Prevalence of sodium-glucose transporter 2 inhibitor-associated diabetic ketoacidosis in real-world data: A systematic review and meta-analysis.

BACKGROUND: The U.S. Food and Drug Administration (FDA) revised the labels of sodium-glucose transporter 2 (SGLT2) inhibitors in December 2015 to inform users regarding the risk of diabetic ketoacidosis (DKA). As more drugs of this class are approved and their indications are expanded, this serious adverse effect has been increasingly reported. OBJECTIVE: This review evaluated observational studies to inform the prevalence of SGLT2-inhibitor-associated DKA compared with other antihyperglycemic agents. METHODS: A systematic review was conducted in PubMed and EMBASE until 19 July 2022 (PROSPERO: CRD42022385425). We included published retrospective cohort active comparator/new user (ACNU) and prevalent new user studies assessing SGLT2-inhibitor-associated DKA prevalence in adult patients with type 2 diabetes mellitus (T2DM) against active comparators. We excluded studies which lacked 1:1 propensity score matching. The JBI Checklist for Cohort Studies guided the risk-of-bias assessments. Meta-analysis was conducted based on the inverse variance method in R software. RESULTS: Sixteen studies with a sample of 2,956,100 nonunique patients met the inclusion criteria. Most studies were conducted in North America (n = 9) and adopted the ACNU design (n = 15). Meta-analysis of 14 studies identified 33% higher DKA risk associated with SGLT2 inhibitors (HR = 1.33, 95% CI: 1.14-1.55, P < 0.01). Meta-regression analysis identified the study location (P = 0.02), analysis principle (P < 0.001), exclusion of chronic comorbidities (P = 0.007), and canagliflozin (P = 0.04) as significant moderator variables. CONCLUSIONS: Despite limitations related to heterogeneity, generalizability, and misclassification, the results of this study show that SGLT2 inhibitors increase the prevalence of DKA among adult T2DM patients in the real world. The findings supplement evidence from randomized controlled trials (RCTs) and call for continued vigilance.

Evaluating EHR-Integrated Digital Technologies for Medication-Related Outcomes and Health Equity in Hospitalised Adults: A Scoping Review.

The purpose of this scoping review is to identify and evaluate studies that examine the effectiveness and implementation strategies of Electronic Health Record (EHR)-integrated digital technologies aimed at improving medication-related outcomes and promoting health equity among hospitalised adults. Using the Consolidated Framework for Implementation Research (CFIR), the implementation methods and outcomes of the studies were evaluated, as was the assessment of methodological quality and risk of bias. Searches through Medline, Embase, Web of Science, and CINAHL Plus yielded 23 relevant studies from 1,232 abstracts, spanning 11 countries and from 2008 to 2022, with varied research designs. Integrated digital tools such as alert systems, clinical decision support systems, predictive analytics, risk assessment, and real-time screening and surveillance within EHRs demonstrated potential in reducing medication errors, adverse events, and inappropriate medication use, particularly in older patients. Challenges include alert fatigue, clinician acceptance, workflow integration, cost, data integrity, interoperability, and the potential for algorithmic bias, with a call for long-term and ongoing monitoring of patient safety and health equity outcomes. This review, guided by the CFIR framework, highlights the importance of designing health technology based on evidence and user-centred practices. Quality assessments identified eligibility and representativeness issues that affected the reliability and generalisability of the findings. This review also highlights a critical research gap on whether EHR-integrated digital tools can address or worsen health inequities among hospitalised patients. Recognising the growing role of Artificial Intelligence (AI) and Machine Learning (ML), this review calls for further research on its influence on medication management and health equity through integration of EHR and digital technology.

Access to medication and pharmacy services for resettled refugees: a systematic review.

