ABSTRACT
Background: Pharmacist-facilitated medicines reviews are effective at identifying medicines-related problems and can improve the appropriate use of medicines in older adults. Current services in Aotearoa New Zealand (NZ) are not developed specifically for Maori (Indigenous people of NZ) and may increase health disparities between Maori and non-Maori. We developed a medicines review intervention for and with Maori older adults, and tested it in a feasibility study. Objective: To assess patient acceptability of a pharmacist-facilitated medicines review intervention for Maori older adults. Methods: The intervention consisted of a medicines education session (pharmacist and participant) and an optional medicines optimisation session (pharmacist, participant, and prescriber). Participant acceptability was assessed post-intervention using a structured telephone interview developed specifically for this study. Participants responded to statements using a five-point Likert scale (strongly agree-strongly disagree; numerical analysis/reporting) which focused on the topics of power/control, support mechanisms, intervention content and delivery, and perceived usefulness. Open-ended questions relating to the intervention value and suggestions for improvement were analysed using general inductive analysis. Results: Seventeen participants took part in the feasibility study from December 2019-March 2020 and all completed the acceptability interview. Participants perceived the intervention content and mode of delivery to be appropriate, and that their power and control over their medicines and health improved and as did their confidence in self-management. Five themes were generated: medicines knowledge from a trusted professional, increased advocacy, 'by Maori, for Maori', increased confidence and control, and financial and resource implications. Conclusion: A pharmacist-facilitated medicines review intervention for Maori older adults developed by Maori, for Maori, was acceptable to patient participants. Participants valued the clinical expertise and advocacy provided by the pharmacist, and the increase in medicines knowledge, control and autonomy. Participants wanted the service to continue on an ongoing basis.
ABSTRACT
Background: Pharmacist-facilitated medicines review services have been postulated as a way to address current inequities in health outcomes between Maori and non-Maori. These interventions have been shown internationally to improve the appropriate use of medicines but remain underutilised in Aotearoa New Zealand (NZ). By reviewing the literature and engaging with key stakeholders, we developed an intervention, which included collaborative goal-setting, education and medicines optimisation, for testing in a feasibility study. Objective: To determine the feasibility (recruitment, intervention delivery, and data collection methods) of a pharmacist-facilitated medicines review intervention for Maori older adults, and proposed intervention outcomes. Methods: This study was reported in accordance with the CONSORT 2010 statement: extension to randomised controlled pilot and feasibility trials and the Consolidated criteria for strengthening reporting of health research involving indigenous peoples: the CONSIDER statement. Participant eligibility criteria were: Maori; aged 55-plus; community-dwelling; enrolled in a general practice in Waitemata District Health Board (Auckland, NZ). Consented participants engaged in a medicines education component (participant and pharmacist) and an optional medicines optimisation component (participant, pharmacist and prescriber). Outcomes measures included: the feasibility of data collection tools and methods, time taken to conduct the intervention and research processes; medicines knowledge, medicines appropriateness and quality of life (QoL); pharmacist recommendations and prescriber acceptance rate. Results: Seventeen consented participants took part in the intervention from December 2019-March 2020 with the majority (n = 12) recruited through general practice mail-outs. Data collection was feasible using the predetermined outcome measure tools and was complete for all patient participants. Pharmacist intervention delivery was feasible. A mean of 9.5 recommendations were made per participant with a prescriber acceptance rate of 95%. These included non-medicine-related recommendations. Conclusion: The feasibility testing of pharmacist-facilitated medicines review intervention developed for (and with) community-dwelling Maori older adults allows for intervention refinement and can be utilised for further studies relating to pharmacist services in primary care.
