https://orcid.org/0000-0001-9755-674X
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Abstract
Background
Medication-related problems (MRPs) contribute significantly to preventable patient harm and global healthcare expenditure. Vulnerable populations, including Indigenous Australians (please note that the use of the term ‘Indigenous’ in this paper includes all Aboriginal and Torres Strait Islander people and acknowledges their rich traditions and heterogenous cultures.) and people living with severe and persistent mental illness (SPMI), may be at increased risk of MRPs. Pharmacist-led medication reviews can identify MRPs for targeted action.
Objective
To characterize MRPs identified and recommendations made by community pharmacists during medication reviews conducted with Indigenous Australians and people living with SPMI.
Methods
Participants were recruited through two Australian trials testing the feasibility and/or effectiveness of novel community pharmacist-led interventions, the Indigenous Medication Review Service (IMeRSe) feasibility study (June 2018–July 2019) and Bridging the Gap between Physical and Mental Illness in Community Pharmacy (PharMIbridge) randomized controlled trial (September 2020–December 2021). Trained community pharmacists conducted medication reviews responsive to the cultural and health needs of participants. MRPs, MRP severity and pharmacist recommendations were documented and classified using an established classification system (DOCUMENT). MRP severity was assessed by pharmacists and an independent assessor. Data were analysed descriptively, and paired t-tests were used to compare severity ratings.
Results
Pharmacists identified 795 MRPs with 411 participants across both trials (n = 255 IMeRSe, n = 156 PharMIbridge). Non-adherence to medication was the most common (n = 157, 25.1%) and second-most common (n = 25, 14.7%) MRP in IMeRSe and PharMIbridge, respectively. Undertreatment was the second-most common MRP in the sample of Indigenous Australians (n = 139, 22.2%), and reports of toxicity/adverse reactions were most common in people living with SPMI (n = 41, 24.1%). A change in pharmacotherapy was the most frequent recommendation made by pharmacists (40.2% and 55.0% in IMeRSe and PharMIbridge, respectively). Severity ratings varied, with the majority being ‘Mild’ or ‘Moderate’ in both groups. Significant differences were found in the severity rating assigned by trial pharmacists and the independent assessor.
Conclusions
Community pharmacists identified a range of MRPs experienced by two at-risk populations, most commonly non-adherence and toxicity or adverse reactions, when conducting medication reviews and proposed diverse strategies to manage these, frequently recommending a change in pharmacotherapy. These findings highlight the opportunity for more targeted approaches to identifying and managing MRPs in primary care and tailored community pharmacist-led interventions may be of value in this space.
Trail Registration: Australian and New Zealand Clinical Trial Registry records (IMeRSe ACTRN12618000188235 registered 06/02/2018 & PharMIbridge ACTRN12620000577910 registered 18/05/2020).
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s40545-023-00637-x.
The use of the term ‘Indigenous’ in this paper includes all Aboriginal and Torres Strait Islander people and acknowledges their rich traditions and heterogenous cultures.
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s40545-023-00637-x.
The use of the term ‘Indigenous’ in this paper includes all Aboriginal and Torres Strait Islander people and acknowledges their rich traditions and heterogenous cultures.
Acknowledgements
The authors wish to acknowledge the Indigenous communities, consumer participants, Aboriginal Health Service staff, and community pharmacists who participated in this research. We thank all members of the project teams and the Expert Panels for their contributions. The IMeRSe study was developed in partnership with The Pharmacy Guild of Australia, the National Aboriginal Community Controlled Health Organisation (NACCHO) and Griffith University. The PharMIbridge RCT was developed in partnership with The Pharmacy Guild of Australia, the Pharmaceutical Society of Australia, Griffith University, and The University of Sydney.
Author contributions
Conceptualization: JC, JH, SM, COR, SED, FK, JS, AW; data curation: JC, JH, JS; formal analysis: JC, JH, SM, FK, JS, TR, AW; funding acquisition: SM, COR, SED, FK, JS, AW; investigation: JC, JH, SM, COR, SED, FK, JS, AW; methodology: JC, JH, SM, COR, SED, FK, JS, AW; writing—original draft: JC, JH; writing—review and editing: JC, JH, SM, COR, SED, FK, JS, TR, AW.
Funding
The IMeRSe feasibility study and PharMIbridge RCT received funding from the Australian Government Department of Health and Aged Care (formerly the Department of Health). The researchers were independent from the funder. This article contains the opinions of the authors and does not in any way reflect the views of the Department of Health and Aged Care or the Australian Government. The funding provided must not be taken as an endorsement of the contents of this paper.
Availability of data and materials
The datasets generated and analysed for this study are not publicly available as consent from participants was not sought to share the data more widely than for the purpose of this study. Data are not publicly available as consent for data sharing was not obtained from participants.
Declarations
Ethical approval and consent to participate
The IMeRSe feasibility study and PharMIbridge RCT received ethical approval from the Griffith University Human Research Ethics Committee (HREC/2018/251 and HREC/2019/473, respectively). Written informed consent was obtained from all consumer participants.
Consent for publication
Not applicable.
Competing interests
None to declare.
Supplementary Information
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Notes
1 Please note that the use of the term ‘Indigenous’ in this paper includes all Aboriginal and Torres Strait Islander people and acknowledges their rich traditions and heterogenous cultures.
2 It is acknowledged that Aboriginal and Torres Strait Islander people may also live with SPMI and the authors are not suggesting these are two discrete populations. Some participants in IMeRSe lived with SPMI and some participants in PharMIbridge identified as Aboriginal or Torres Strait Islander.