The difficulties that resettled refugees experience in accessing primary health-care services have been widely documented. In most developed countries, pharmacists are often the first health-care professional contacted by consumers; however, the ability of refugees to access community pharmacies and medication may be limited. This review systematically reviewed the literature and synthesised findings of research that explored barriers and/or facilitators of access to medication and pharmacy services for resettled refugees. This review adhered to guidelines for systematic reviews by PRISMA (preferred reporting items for systematic reviews and meta-analyses). Databases were searched during March 2014 and included Scopus, ProQuest Sociological Abstracts, PubMed, Embase and APAIS Health. The Australian and International grey literature was also explored. Nine studies met the quality and inclusion criteria. The research reported in seven of the nine studies was conducted in the US, one was conducted in Australia and the other in the UK. The majority of studies focussed on South-east Asian refugees. Themes identified across the studies included language and the use of interpreters; navigating the Western health-care system; culture and illness beliefs; medication non-adherence; use of traditional medicine; and family, peer and community support. There is a significant paucity of published research exploring barriers to medication and pharmacy services among resettled refugees. This systematic review highlights the need for appropriate interpreting and translation services, as well as pharmacy staff demonstrating effective cross-cultural communication skills.

Exploring telepharmacy: A bibliometric analysis of past research and future directions.

This bibliometric review analyzes the evolution of telepharmacy research, significantly amplified by the COVID-19 pandemic. By employing bibliometric analysis, the study aims to provide a comprehensive overview of the current state and emerging trends in telepharmacy. This approach helps in identifying key areas of growth, predominant themes, and potential gaps in the literature. Utilizing data from 330 papers (1981-2023) sourced from Scopus and analyzed with Bibliometrix™, this study applies both performance analysis and science mapping methods to examine the telepharmacy literature. The findings reveal a consistent growth in telepharmacy research, with an 8.07 % average annual growth rate. Performance analysis highlights key authors, influential works, and leading journals and countries in the field. Document co-citation analysis identifies four developmental phases of telepharmacy: emergence, take-off, expansion, and future trajectory by uncovering the intellectual structure of the field. Co-words analysis elucidates evolving conceptual structures and significant subfields over time. These findings serve to inform practitioners and researchers about the evolving landscape of telepharmacy, guiding future research and practice in this increasingly important field.

The future of pharmacy work: How pharmacists are adapting to and preparing for technology infusion.

Background: The pharmacy sector is rapidly evolving due to technological advancements, presenting challenges and opportunities for pharmacists. However, limited literature exists on the future of pharmacy work, especially concerning technology adoption. Objective: This exploratory study investigates pharmacists' perspectives on the impact of technologies on the profession - including career security, role evolution, adjustments to changes - and the impact of the COVID-19 pandemic on technology implementation and the broader future of work in pharmacy. Method: A cross-sectional survey design was used, targeting all registered pharmacists in New Zealand. A questionnaire, adapted from Future of Work literature, was piloted and distributed to 3037 pharmacists. Data were analyzed using descriptive statistics, two-step hierarchical analysis, and content and thematic analysis. Ethics approval was obtained. Results: 177 responses met the inclusion criteria, yielding a 5.82% response rate. Respondent demographics included a lower proportion of community pharmacists and individuals of Asian ethnicity, but a higher proportion of males and hospital pharmacists compared to the national workforce. Most respondents were aged between 30 and 59 years, representing all District Health Board locations.Qualitative analysis identified two themes: 1) Factors affecting technology adoption across macro, meso and micro levels, including COVID-19's impact on work efficiency, regulatory gaps, fragmented IT and organizational infrastructures, patient safety, and attitudes at workforce and individual levels; 2) Career impacts, highlighting role expansion, job replacement fears, and the need for adaptation and upskilling. Quantitative findings indicate that early technology adopters are more prepared to learn new skills and plan their careers. Technology impact positively correlates with career planning, while job loss concerns negatively affect skill development readiness. Conclusion: The study underscores the importance of early technological adoption for readiness to acquire new skills and career planning in pharmacy. Embracing technological change, supported by regulatory and policy frameworks, is crucial for advancing the profession.

Delivering Culturally-Appropriate, Technology-Enabled Health Care in Indigenous Communities.

Indigenous health is becoming a top priority globally. The aim is to ensure equal health opportunities, with a focus on Indigenous populations who have faced historical disparities. Effective health interventions in Indigenous communities must incorporate Indigenous knowledge, beliefs, and worldviews to be culturally appropriate.

