Patient-Centered Care Experiences of First-Generation, South Asian Migrants with Chronic Diseases Living in High-Income, Western Countries: Systematic Review.

Background: First-generation migrants from South Asia account for a considerable proportion of the immigrant populations in high-income, western countries and are at a high risk of developing complex, chronic diseases such as cardiovascular disease and diabetes. Yet, previous systematic reviews have not synthesized information about the healthcare needs and preferences of such migrants and the best ways for health services to provide them with appropriate, culturally sensitive, patient-centered care. The aim of this study is to systematically review the international evidence about first-generation, South Asian migrants' healthcare experiences from the patients' perspectives. Methods: Five databases were searched for qualitative, quantitative, and mixed methods studies published between January 1990 and April 2020. Fourteen thousand, six hundred and forty-four papers were retrieved and screened using pre-determined eligibility criteria. Sixty-one papers were included in this narrative synthesis. Relevant qualitative findings from the included papers were thematically analyzed, and quantitative findings were summarized. Results: Five themes emerged from findings: 1) Healthcare services engaged; 2) the language barrier; 3) experiences and perceptions of healthcare advice; 4) the doctor-patient relationship; and 5) the role of patients' families in supporting access and delivery of healthcare. Conclusion: The findings indicate that communication barriers reduce the cultural and linguistic appropriateness of healthcare. Potential solutions include employing healthcare staff from the same cultural background, training healthcare professionals in cultural competence, and proactively including first-generation, South Asian migrants in decision-making about their healthcare. Future research should explore South Asian migrants' experiences of multimorbidity management, continuity of care, interdisciplinary collaboration, the formation of treatment plans and goals as little to no data were available about these issues.

Impact of clinical pharmacy interventions on health and economic outcomes in type 2 diabetes: A systematic review and meta-analysis.

AIM: To examine the effectiveness of clinical pharmacy interventions on health and economic outcomes of people with type 2 diabetes in hospital settings. METHODS: We searched MEDLINE, EMBASE, PsycInfo, CINAHL, COCHRANE Library and citations and reference lists of key articles. We included randomized and non-randomized controlled trials, cohort and controlled before-after studies. Primary outcomes were glycosylated haemoglobin (HbA1c ), all-cause mortality, major cardiovascular events, adverse events (AEs), health-related quality of life and economic outcomes. RESULTS: We retrieved 11,853 studies, of which 44 studies were included in the review (n = 8623). We included 29 randomized controlled studies in the meta-analyses (n = 4055). Clinical pharmacy interventions significantly reduced HbA1c levels compared to usual care (standardized mean difference: -0.52, p < 0.001). The interventions significantly reduced AEs compared to usual care. No studies were reported on the effectiveness of clinical pharmacy interventions on major cardiovascular events. In one study that examined the impact of clinical pharmacy interventions on all-cause mortality, a non-significant reduction was observed compared with usual care. There was significant improvement in quality of life and significant reduction in costs of type 2 diabetes care compared to usual care. CONCLUSIONS: Clinical pharmacy interventions were effective in improving glycaemic control, quality of life and reducing the rate of AEs and costs of type 2 diabetes care.

Medicines Management, Medication Errors and Adverse Medication Events in Older People Referred to a Community Nursing Service: A Retrospective Observational Study.

BACKGROUND: Increasing numbers of older people are receiving support with medicines management from community nursing services (CNSs) to enable them to live in their own homes. Little is known about these people and the support they receive. OBJECTIVES: To explore the characteristics of older people referred for medicines management support, type of support provided, medication errors and adverse medication events (AMEs). METHODS: A retrospective observational study of a random sample of 100 older people referred to a large non-profit CNS for medicines management support over a 3-month period was conducted. Measures were: demographics, referral source, current medical problems, medicines, medication aids, types of medication authorisations used by nurses, frequency of nurse visits and type of support provided, medication errors, AMEs and interdisciplinary teamwork among community nurses, general practitioners and pharmacists. RESULTS: Older people (median 80 years) were referred for medicines support most often by hospitals (39 %). Other referrals were from families/carers, case-managers, palliative care services and general practitioners. Multiple health conditions (median 5) and medicines (median 10) were common; 66 % used ≥5 medicines; 48 % used ≥1 high-risk medicines-most commonly opiates, anticoagulants and insulin. Medication aids were frequently used, mostly multi-compartment dose administration aids (47 %). Most people received regular community nurse visits (≥4 per week) to administer medicines or monitor medicine-taking. Only 16 % had a medication administration chart; for other clients nurses used medicine lists or letters from doctors for medication authorisation. Medication errors occurred in 41 % of people and 13 % had ≥1 AME requiring medical consultation or hospitalisation; 9/13 (64 %) AMEs were potentially preventable. There was little evidence of interdisciplinary teamwork or medication review. CONCLUSION: CNS clients had multiple risk-factors for medication misadventure. Deficiencies in medicines management were identified, including low use of medication charts and interdisciplinary medication review. Strategies are needed to improve medicines management in the home-care setting.