Medication reviews are useful, but the model needs to be changed: Perspectives of Aboriginal Health Service health professionals on Home Medicines Reviews

Abstract

BackgroundThe Australian Home Medicines Review (HMR) program consists of a pharmacist reviewing a patient’s medicines at his or her home and reporting findings to the patient’s general practitioner (GP) to assist optimisation of medicine management. Previous research has shown that the complex HMR program rules impede access to the HMR program by Aboriginal and Torres Strait Islander clients.This study explores the attitudes and perceptions of health professional employees working within Aboriginal Health Services (AHSs) towards the HMR program. The goal was to identify how the HMR program might better address the needs of Aboriginal and Torres Strait Islander people.MethodsThirty-one semi-structured interviews were conducted with health professionals at 11 diverse AHSs. Fourteen Aboriginal Health Workers (AHWs), five nurses, one manager and 11 GPs were interviewed. Interviews were recorded, de-identified and transcribed verbatim. Transcripts were coded and analysed for themes that recurred throughout the interviews.ResultsThis study identified a number of barriers to provision of HMRs specific to Aboriginal and Torres Strait Islander clients. These included paternalistic attitudes of health professionals to clients, heightened protection of the GP-client relationship, lack of AHS-pharmacist relationships, need for more culturally responsive pharmacists and the lack of recognition of the AHS’s role in implementation of culturally effective HMRs.Changes to the HMR model, which make it more effective and culturally appropriate for Aboriginal and Torres Strait Islander people, were recommended. Improved relationships between GPs and pharmacists, between pharmacists and AHSs, and between pharmacists and Aboriginal and Torres Strait Islander clients were identified as key to increasing HMRs for Aboriginal and Torres Strait Islander people.ConclusionsAboriginal Health Services are well-placed to be the promoters, organisers, facilitators and implementers of health programs, such as HMR, for Aboriginal and Torres Strait Islander clients.Embedding a pharmacist within an AHS addresses many of the barriers to HMRs. It ensures pharmacists are culturally mentored and that they build strong relationships with health professionals and clients.The HMR program rules need to be changed significantly if medication review is to be an effective tool for improving medication safety and adherence for Aboriginal and Torres Strait Islander people.

Improving medication safety for home nursing clients: A prospective observational study of a novel clinical pharmacy service-The Visiting Pharmacist (ViP) study

“…HMRs can only be initiated by a GP. There is a low HMR participation rate from GPs and a poor awareness among patients . Low GP participation has been reported to relate to the cumbersome consent, referral and implementation processes, and inconsistent quality of service provided by pharmacists .…”

“…There is a low HMR participation rate from GPs and a poor awareness among patients. 14,[17][18][19][20][21] Low GP participation has been reported to relate to the cumbersome consent, referral and implementation processes, and inconsistent quality of service provided by pharmacists. 18,19 Attempts to increase HMR uptake, including for home nursing clients, have been unsuccessful.…”

Adaptation of potentially preventable medication-related hospitalisation indicators for Indigenous populations in Australia using a modified Delphi technique

“…These reviews are aimed at enhancing the quality use of medicines and reducing the number of adverse drug events experienced by consumers. A Home Medicines Review is designed to enhance the quality use of medicines and reduce the number of adverse medicine events by assisting consumers to better manage and understand their medicines through a medication review conducted by an accredited pharmacist in the patient's home (http://www.6cpa.com.au/medication-management-programs) at a lower rate than non-Indigenous Australian for reasons including the lack of culturally responsive services, not having established and trusting relationships with pharmacists and because pharmacists are not usually integrated into AHSs 16 17…”

“…The IMeRSe intervention is delivered by local community pharmacists (on a fee-for-service basis) integrated with local Aboriginal health services (AHSs). Previous research has shown that Indigenous people encounter barriers to accessing medication review services,16 17 thus the aim of IMeRSe is to overcome these barriers and meet the health needs of the population 15…”

Chronic disease, medications and lifestyle: perceptions from a regional Victorian Aboriginal community

“…37 More recently, there have been calls for pharmacists to play an integral role within AHS, particularly in the delivery of Home Medication Reviews. 37 Being more closely involved with the AHS would enable pharmacists to attain appropriate education in the cultural sensitivities required to reduce barriers to delivery of such an important service in medication management 38 , 39 and may provide a catalyst that would potentially be of benefit to such a co-ordinated approach.…”