Potentially inappropriate medications and potential prescribing omissions in hospitalised older adults in New Zealand: A retrospective study.

OBJECTIVE: Medication errors can have detrimental effects on patient outcomes, yet there are limited data on the prevalence of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) among older adult inpatients in New Zealand (NZ). This study investigated exposure to PIMs and PPOs in older adults in a New Zealand hospital. METHODS: Electronic medical records of 846 older adults (≥ 65 years) discharged from the Auckland District Health Board between June 2020 and May 2021 were retrospectively reviewed to extract data on sociodemographic, medication and diagnostic information. STOPP/START version 2 was used to evaluate PIMs and PPOs on admission and discharge. RESULTS: The mean age was 77.47 ± 8.12 years, and 51% were female. On admission, 48% had ≥1 PIMs and 40% had ≥1 PPOs. On discharge, 45% had ≥1 PIMs and 40% had ≥1 PPOs. Increasing age (adjusted odds ratio [AOR] = 1.02, 95% CI [confidence interval] 1.01, 1.04), number of medicines (AOR = 1.23, CI 1.17, 1.29) and 28-day admission history (AOR = 1.58, CI 1.15, 2.18) were associated with higher odds of PIMs use on admission. At discharge, the number of medicines (AOR = 1.19, CI 1.13, 1.25) and history of readmission (AOR = 1.47, CI 1.08, 2.02) were associated with higher odds of PIMs. Female patients had higher odds of PPOs both on admission (AOR = 1.35, CI 1.02, 1.78) and discharge (AOR = 1.34, CI 1.01, 1.78). Maori, Asian and Pacific patients were more likely to have prescribing omissions compared to NZ Europeans. CONCLUSIONS: Prescribing omissions and inappropriate medications were common in older inpatients. There were differences observed between different ethnic groups, with NZ Europeans having fewer omissions than other ethnic groups. These findings highlight key opportunities for health-care providers to improve medication use in older adults in NZ.

Living with gout in New Zealand: an exploratory study into people's knowledge about the disease and its treatment.

BACKGROUND: In New Zealand, gout disproportionately affects Maori and Pacific people who also experience symptoms at an earlier age. Gout occurs predominantly in men and is associated with cardiovascular disease, diabetes, and renal disease. The impact on daily social activities, family, and work is enormous, and many people remain inadequately treated. OBJECTIVES: The objectives of this study were to explore the knowledge and perceptions of people with gout toward the disease and to determine the impact gout has on lifestyle including possible barriers to treatment. METHODS: Sixty people with gout from the Auckland and Waikato regions of New Zealand were invited to participate in 30-minute semistructured interviews. The data were analyzed using a general inductive thematic approach. RESULTS: Although 85% of participants were aware of dietary triggers of gout, these were not always avoided. Less than 50% knew something about how their medicines worked, and only 33% knew which medicines to use both acutely and chronically. The negative impact of gout episodes was noted through the number participants unable to work or participate in family activities. Healthcare professionals were not always the main source of information, which is an area that could be developed to improve knowledge about gout. CONCLUSIONS: There were substantial gaps in the knowledge about gout and its causes and management. All healthcare providers could help identify patients with suboptimal knowledge and improve the management of gout.

Exploring community pharmacists' clinical decision-making using think aloud and protocol analysis.

