Abstract
In Australia, Home Medicines Review (HMR) has been found to be an important tool to raise awareness of medication safety, reduce adverse events and improve medication adherence. Aboriginal and Torres Strait Islander people are 'underserviced' by the HMR program and are the most likely of all Australians to miss out on HMRs despite their high burden of chronic disease and high rates of hospitalisation due to medication misadventure. The goal of this study was to explore Aboriginal and Torres Strait Islander perspectives of the Home Medicines Review program and their suggestions for an 'improved' or more readily accessible model of service. Eighteen semi-structured focus groups were conducted with 102 Aboriginal and Torres Strait Islander patients at 11 Aboriginal Health Services (AHSs). Participants who were multiple medication users and understood English were recruited to the study by AHS staff. Seven focus groups were conducted for people who had already used the HMR program (User, n=23) and 11 focus groups were conducted for people who had not had an HMR (Non User, n=79). Focus groups were recorded, de-identified and transcribed. Transcripts were coded and analysed for themes. Focus groups continued and concepts were explored until no new findings were being generated and thus saturation of data occurred. Focus group participants who had not had an HMR had little or no awareness of the HMR program. All the participants felt that lack of awareness and promotion of the HMR program were contributing factors to the low uptake of the HMR program by Aboriginal and Torres Strait Islander people. Most participants felt that an HMR would assist them to better understand their medicines, would empower them to seek information about medicines, would improve relationships with health professionals and would increase the likelihood of medication adherence. Most of the User participants reported that the HMR interview had been very useful for learning more about their medicines. However, many reported that they found the process confusing and confronting. The majority of participants felt HMRs for Aboriginal and Torres Strait Islander patients should be organised by AHS staff, with patients being offered a choice of location for the HMR interview. Participants identified that Aboriginal Health Workers should play a key role in communication, knowledge translation, referral and follow-up. Current HMR rules impede rather than facilitate HMRs for Aboriginal and Torres Strait Islander people. Tailoring and remodelling of the HMR program is needed to increase the awareness, accessibility, acceptability and effectiveness of the HMR program for Aboriginal and Torres Strait Islander people.
Highlights
Seven focus groups were conducted for people who had already used the Home Medicines Review (HMR) program (User, n=23 ) and 11 focus groups were conducted for people who had not had an HMR (Non User, n=79)
Most of the User participants reported that the HMR interview had been very useful for learning more about their medicines
Changes needed to increase the uptake of HMRs by Aboriginal and Torres Strait Islander people include promotion to increase awareness of HMRs; providing leaflets to patients outlining the HMR process; allowing an HMR referral to be written by a nurse or Aboriginal Health Worker (AHW); facilitating the HMR interview by allowing choice of location, AHW and family member; reimbursing Aboriginal Health Services (AHSs) for staff organisation and attendance of HMR interviews; and providing HMR follow-up to patients
Summary
Factors that have an impact on Aboriginal people’s engagement with health services and medicines are various They may include the cost of multiple medicines, the distance to services, poverty, racism, dispossession, lack of control, the stigma associated with a diagnosis of chronic disease, educational disadvantage, shared crowded households, increased patient mobility and inadequate health professional support[4,5]. Compounding these may be language, health literacy and cultural issues, concurrent use of bush or traditional medicines, lack of continuity of care and the absence of strong relationships with health practitioners[6]. Failed patient–clinician interactions, poor healthcare delivery systems, complex medicine regimens and struggles with social and emotional wellbeing decrease the likelihood of effective management of medicines[7,8]
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