Structural Equation Modelling to Identify Psychometric Determinants of Medication Adherence in a Survey of Kidney Dialysis Patients.

Purpose: Medication non-adherence in dialysis patients is associated with increased mortality and higher healthcare costs. We assessed whether medication adherence is influenced by specific psychometric constructs measuring beliefs about the necessity for medication and concerns about them. We also tested whether medication knowledge, health literacy, and illness perceptions influenced this relationship. Patients and Methods: This study is based on data from a cross-sectional in-person questionnaire, administered to a random sample of all adult dialysis patients at a teaching hospital. The main outcome was self-assessed medication adherence (8-Item Morisky Medication Adherence Scale). The predictors were: concerns about medications and necessity for medication (Beliefs About Medication Questionnaire); health literacy; medication knowledge (Medication Knowledge Evaluation Tool); cognitive, emotional, and comprehensibility Illness perceptions (Brief Illness Perception Questionnaire). Path analysis was performed using structural equations in both covariance and variance-based models. Results: Necessity for medication increased (standardized path coefficient [ß] 0.30 [95% CI 0.05, 0.54]) and concerns about medication decreased (standardized ß -0.33 [-0.57, -0.09]) medication adherence, explaining most of the variance in outcome (r2=0.95). Medication knowledge and cognitive illness perceptions had no effects on medication adherence, either directly or indirectly. Higher health literacy, greater illness comprehension, and a more positive emotional view of their illness had medium-to-large sized effects in increasing medication adherence. These were indirect rather and direct effects mediated by decreases in concerns about medications (standardized ß respectively -0.40 [-0.63,-0.16], -0.60 [-0.85, -0.34], -0.33 [-0.52, -0.13]). Conclusion: Interventions that reduce patients' concerns about their medications are likely to improve adherence, rather than interventions that increase patients' perceived necessity for medication. Improving patients' general health literacy and facilitating a better understanding and more positive perception of the illness can probably achieve this. Our study is potentially limited by a lack of generalizability outside of the population and setting in which it was conducted.

How pharmacist-led health services are tailored to minoritized populations, their acceptability and effectiveness: A scoping literature review.

BACKGROUND: Worldwide, minoritized populations experience inequitable health risks and outcomes. The importance of offering tailored services to meet the specific needs of target populations should be addressed during service development. Within healthcare systems, pharmacists play a crucial role in supporting patients to manage their medicines and health conditions. OBJECTIVES: This scoping review aims to identify, collate and analyse literature describing pharmacist-led services tailored for minoritized populations in order to strengthen the knowledge base and support for achieving health equity. METHODS: A scoping review was guided by the PRISMA-ScR checklist and the five-stage process outlined by Arksey and O'Malley. Medline, EMBASE, Scopus, CINAHL Plus, International Pharmaceutical Abstracts, and Google Scholar databases, plus grey literature were searched to identify relevant studies published up to October 2022. Texts were included if they reported on a pharmacist-led health service tailored to meet the needs of a minoritized population. The review protocol was registered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/E8B7D). RESULTS: Of the 566 records initially identified, 16 full-text articles were assessed for eligibility and 9 articles describing 6 unique services met the criteria and were included in the review. Three services were non-health-condition-specific, 2 targeted type two diabetes and 1 focussed on opioid dependency disorders. Service acceptability was consistently explored, and all services ensured that pharmacists' views were considered. However, only 4 consulted with the people from the group that the service targeted. Where reported, the effectiveness was not comprehensively evaluated. CONCLUSION: There is limited literature in this area and a critical need for more evidence on the effectiveness of pharmacist-led services for minoritized populations. We need a better understanding of how pharmacists contribute to health equity pathways and how to expand this. Doing so will inform future services and contribute towards achieving equitable health outcomes.

Exploring medicines information needs of mental health service users at a New Zealand hospital.

