Translating research into a relevant education activity to fulfil pharmacists' continuing professional development requirements.

Background: In New Zealand (NZ), provision of culturally safe care by pharmacists is mandated, including an expectation of understanding issues relevant to Maori, the Indigenous people of NZ, yet there are few pharmacy-specific resources to support attainment. Objectives: To: i) test whether a research-informed education activity (short video summarising research findings plus reflective exercises) meets NZ pharmacists' annual continuing professional development requirements including those relating to culturally safe care ii) identify suggested improvements to the education activity; and iii) identify individual pharmacists' proposed actions in response to reflection prompted by the education activity. Methods: Previous research was utilised to develop an education activity (short, animated research summary video and reflective questions). Participants (NZ-registered pharmacists or intern pharmacists) were asked to watch the video and respond to questions online related to perceived relevance and usefulness of the video to informing practice and meeting CPD requirements. Simple descriptive analysis (quantitative data) and general inductive thematic analysis (qualitative data) were applied to the research data. Results: Thirty-three people participated from Nov-Dec 2022. Most participants said the video was relevant/very relevant to practice (91%), that the reflective exercise was very or extremely useful (100%) and that it met their CPD requirements as relevant to cultural safety (100%). Conclusion: The education activity appeared to be an appropriate and relevant for CPD and was seen to be concise and exposed ideas in a logical and succinct manner with the potential to benefit the populations receiving care from these providers.

A realist evaluation of the development of extended pharmacist roles and services in community pharmacies.

BACKGROUND: Internationally, community pharmacy models of care have been moving away from a focus on dispensing to extended, clinically-focused roles for pharmacists. OBJECTIVES: To identify how community pharmacy strategies were being implemented in Aotearoa New Zealand; how changes were expected to influence health and health system outcomes; what extended services were being delivered; the responses of pharmacists, other health professionals and consumers to these developments; and the contexts and mechanisms supporting the successful implementation of new community pharmacy services. METHODS: A realist evaluation methodology was employed, to explore a complex policy intervention. Realist evaluation explores the contexts (C) within which initiatives are introduced and identifies the mechanisms (M) triggered by different contexts to produce outcomes (O). Realist evaluation processes iteratively develop, test, and refine CMO configurations. In this study, initial programme theories were developed through key government and professional policy documents, then refined through key informant interviews, a survey and interviews with pharmacists and intern (pre-registration) pharmacists, and finally, 10 case studies of diverse community pharmacies. RESULTS: Four intermediate health service outcomes were identified: development of extended community pharmacist services; consumers using extended community pharmacist services; more integrated, collaborative primary health care services; and a fit-for-purpose community pharmacy workforce. Enabling and constraining contexts are detailed for each outcome, along with the mechanisms that they trigger (or inhibit). CONCLUSIONS: There are wide-ranging and disparate levers to support the further development of extended community pharmacy services. These include aligning funding with desired services, undergraduate educators and professional leaders setting expectations for the pharmacists' role in practice, and the availability of sufficient funding and time for both specific extended service accreditation and broader postgraduate training. However, no simple "fix" can be universally applied internationally, nor even in pharmacies within a single jurisdiction, to facilitate service development.

Enacting Mana Maori Motuhake during COVID-19 in Aotearoa (New Zealand): "We Weren't Waiting to Be Told What to Do".

Maori, the Indigenous people of Aotearoa (New Zealand), were at the centre of their country's internationally praised COVID-19 response. This paper, which presents the results of qualitative research conducted with 27 Maori health leaders exploring issues impacting the effective delivery of primary health care services to Maori, reports this response. Against a backdrop of dominant system services closing their doors or reducing capacity, iwi, hapu and ropu Maori ('tribal' collectives and Maori groups) immediately collectivised, to deliver culturally embedded, comprehensive COVID-19 responses that served the entire community. The results show how the exceptional and unprecedented circumstances of COVID-19 provided a unique opportunity for iwi, hapu and ropu Maori to authentically activate mana motuhake; self-determination and control over one's destiny. Underpinned by foundational principles of transformative Kaupapa Maori theory, Maori-led COVID-19 responses tangibly demonstrated the outcomes able to be achieved for everyone in Aotearoa when the wider, dominant system was forced to step aside, to be replaced instead with self-determining, collective, Indigenous leadership.

