The COVID-19 pandemic is straining every corner of the health care system, and pharmacies are no exception. Consequently, some hospice providers and patients are experiencing difficulty accessing some essential medications.
In some instances, the pandemic is exacerbating existing problems. Hospice providers around the country have been seeing ongoing shortages of general opioids, such as morphine and fentanyl, for some time even prior to the pandemic, as Jason Kimbrel, MyNHPCO pharmacist community leader for the National Hospice and Palliative Care Organization (NHPCO), told Hospice News.
“The pandemic did not make these [shortages] any better to deal with,” said Kimbrel. “It actually made them a little bit worse. So, hospices that are either looking for some type of an infusion or maybe in a setting where they might have an inpatient unit could be facing struggles with finding some of these medications.”
While not all regions throughout the country are experiencing difficulty, pockets exist in which accessing medications is more difficult for both hospice patients and providers. Patients in rural areas receiving home hospice care, for example, often have limited access to refills if caregivers are unable to provide as much in-person assistance due to the pandemic.
States reporting the highest COVID-19-related deaths, are seeing the most problems, with New York, New Jersey, Michigan, Louisiana and Illinois in the top five. Overwhelmed pharmacies are seeing rapidly increasing demands for medications as infection counts climb. Another challenge is an uptick of patients seeking pharmacy delivery services to minimize their risk of exposure.
Linda V. DeCherrie, M.D., clinical director of Mount Sinai at Home, explained to Hospice News that smaller hospice organizations in these areas may not have the same capital that major systems have to afford inflated medication costs. Medications in highest demand for hospice and palliative care, such as oral medications for pain management, are taking longer to reach homebound patients. Supplies are slower to reach pharmacies, resulting in longer gaps of time stretching between medication home deliveries.
“In hospice, you often need to have liquid formulations, and we found that among many of the pharmacies where we would have normally been able to find liquid formulations of medications, their suppliers just weren’t able to get them in — or would take five days to get them in — which is usually not the timeframe we would like,” DeCherrie told Hospice News.
Hospices can help reduce the impact of medication shortages by ensuring that comprehensive patient assessments are thorough and effective, including medication reconciliation and profile review. Patient assessment was among the top survey deficiencies identified by the U.S. Centers for Medicare & Medicaid Services during 2019, with medication monitoring as an area hospice programs could improve upon.
“The medication profile review has been a CMS deficiency for multiple years,” Kimbrel said. “Hospices can have a strategy inside of your interdisciplinary teams to look at medications and understand their usefulness, understand where there’s risk, and make sure that you’re prescribing and deprescribing where it’s appropriate. Deprescribing can sometimes sound scary because it can seem like it’s stopping things. In general, hospice and geriatric populations in this country are on too many medications, and this can run the risk of more side effects and drug interactions. All of those things loop back to why the drug profile review continues to be high on the radar.”