After the teleconsultation: getting medicines to patients when pharmacy services are not available

Box 1. Fictionalised examples of challenges accessing medication in the Falkland Islands, Australia, and the UKJane Smith is a 45-year-old woman who lives in a small settlement in the south of West Falkland Island, a remote island with fewer than 200 residents and no healthcare facilities.She calls the Falkland Islands' only emergency department as she has felt unwell for the last 9 days with ear pain, a sore throat, and dizziness.She is advised to obtain clarithromycin tablets from the medical chest located near her and given advice and safety netting over the phone.She is then booked into a face-to-face appointment with the doctor on their next visit to her part of the island.She visits the 'chest holder' and is given the medication.The pharmacist then organises re-supply of these medications to the medicine chest holder.They are delivered on a routine flight the next day.Marie is a 40-year-old farmer who lives 30 minutes' drive from a small rural Australian town.She has had symptoms of a urinary tract infection for several days.She decides late in the afternoon that she needs to see a GP.She receives a call back from a doctor based in Melbourne.The doctor prescribes antibiotics and suggests that she start taking them immediately.She asks whether she wants an electronic prescription sent to her phone or to the local chemist.As Marie would face a 90-minute drive to collect medication, she delays starting until she can collect more locally the next day.Seema Patel is an 88-year-old who lives in a small town in the UK.She has become increasingly frail over recent months.Both she and her family believe that she is dying.Her daughter calls 111 on a Friday evening as she is in pain.The out-of-hours GP attends, gives a stat dose of diamorphine, and issues a prescription for further end-of-life medication for the family to collect the next morning.Her son spends the morning driving around nearby pharmacies attempting to source the medication.He returns at 2 pm, by which stage his mother is no longer able to communicate.Seema dies 2 days later.The family feel she was comfortable but her son is deeply distressed that he was not present for the last morning that she was able to communicate.