BACKGROUND: Clinical decision-making (CDM) is the dynamic process used to gather, interpret and evaluate data to select an evidence-based choice of action. As the role of the pharmacist becomes more patient-focused, effective CDM skills are increasingly vital to achieve patient outcomes centred on quality, safety and efficacy. OBJECTIVE: To examine how community pharmacists reason through a clinical problem and what factors assist or hinder decision-making. METHOD: Fifteen New Zealand registered community pharmacists in central Auckland were presented with a bacterial conjunctivitis case. Think Aloud and protocol analysis were employed to examine pharmacists' cognitive processes when working through the case. Factors that affect CDM were explored through semi-structured interviews and analyzed using thematic analysis. RESULTS: Pharmacists used pattern recognition and analytical reasoning to diagnose and recommend treatment. Three main factors affecting CDM were: 1. community pharmacy environment, where pharmacy size and layout prevented patient privacy; 2. clinical knowledge, which was outdated and limited by poor access to up-to-date resources; and 3. patient factors, where CDM was affected by time, patient's attitudes, and language barriers. When uncertain, pharmacists typically referred patients to their GP to ensure patient safety and believed offering treatment was not within their scope of practice. CONCLUSION: Pharmacists used dual processing when encountering a familiar case. Further research is required to explore how pharmacists apply CDM when exposed to less familiar, more complex cases presenting greater ambiguity. Barriers in community pharmacy deter effective CDM skills and could inhibit community pharmacists from fulfilling their expanding role within the modern healthcare system.

The Impact of a Pharmacist-Led Intravenous to Oral Switch of Metronidazole: A Before-and-After Study.

(1) Background. Intravenous (IV) to oral switch (IVOS) of antibiotics can reduce the length of hospitalisation, risk of IV catheter complications, and hospital costs. Pharmacists can play an instrumental role in implementing an IVOS initiative. The aim of this study is to evaluate the impact of pharmacist-led IVOS of metronidazole. (2) Method. This was an observational study conducted in a New Zealand hospital. During a 3-month intervention period, pharmacists identified patients receiving IV metronidazole; then initiated an IVOS for patients who met the criteria. The comparator groups were patients who were not switched by pharmacists in the post-intervention (post-IVOS) group, or patients treated with either IV or oral metronidazole prior to the intervention (pre-IVOS). Primary outcome measures were switch rate and duration of IV metronidazole treatment. Secondary outcome measures were readmission and/or repeat surgery within 90 days of discharge and the length of hospital stay. (3) Results. In total, 203 patients were included: 100 in the pre-IVOS and 103 in the post-IVOS groups. Pharmacists switched 63/93 (67.7%) of eligible patients to oral metronidazole in the post-IVOS period. Only 9/89 (10.1%) of IVOS eligible patients were switched in the pre-IVOS group. In the post-IVOS group, the mean duration of IV metronidazole treatment in patients switched by pharmacists was shorter than in those who were not switched by pharmacists (2.5 ± 2.8 days vs. 4.8 ± 5.9 days, p = 0.012). No significant difference was found in readmission or repeat surgery within 90 days of discharge for patients switched by pharmacists versus patients who were not switched by pharmacists. (4) Conclusion. Our data have demonstrated successful implementation of the hospital-approved pharmacist-led IVOS service.

Niosomal Nanocarriers for Enhanced Dermal Delivery of Epigallocatechin Gallate for Protection against Oxidative Stress of the Skin.

Among green tea catechins, epigallocatechin gallate (EGCG) is the most abundant and has the highest biological activities. This study aims to develop and statistically optimise an EGCG-loaded niosomal system to overcome the cutaneous barriers and provide an antioxidant effect. EGCG-niosomes were prepared by thin film hydration method and statistically optimised. The niosomes were characterised for size, zeta potential, morphology and entrapment efficiency. Ex vivo permeation and deposition studies were conducted using full-thickness human skin. Cell viability, lipid peroxidation, antioxidant enzyme activities after UVA-irradiation and cellular uptake were determined. The optimised niosomes were spherical and had a relatively uniform size of 235.4 ± 15.64 nm, with a zeta potential of -45.2 ± 0.03 mV and an EE of 53.05 ± 4.46%. The niosomes effectively prolonged drug release and demonstrated much greater skin penetration and deposition than free EGCG. They also increased cell survival after UVA-irradiation, reduced lipid peroxidation, and increased the antioxidant enzymes' activities in human dermal fibroblasts (Fbs) compared to free EGCG. Finally, the uptake of niosomes was via energy-dependent endocytosis. The optimised niosomes have the potential to be used as a dermal carrier for antioxidants and other therapeutic compounds in the pharmaceutical and cosmetic industries.

