A systematic review of pharmacist-led medicines review services in New Zealand - is there equity for Māori older adults?

Joanna Hikaka; Carmel Hughes; Rhys Jones; Martin J Connolly; Nataly Martini

doi:10.1016/j.sapharm.2019.01.009

A systematic review of pharmacist-led medicines review services in New Zealand - is there equity for Māori older adults?

Res Social Adm Pharm. 2019 Dec;15(12):1383-1394. doi: 10.1016/j.sapharm.2019.01.009. Epub 2019 Jan 14.

Authors

Joanna Hikaka¹, Carmel Hughes², Rhys Jones³, Martin J Connolly⁴, Nataly Martini⁵

Affiliations

¹ School of Pharmacy, University of Auckland, Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand. Electronic address: j.hikaka@auckland.ac.nz.
² School of Pharmacy, Queen's University, Belfast, Northern Ireland, United Kingdom.
³ Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand.
⁴ Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand.
⁵ School of Pharmacy, University of Auckland, Auckland, New Zealand.

PMID: 30733137
DOI: 10.1016/j.sapharm.2019.01.009

Abstract

Background: Pharmacist involvement in medicines reviews for older adults can improve prescribing and reduce adverse drug reactions. Māori experience poorer health outcomes than non-Māori resulting, in part, from inequitable access to and quality of medicine-related care. Despite international data showing benefit, it is unclear whether pharmacist-led medicines review services can improve outcomes for Māori older adults.

Objective: This systematic review aims to describe pharmacist-led medicines review services for community-dwelling adults in New Zealand, assess effectiveness of these interventions and identify their effect on health equity for Māori and older adults.

Methods: The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Equity (PRISMA-E 2012). Observational studies were included. The intervention in included studies had to involve a pharmacist, occur in the outpatient setting in New Zealand, and involve review of all medicines for an individual patient. At least one patient-related outcome had to be reported.

Results: The search identified seven observational studies with 542 total participants. Study interventions included adherence-based reviews in community pharmacies and multi-step comprehensive clinical reviews in outpatient haemodialysis units. Medicines reviews identified up to a median of 3 drug-related problems per review. The effect of interventions on medicines adherence and knowledge was not clear. Māori may have been less likely than non-Māori to benefit from improved medicines knowledge as a result of interventions. None of the studies incorporated aspects in study design or delivery to address inequities for Māori.

Conclusion: Further investigation is needed to understand whether the development of culturally safe pharmacist-led medicines review services, responsive to community identified needs, can help to achieve equity in health outcomes for Māori older adults.

Keywords: Equity; Indigenous health; Medicines review; Māori; Older adult; Pharmacist.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Adult
Drug-Related Side Effects and Adverse Reactions / prevention & control
Health Equity*
Humans
Inappropriate Prescribing / prevention & control
Indigenous Peoples
Medication Reconciliation*
New Zealand
Observational Studies as Topic
Pharmaceutical Services / organization & administration
Pharmacists / organization & administration*
Professional Role