Providing effective medicines information to individuals can improve outcomes, yet little is known about what information mental health service users need and want about their medicines, and how best to deliver this. The aim of this study was to explore the medicines information needs of mental health service users. Adults (n=30) under the care of acute mental health services in a New Zealand hospital were invited to take part in semi-structured interviews or a focus group to explore preferences for medicines information. Interview data were analysed using an inductive thematic approach. Six key themes were identified: 1) personalisation of information, 2) adverse and beneficial effects, 3) relationships and trust, 4) informed choice, 5) use of reliable internet resources and 6) involvement of family and support people. Preferences on content, timing, provider and format of information delivery were highly individualised indicating the need for information to be personalised to the needs of the service user. A trusted relationship with their healthcare provider was essential . Making informed decisions reduced confusion or fear about medicines. Understanding medicines information needs of patients can help improve the education health professionals provide on medicines, thus potentially improving patient engagement and outcomes.

Why do pharmacists leave the profession? A mixed-method exploratory study.

BACKGROUND: Recent New Zealand policy documents aim for pharmacists to be retained, and promote the provision of extended clinical pharmacy services. However, younger pharmacists have expressed dissatisfaction with the profession on informal social for a. OBJECTIVES: To explore the characteristics, and perspectives of pharmacy as a career, of recent Bachelor of Pharmacy (BPharm, four-year degree) graduates who have left, or are seriously considering leaving the New Zealand pharmacy profession in the near future and where they have gone, or plan to go. METHODS: We conducted a cross-sectional study with a mixed-method explanatory sequential design. An anonymous online survey among those who completed their pharmacy undergraduate degree (BPharm or equivalent) in 2003 or later and who had left or who were seriously considering leaving the New Zealand pharmacy profession in the next five years, was open from 1st December 2018 to 1st February 2019. Recruitment occurred via University alumni databases, pharmacy professional organisations, pharmaceutical print media, social media and word-of-mouth. Ten semi-structured interviews were then conducted with a purposive sample of survey respondents. Descriptive statistics were generated from the quantitative data and qualitative data were analysed using manifest content analysis. RESULTS: We received 327 analysable surveys of which 40.4% (n=132) were from those who had already left the New Zealand pharmacy sector at the time of the data collection and the rest (59.6% n=195) were those working within the sector, but seriously considering leaving the profession. Reasons most commonly reported for studying pharmacy were having an interest in health and wanting to work with people. The most common reasons for leaving, or wanting to leave, were dissatisfaction with the professional environment, including inadequate remuneration, and a perceived lack of career pathways or promotion opportunities. A wide range of career destinations were declared, with medicine being most frequently reported. CONCLUSIONS: Most of the reasons for leaving/considering leaving the profession reported relate to the values and features of the pharmacy profession such as the professional environment, remuneration and career pathways. These findings are consistent with other studies and may represent a barrier to achieving the aims of recent health policy documents.

Why do pharmacists leave the profession? A mixed-method exploratory study

Background: Recent New Zealand policy documents aim for pharmacists to be retained, and promote the provision of extended clinical pharmacy services. However, younger pharmacists have expressed dissatisfaction with the profession on informal social for a. Objectives: To explore the characteristics, and perspectives of pharmacy as a career, of recent Bachelor of Pharmacy (BPharm, four-year degree) graduates who have left, or are seriously considering leaving the New Zealand pharmacy profession in the near future and where they have gone, or plan to go. Methods: We conducted a cross-sectional study with a mixed-method explanatory sequential design. An anonymous online survey among those who completed their pharmacy undergraduate degree (BPharm or equivalent) in 2003 or later and who had left or who were seriously considering leaving the New Zealand pharmacy profession in the next five years, was open from 1st December 2018 to 1st February 2019. Recruitment occurred via University alumni databases, pharmacy professional organisations, pharmaceutical print media, social media and word-of-mouth. Ten semi-structured interviews were then conducted with a purposive sample of survey respondents. Descriptive statistics were generated from the quantitative data and qualitative data were analysed using manifest content analysis. Results: We received 327 analysable surveys of which 40.4% (n=132) were from those who had already left the New Zealand pharmacy sector at the time of the data collection and the rest (59.6% n=195) were those working within the sector, but seriously considering leaving the profession. Reasons most commonly reported for studying pharmacy were having an interest in health and wanting to work with people (AU)