Investigating the Usability, Efficacy and Accuracy of a Medication Entering Software System for a Healthcare Robot.

Purpose: This research aimed to evaluate medication software for a healthcare robot. Study I compared two software versions (RoboGen and RoboGen2) for system usability, speed and accuracy of medication entry; Study II evaluated system usability and community pharmacists' views of RoboGen2. Methods: Study I had a within-subjects experimental design and recruited 40 Health Sciences students to enter different, comparable sets of prescriptions into the two systems, in randomized order, within a limit of 15 min. Screen activity was recorded to observe prescription errors. Study II had a cross-sectional observational design and recruited 20 community pharmacists using convenience sampling. Pharmacists entered three prescriptions using RoboGen2. Participants in both studies completed the System Usability Scale (SUS) following each task. Study I participants completed a questionnaire on system preference, and Study II participants a semi-structured interview. Results: Study I participants preferred Robogen2 (p < 0.001) due to its sleek and modern layout, good flow, ease of use, and intuitive design. SUS scores [t (40) = -3.40, p = 0.002] and speed of medication entry favored Robogen2 (t = 3.65, p < 0.001). No significance was found in accuracy (t = 1.12, p = 0.27). In study 2, pharmacists rated the usability of RoboGen2 below average. Themes from interviews were navigation and streamlining the system, ease of use, and integration with pharmacy software systems. Conclusion: Adding safety features and better aesthetics can improve the usability and safety of a medication prescription system. Streamlining workflow and pre-populating data can increase speed of prescription entry without compromising patient safety. However, a better approach is integration with pre-existing pharmacy systems to reduce workload while incorporating safety features built into existing dispensing systems.

Assessing antibiotic prescribing in nurse practitioners: Applied cognitive task analysis.

Background: Prescribing antibiotics is a demanding and complex task where decision-making skills are of critical importance to minimize the risk of antimicrobial resistance. Despite its importance, little is known about the decision-making skills and cognitive strategies new Nurse Practitioners (NPs) use when prescribing antibiotics. Objective: To identify the cognitive demands of antibiotic prescribing complexity and to explore the cognitive strategies that new NPs in New Zealand use when prescribing antibiotics. Design: A qualitative approach using Applied Cognitive Task Analysis (ACTA) methodology. Participants: A purposive sample was recruited consisting of five NPs who had been registered within the last five years and were prescribing antibiotics as part of their scope of practice. Methods: In-depth face-to-face interviews consisting of a task diagram interview and a knowledge audit were conducted and analyzed following the ACTA protocol. Results: Four cognitive elements were identified from the data which showed the cognitive demands of prescribing antibiotics, and the cues and strategies NPs use for safe practice. These were: 1 prescribing in the face of uncertainty (complex patients and diagnostic uncertainty); 2 making clinical decisions with insufficient/poor guidance (lack of guidelines, conflicting information); 3 producing an individualized treatment plan in view of clinical and non-clinical patient factors (patient demand/expectation, inadequate patient education, risks versus benefits of antibiotic treatment); 4 ensuring treatment efficacy and continuity of care (ineffective treatment, patient care follow up). Conclusion: The ACTA framework has given insight into the current antibiotic prescribing practice of new NPs, identifying areas where professional development courses and treatment resources can be targeted to support antibiotic prescribing. NPs are likely to benefit from resources that are freely available and reflect national or local antimicrobial data. Further work is also warranted to determine whether targeted education resources and clinical pathways will help with diagnostic uncertainty, and how this could be embedded into existing curricula.

Advanced carrier systems in cosmetics and cosmeceuticals: a review.

Carrier systems refer to carrier vesicles such as liposomes, nano/microparticles, emulsions, etc., that are coupled with active agents and applied to products to achieve the promoted effects of the active ingredients. This article reviews the recent research on carrier systems, focusing on cosmetic and cosmeceutical applications; the pros and cons of each carrier system and products on the market utilizing the technologies are discussed.

Primary medication non-adherence to analgesics and antibiotics at Counties Manukau Health Emergency Department.

