Developing pharmacist-facilitated medicines review services for community-dwelling Maori older adults in New Zealand - A qualitative study exploring stakeholder views

摘要

Maori (Indigenous people of New Zealand [NZ]) experience inequitable health outcomes compared to non-Maori, across the spectrum of clinical care, including those relating to medicines. Internationally, pharmacist-facilitated medicines review services have been shown to benefit older adults. Despite national policies calling for the increased implementation of these services, NZ data relating to them remain limited, and these services may increase disparities between Maori and non-Maori. There are currently no medicines review services developed specifically for Maori older adults. The current study aims to elicit stakeholder views of current and potential pharmacist services to help inform the development of a pharmacist-facilitated medicines review service for community-dwelling Maori older adults. Kaupapa Maori theory was applied within this qualitative research. Purposive sampling was used to recruit participants who were involved in providing, planning, funding developing or culturally supporting health services in Waitemata District Health Board, Auckland, NZ. Data were collected in semi-structured interviews and in a focus group and analysed using reflexive thematic analysis. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative research. Eleven participants took part in the research in one focus group (n = 4) and seven semi-structured interviews, conducted between November 2018 and March 2019. Three main themes were generated: (a) moving out of the shadows - claiming pharmacists' unique role within a healthcare whanau (family); (b) 'give them the power to be able to ask' - upholding the mana (self-esteem, pride, standing) and autonomy of kaumatua (Maori older adults) and (c) rights versus realities - reimagining pro-equity Maori health services within the constraints of the colonial health system. The right of Maori to experience equitable health outcomes needs to be included in policy and also operationalised in relation to medicines review services through improved utilisation of pharmacist skills and improving Maori older adults' autonomy and control.