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Equity of delivery: access to voluntary assisted dying substances using a centralised pharmacy model.

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Title: Equity of delivery: access to voluntary assisted dying substances using a centralised pharmacy model.
Authors: Cole E; Metro South Health, Community and Oral Health, Queensland Voluntary Assisted Dying Support and Pharmacy Service (QVAD SPS), Brisbane, Qld, Australia.;, Reymond L; Metro South Health, Community and Oral Health, Queensland Voluntary Assisted Dying Support and Pharmacy Service (QVAD SPS), Brisbane, Qld, Australia.; Griffith University, School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Southport, Qld 4222, Australia.;, Stroil-Salama E; Metro South Health, Community and Oral Health, Queensland Voluntary Assisted Dying Support and Pharmacy Service (QVAD SPS), Brisbane, Qld, Australia.;, Phelan C; Flinders University, College of Nursing and Health Sciences, Research Centre for Palliative Care, Death and Dying, Adelaide, SA, Australia.; College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia.
Source: Australian health review : a publication of the Australian Hospital Association [Aust Health Rev] 2025 Dec 04; Vol. 49 (6).
Publication Type: Journal Article
Language: English
Journal Info: Publisher: CSIRO Pub Country of Publication: Australia NLM ID: 8214381 Publication Model: Print Cited Medium: Internet ISSN: 1449-8944 (Electronic) Linking ISSN: 01565788 NLM ISO Abbreviation: Aust Health Rev Subsets: MEDLINE
Imprint Name(s): Publication: 2010- : Collingwood, Victoria : CSIRO Pub.
Original Publication: [Sydney, Australia] : The Association.
MeSH Terms: Health Services Accessibility*/statistics & numerical data , Suicide, Assisted*/statistics & numerical data, Humans ; Queensland ; Female ; Male ; Middle Aged ; Adult ; Aged
Abstract: Objective: Queensland implemented a centralised voluntary assisted dying (VAD) pharmacy model to promote safety, consistency and equitable access to VAD substances. In a geographically dispersed state, such as Queensland, a potential concern is whether centralisation affects time-to-delivery (TTD) for patients in regional and rural areas. This audit examined whether differences exist in TTD between South East Queensland (SEQ; metropolitan) and non-SEQ (non-metropolitan) patients, and explored reasons for prescription and visit cancellations to determine whether geographic factors, particularly remoteness, influenced service reliability.
Methods: All VAD substance deliveries between 1 January 2023 and 31 January 2024 were analysed. TTD was defined as the difference between the patient's preferred and actual supply dates. Comparisons were made across region (SEQ vs non-SEQ), hospital and health service districts, and Modified Monash Model categories. Reasons for prescription and visit cancellations were also explored, as these cases were not captured in the TTD dataset if a delivery did not proceed, and may reveal potential geographic barriers for timely access.
Results: Of 911 patients, 723 (83%) received the VAD substance on their preferred date. No statistically significant differences in TTD were observed across region, hospital and health service districts or Modified Monash Model classifications, demonstrating consistent and reliable statewide delivery - an indicator of safety and standardised practice. Cancellations (prescriptions n = 58, visits n = 56) were geographically uniform and most commonly due to patient death.
Conclusions: Queensland's centralised VAD pharmacy enables equity of access and safe delivery of VAD substances regardless of geography, supporting standardised practice and mitigating operational risks through centralised oversight.
(© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.)
Contributed Indexing: Keywords: centralised pharmacy model; end-of-life care; euthanasia; geographic disparities in health care; health equity; health policy; health service delivery; healthcare access; medical assistance in dying (MAiD); pharmacy services; regional and rural health care; timely access to medication; voluntary assisted dying (VAD)
Entry Date(s): Date Created: 20251126 Date Completed: 20251130 Latest Revision: 20251201
Update Code: 20251202
DOI: 10.1071/AH25250
PMID: 41292034
Database: MEDLINE
Description
Abstract:Objective: Queensland implemented a centralised voluntary assisted dying (VAD) pharmacy model to promote safety, consistency and equitable access to VAD substances. In a geographically dispersed state, such as Queensland, a potential concern is whether centralisation affects time-to-delivery (TTD) for patients in regional and rural areas. This audit examined whether differences exist in TTD between South East Queensland (SEQ; metropolitan) and non-SEQ (non-metropolitan) patients, and explored reasons for prescription and visit cancellations to determine whether geographic factors, particularly remoteness, influenced service reliability.<br />Methods: All VAD substance deliveries between 1 January 2023 and 31 January 2024 were analysed. TTD was defined as the difference between the patient's preferred and actual supply dates. Comparisons were made across region (SEQ vs non-SEQ), hospital and health service districts, and Modified Monash Model categories. Reasons for prescription and visit cancellations were also explored, as these cases were not captured in the TTD dataset if a delivery did not proceed, and may reveal potential geographic barriers for timely access.<br />Results: Of 911 patients, 723 (83%) received the VAD substance on their preferred date. No statistically significant differences in TTD were observed across region, hospital and health service districts or Modified Monash Model classifications, demonstrating consistent and reliable statewide delivery - an indicator of safety and standardised practice. Cancellations (prescriptions n = 58, visits n = 56) were geographically uniform and most commonly due to patient death.<br />Conclusions: Queensland's centralised VAD pharmacy enables equity of access and safe delivery of VAD substances regardless of geography, supporting standardised practice and mitigating operational risks through centralised oversight.<br /> (© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.)
ISSN:1449-8944
DOI:10.1071/AH25250