Objective To evaluate the circumstances in which parent-carers of children in primary care will request urgent medication supplies (rescue medicines) from a paediatric hospital pharmacy.
Methods A cross-sectional 17 point survey tool was constructed in MS Word 2003 with input from key stakeholders, to identify the experiences and opinions of parent-carers who requested ‘rescue’ medication. Requestees presenting between 21 November 2008 and 16 June 2009 were invited to complete the survey if attending the Pharmacy Birmingham Children's Hospital (BCH) during normal weekday opening and where it was clear that the primary care route of supply was judged to have failed or was likely to fail. The study was confirmed as service evaluation by the head of Research & Development at BCH: ethical approval was not required. Classification (coding) of free text answers was determined by an expert panel of pharmacy staff. The panel was given suggested codes and code assignments to answers given and asked to modify according to their judgement. The modifications were passed to all panel members and further modifications requested until consensus was reached or no further agreement could be obtained. Responses were entered into MS Excel 2003 and SPSS v16 for analysis.
Results 25 completed surveys were obtained. Patients were registered with 10 different primary care trusts (22 GP practices). 76% (n=19) made special journeys to attend BCH. 56% (n=14) took advice from a healthcare professional before deciding to attend with 44% (n=11) stating they had attended BCH for rescue medicines before. 48% (n=12) obtain their repeat prescriptions from a hospital and another 44% (n=11) from their GP: 76% (n=19) have their prescriptions dispensed by community pharmacies. 36% of respondents (n=9) report that they have problems getting medicines for the patient ‘often’ or ‘very often’. 28% of respondents (n=7) stated that the patient had missed doses of their medicine(s) as a consequence of not being able to obtain the medicines. 16 respondents (64%) recorded the medication they had difficulty obtaining, naming 21 different medications, with one (captopril) recorded three times. Of these 21 medicines BCH routinely uses unlicensed products for 62% (n=13). The main reasons for needing rescue medicines was coded as a community pharmacy supply problem (52%, n=13) or other community pharmacy problem (28%, n=7). The most common responses to how can systems be improved were coded as procurement – improve procurement of medicines for cerebral palsy (20%, n=5) and communication – improve communication (20%, n=5).
Conclusions Parent-carers of children who may be expected to get their medication from primary care use hospital pharmacy services to maintain their supply. They do so for both licensed and unlicensed drugs and regardless of the origin of the prescription if the item is to be dispensed by community pharmacies. Respondents indicate that problems may be reduced by improved procurement by community pharmacies and improved communication between the parties involved.