AIM: To measure primary medication non-adherence to antibiotics, paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) in patients discharged from Counties Manukau Health Emergency Department (CMH-ED). METHOD: A retrospective observational study based on 1,600 discharged patients' data collected between 28 April-6 May and 28 July-9 August 2014. Data were included for patients who were residents within the Auckland Regional Public Health Service boundaries, presented to CMH-ED and were discharged with a prescription. RESULTS: Of 992 patients, 48.5% did not have at least one medication on their discharge prescription filled. Patients were mostly born in New Zealand (66.5%), of Pacific Island descent (42.8%), living in the most socioeconomically deprived areas (78.1%) and under 10 years of age (32.6%). Filling rates significantly increased with >1 prescribed item (p≤0.01). NSAIDs were significantly more likely to be filled compared with paracetamol (59.9% vs 51.3%, p=0.034); antibiotics were significantly more likely to be filled than all other medicines (80.4%, p<0.001). The most significant predictors for non-adherence when accounting for number and types of medications were patients 10-44 years (p<0.05) and smokers (p<0.01). CONCLUSIONS: Age, smoking and number of prescribed medications were predictors of non-adherence to medication type. Further research is warranted to assess whether changes to prescription co-payments affect the rate of nonadherence.

Utilising te Tiriti o Waitangi to approach health intervention development and research: pharmacist-facilitated medicines review interventions for Maori older adults.

INTRODUCTION te Tiriti o Waitangi guarantees Maori the right to: self-determination, equitable health outcomes, be well informed, health care options, including kaupapa Maori and culturally safe mainstream services, and partnership in the health care journey. Despite integration of these principles into policy, there remains a lack of application in health service development, and health inequities remain. AIM We aimed to use te Tiriti o Waitangi to structure the development of a culturally safe health intervention, using as an exemplar pharmacist-facilitated medicines review for Maori older adults. METHODS Previous research undertaken by our group (a systematic review, and interviews with stakeholders including Maori older adults) was used to inform the aspects to include in the intervention. Kaupapa Maori theory was used to underpin the approach. Intended outcomes, requirements for change, and outcome measures to assess change were mapped to te Tiriti o Waitangi principles as a way to structure the pharmacist-facilitated medicines review intervention and research processes. RESULTS Findings from our previous research identified 12 intended intervention outcomes, including that the intervention be flexible to adapt to diverse needs in a way that is acceptable and culturally safe for Maori and that it supports Maori older adults to control and have confidence in their medicine treatment and wellbeing. DISCUSSION We present an approach to the development of a pharmacist-facilitated medicines review intervention for Maori older adults, structured around the principles of te Tiriti o Waitangi, to support the implementation of a culturally safe, pro-equity intervention.

Ethnic Variations in the Quality Use of Medicines in Older Adults: Maori and Non-Maori in Aotearoa New Zealand.

In Aotearoa New Zealand (NZ), ethnic inequities in health outcomes exist. Non-Maori experience better access to healthcare than Maori, including access to the quality use of medicines. Quality medicines use requires that medicines provide maximal therapeutic benefit with minimal harm. As older adults are more at risk of harm from medicines, and, because inequities are compounded with age, Maori older adults may be at more risk of medicines-related harm than younger and non-Maori populations. This narrative review examined ethnic variation in the quality use of medicines, including medicines utilisation and associated clinical outcomes, between Maori and non-Maori older adult populations in NZ. The review was structured around prevalence of medicine utilisation by medicine class and in particular disease states; high-risk medicines; polypharmacy; prevalence of potentially inappropriate prescribing (PIP); and association between PIP and clinical outcomes. 22 studies were included in the review. There is ethnic variation in the access to medicines in NZ, with Maori older adults often having reduced access to particular medicine types, or in particular disease states, compared with non-Maori older adults. Maori older adults are less likely than non-Maori to be prescribed medicines inappropriately, as defined by standardised tools; however, PIP is more strongly associated with adverse outcomes for Maori than non-Maori. This review identifies that inequities in quality medicines use exist and provides a starting point to develop pro-equity solutions. The aetiology of inequities in the quality use of medicines is multifactorial and our approaches to addressing the inequitable ethnic variation also need to be.

