester General Hospital, Manchester, UK. Manchester Medical School, The University of Manchester, Manchester, UK.Medicine, St Christopher's Hospice, London, UK. Cicely Saunders Institute, King's College London School of Medical Education, London, UK.Department of Public Health and Primary Care, University of Cambridge Primary Care Unit, Cambridge, Cambridgeshire, UK. Community Specialist Palliative Care Team, Arthur Rank Hospice Charity, Cambridge, UK.Department of Public Health and Primary Care, University of Cambridge Primary Care Unit, Cambridge, Cambridgeshire, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32546559

Citation

Antunes, Bárbara, et al. "Anticipatory Prescribing in Community End-of-life Care in the UK and Ireland During the COVID-19 Pandemic: Online Survey." BMJ Supportive & Palliative Care, 2020.
Antunes B, Bowers B, Winterburn I, et al. Anticipatory prescribing in community end-of-life care in the UK and Ireland during the COVID-19 pandemic: online survey. BMJ Support Palliat Care. 2020.
Antunes, B., Bowers, B., Winterburn, I., Kelly, M. P., Brodrick, R., Pollock, K., Majumder, M., Spathis, A., Lawrie, I., George, R., Ryan, R., & Barclay, S. (2020). Anticipatory prescribing in community end-of-life care in the UK and Ireland during the COVID-19 pandemic: online survey. BMJ Supportive & Palliative Care. https://doi.org/10.1136/bmjspcare-2020-002394
Antunes B, et al. Anticipatory Prescribing in Community End-of-life Care in the UK and Ireland During the COVID-19 Pandemic: Online Survey. BMJ Support Palliat Care. 2020 Jun 16; PubMed PMID: 32546559.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anticipatory prescribing in community end-of-life care in the UK and Ireland during the COVID-19 pandemic: online survey. AU - Antunes,Bárbara, AU - Bowers,Ben, AU - Winterburn,Isaac, AU - Kelly,Michael P, AU - Brodrick,Robert, AU - Pollock,Kristian, AU - Majumder,Megha, AU - Spathis,Anna, AU - Lawrie,Iain, AU - George,Rob, AU - Ryan,Richella, AU - Barclay,Stephen, Y1 - 2020/06/16/ PY - 2020/04/30/received PY - 2020/06/01/accepted PY - 2020/6/18/entrez PY - 2020/6/18/pubmed PY - 2020/6/18/medline KW - drug administration KW - end of life care KW - home care KW - nursing home care KW - supportive care KW - terminal care JF - BMJ supportive & palliative care JO - BMJ Support Palliat Care N2 - BACKGROUND: Anticipatory prescribing (AP) of injectable medications in advance of clinical need is established practice in community end-of-life care. Changes to prescribing guidelines and practice have been reported during the COVID-19 pandemic. AIMS AND OBJECTIVES: To investigate UK and Ireland clinicians' experiences concerning changes in AP during the COVID-19 pandemic and their recommendations for change. METHODS: Online survey of participants at previous AP national workshops, members of the Association for Palliative Medicine of Great Britain and Ireland and other professional organisations, with snowball sampling. RESULTS: Two hundred and sixty-one replies were received between 9 and 19 April 2020 from clinicians in community, hospice and hospital settings across all areas of the UK and Ireland. Changes to AP local guidance and practice were reported: route of administration (47%), drugs prescribed (38%), total quantities prescribed (35%), doses and ranges (29%). Concerns over shortages of nurses and doctors to administer subcutaneous injections led 37% to consider drug administration by family or social caregivers, often by buccal, sublingual and transdermal routes. Clinical contact and patient assessment were more often remote via telephone or video (63%). Recommendations for regulatory changes to permit drug repurposing and easier community access were made. CONCLUSIONS: The challenges of the COVID-19 pandemic for UK community palliative care has stimulated rapid innovation in AP. The extent to which these are implemented and their clinical efficacy need further examination. SN - 2045-4368 UR - https://www.unboundmedicine.com/medline/citation/32546559/Anticipatory_prescribing_in_community_end-of-life_care_in_the_UK_and_Ireland_during_the_COVID-19_pandemic:_online_survey L2 - http://spcare.bmj.com/cgi/pmidlookup?view=long&pmid=32546559 DB - PRIME DP - Unbound Medicine ER -
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