Equitable medicines use and pharmacist services for older Māori

Abstract

Background: Inequities are a feature of the health system in Aotearoa New Zealand (NZ) with non-Māori being in the privileged position of receiving better access to and quality of healthcare than Māori. Medicines are the most commonly used therapeutic intervention in Western medicine, yet there is little information available relating to the equity of medicines access and quality use for older New Zealanders, and how pharmacists can support the achievement of Māori health equity. Aim: This research aimed to develop a pharmacist-facilitated medicines review intervention model for community-dwelling Māori older adults in Waitematā District Health Board (WDHB). Method: Kaupapa Māori theory underpinned the present research and multiple studies were undertaken to achieve the aim including: a narrative review of ethnic variation in medicines use in older New Zealanders; a systematic review of pharmacist-facilitated medicines review services in NZ; semi-structured interviews with older Māori and other stakeholders to explore experiences of medicine, medicine-related services and views relating to future interventions; utilising the principles of Te Tiriti o Waitangi to approach intervention development; and testing of an intervention (consisting of medicines education and medicines optimisation components) in a single-arm, prospective feasibility study. Findings: The narrative review reported that ethnic differences exist in medicines access in NZ between Māori and non-Māori older adults and inappropriate prescribing is more strongly associated with adverse outcomes for Māori than for non-Māori. The systematic review showed that current pharmacist-facilitated medicines review services in NZ are not designed or targeted for Māori and may increase disparities in health outcomes. The semi-structured interviews with ten older Māori found that medicines impact on all facets of their lives and that they have the desire, ability and right to take control of their medicines treatment but that they want this to occur in partnership with trusted health professionals. Semi-structured interviews and a focus group with eleven WDHB health professionals and/or employees found that pharmacists need to claim their roles as medicines experts and provide services that uphold the mana of older Māori. Seventeen participants were included in the feasibility study. The intervention was acceptable to participants with the perceived increase in medicines knowledge, delivery of care from a trusted health professional and a by Māori, for Māori approach being regarded as some of the most important aspects of the intervention. The intervention content and delivery, as well as the research process utilised, were feasible. Conclusion: This research highlighted inequitable ethnic variation in the quality use of medicines between older Māori and non-Māori, and that disparities in health outcomes may be perpetuated by current medicines review services. Engagement with older Māori and other stakeholders was central to the development of the intervention. The findings in this thesis provide evidence that this engagement is critical for effective health services development for Māori and that ‘by Māori, for Māori’ health interventions can be developed in a way that responds to the expectations of multiple, diverse stakeholders, in a way that is acceptable and feasible.