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

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.

Clinical expertise, advocacy and enhanced autonomy - Acceptability of a pharmacist-facilitated medicines review intervention for community-dwelling Maori older adults.

Background: Pharmacist-facilitated medicines reviews are effective at identifying medicines-related problems and can improve the appropriate use of medicines in older adults. Current services in Aotearoa New Zealand (NZ) are not developed specifically for Maori (Indigenous people of NZ) and may increase health disparities between Maori and non-Maori. We developed a medicines review intervention for and with Maori older adults, and tested it in a feasibility study. Objective: To assess patient acceptability of a pharmacist-facilitated medicines review intervention for Maori older adults. Methods: The intervention consisted of a medicines education session (pharmacist and participant) and an optional medicines optimisation session (pharmacist, participant, and prescriber). Participant acceptability was assessed post-intervention using a structured telephone interview developed specifically for this study. Participants responded to statements using a five-point Likert scale (strongly agree-strongly disagree; numerical analysis/reporting) which focused on the topics of power/control, support mechanisms, intervention content and delivery, and perceived usefulness. Open-ended questions relating to the intervention value and suggestions for improvement were analysed using general inductive analysis. Results: Seventeen participants took part in the feasibility study from December 2019-March 2020 and all completed the acceptability interview. Participants perceived the intervention content and mode of delivery to be appropriate, and that their power and control over their medicines and health improved and as did their confidence in self-management. Five themes were generated: medicines knowledge from a trusted professional, increased advocacy, 'by Maori, for Maori', increased confidence and control, and financial and resource implications. Conclusion: A pharmacist-facilitated medicines review intervention for Maori older adults developed by Maori, for Maori, was acceptable to patient participants. Participants valued the clinical expertise and advocacy provided by the pharmacist, and the increase in medicines knowledge, control and autonomy. Participants wanted the service to continue on an ongoing basis.

Feasibility of a pharmacist-facilitated medicines review intervention for community-dwelling Maori older adults.

Background: Pharmacist-facilitated medicines review services have been postulated as a way to address current inequities in health outcomes between Maori and non-Maori. These interventions have been shown internationally to improve the appropriate use of medicines but remain underutilised in Aotearoa New Zealand (NZ). By reviewing the literature and engaging with key stakeholders, we developed an intervention, which included collaborative goal-setting, education and medicines optimisation, for testing in a feasibility study. Objective: To determine the feasibility (recruitment, intervention delivery, and data collection methods) of a pharmacist-facilitated medicines review intervention for Maori older adults, and proposed intervention outcomes. Methods: This study was reported in accordance with the CONSORT 2010 statement: extension to randomised controlled pilot and feasibility trials and the Consolidated criteria for strengthening reporting of health research involving indigenous peoples: the CONSIDER statement. Participant eligibility criteria were: Maori; aged 55-plus; community-dwelling; enrolled in a general practice in Waitemata District Health Board (Auckland, NZ). Consented participants engaged in a medicines education component (participant and pharmacist) and an optional medicines optimisation component (participant, pharmacist and prescriber). Outcomes measures included: the feasibility of data collection tools and methods, time taken to conduct the intervention and research processes; medicines knowledge, medicines appropriateness and quality of life (QoL); pharmacist recommendations and prescriber acceptance rate. Results: Seventeen consented participants took part in the intervention from December 2019-March 2020 with the majority (n = 12) recruited through general practice mail-outs. Data collection was feasible using the predetermined outcome measure tools and was complete for all patient participants. Pharmacist intervention delivery was feasible. A mean of 9.5 recommendations were made per participant with a prescriber acceptance rate of 95%. These included non-medicine-related recommendations. Conclusion: The feasibility testing of pharmacist-facilitated medicines review intervention developed for (and with) community-dwelling Maori older adults allows for intervention refinement and can be utilised for further studies relating to pharmacist services in primary care.