Community-based anticipatory prescribing during Covid-19: qualitative study

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Antunes, Barbara 
Gallagher, Joshua 
Conci, Riccardo 


Objectives: To understand healthcare professionals’ experiences of delivering anticipatory prescribing [AP] during the first wave of the UK covid-19 pandemic.

Methods: Semi-structured qualitative interviews were conducted with a purposive sample of 16healthcare professionals involved in community palliative care. Data were analysed inductively using thematic analysis.

Results: Some of practitioners’ fears about the pandemic’s impact on delivering AP had not been realised during the first wave. Amongst covid-19 patients for whom community end-of-life care was deemed appropriate, deaths were perceived to be relatively easy to palliate with standard medications. These deaths were typically too rapid for AP to be appropriate or feasible. For non-covid deaths, providing timely AP was more challenging: although community nurses and some palliative specialists continued to visit patients regularly, GPs did many fewer visits, moving abruptly to mainly remote consultations. This left some community nurses feeling under-supported, and prompted some palliative specialists to increase their direct involvement in AP. Several other changes were widely welcomed: collaboration to maintain drug supplies, adoption of online meetings and paperless practice, enhanced specialist helplines, and a new policy allowing re-use of medication in care homes. The inclusion of more non-injectable options in AP protocols allowed clinicians to offer selected patients more choice, but few had yet done this in practice. No participants reported changing their pre-pandemic practice regarding administration of AP by lay caregivers.

Conclusions: Accomplishing AP during a pandemic was challenging, requiring healthcare professionals to make rapid changes to their systems and practices. Some changes may produce lasting improvements.

COVID-19, clinical decisions, drug administration, home care, terminal care
Journal Title
BMJ Supportive & Palliative Care
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BMJ Publishing Group
National Institute for Health Research (NIHR) (via University of Oxford) (Capacity Building Award 9)
National Institute for Health Research (NIHR) (SPCR-146)
BA, JG and SB are funded by the National Institute for Health Research (NIHR) Applied Research Collaboration East of England (ARC EoE) programme. BB is funded by the NIHR School for Primary Care Research.