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The hidden issues of anticipatory medications in community palliative care

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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.…