Designing for health equity: A mixed method study exploring community experiences and perceptions of pharmacists' role in minor ailment care.

BACKGROUND: Minor ailments are self-limiting, easily diagnosable and treatable conditions. Funded pharmacist minor ailments services (PMAS) have been posited to improve medicines access equity and, despite ethnic minorities across the globe experiencing reduced access to medicines and health care, PMAS internationally have not explicitly centered ethnic equity in service design or outcome measurement. OBJECTIVE: To explore Maori experiences of minor ailments care and perceptions of the pharmacists' role. METHODS: This mixed methods study collected data through facilitated wananga (collaborative knowledge-sharing group discussions). Eligible participants (Maori, 18 years plus, obtained medicine from pharmacy in last 3 years) were recruited through local pharmacist networks using convenience sampling. Wananga included qualitative data collection through discussion using a topic guide and a quantitative questionnaire. Indigenous theory was applied within a general inductive approach to thematic development to analyze qualitative data. Quantitative data was reported using simple descriptive statistics. RESULTS: Thirteen wananga (3 in-person, 10 online) were conducted from September 2021-February 2022 with 62 participants from seven New Zealand regions. The minor ailments that participants were most likely to seek treatment from pharmacy first, instead of a doctor, were eczema (87.2%), coughs and colds (85.7%), headlice (85.7%), insect bites (83.9%), and hayfever (83.9%). Four themes were generated from the qualitative data: designing the right environment for minor ailment care; clinically and culturally safe care; moving from stigmatizing to strengths-based services; the benefits of PMAS. Participant-informed ideas for PMAS service development centered on Maori aspirations included: developing clinically and culturally safe pharmacy environments, enabling medicine supply outside of the physical pharmacy setting, avoiding stigmatizing language when promoting PMAS availability, and collaborative practice with other health providers. CONCLUSION: This study provides important recommendations when developing PMAS to increase the likelihood of delivering equitable care, and has international application across multiple pharmacy and health service settings.

Maori, pharmacists, and medicines adherence - A mixed methods study exploring indigenous experiences of taking medicines 'as prescribed' and mechanisms of support.

Background: Medicines are the most common medical intervention and medicines adherence is associated with improved clinical outcomes. Understanding drivers and experiences of medicines adherence is important for optimising medicines use. Maori (Indigenous people of Aotearoa New Zealand) experience inequities in access to medicines yet little evidence exists regarding Maori and medicines adherence, or the role of pharmacists in supporting medicines adherence for Maori. Objectives: To explore Maori experiences of medicines adherence and non-adherence, and pharmacists' role in supporting adherence. Methods: This was a convergent parallel mixed methods study. Facilitated wananga (collaborative knowledge-sharing group discussions) were undertaken either online or in-person with eligible participants, using convenience and snowball sampling to recruit. Participants were eligible if they were Maori, 18 years or older, and had recently obtained medicine from a pharmacy. Wananga involved semi-structured interviewing and questionnaire completion. General inductive coding and thematic analysis and descriptive statistical analysis were used respectively, and findings were situated in social, cultural and political Maori contexts. Results: Thirteen wananga were conducted with 62 participants (71% female, median age range 35-44) from September 2021 to February 2022. Four themes were identified: The aspirations of hauora Maori (Maori wellbeing) - medicines as a component of holistic wellbeing; whanaungatanga (relationships); knowledge; and whanau (family and support network) advocacy and problem solving. Forgetting to take medicines was the most frequently identified reason for non-adherence, followed by not having medicines on hand, adverse effects, and lack of symptoms of health conditions. Participants identified that proactive pharmacist support, including developing caring therapeutic relationships, sharing knowledge, acknowledging medicines as just one component of holistic wellbeing, and giving adherence tips to support routine medicine taking were positive ways that pharmacists could support medicines adherence. Conclusions: Factors contributing to medicines adherence were diverse and participants identified numerous practical solutions that pharmacists, health service providers and policymakers could employ to support Maori medicines adherence.

He Wananga Whakarite: preparing Maori for surgical selection interviews.

BACKGROUND: Maori are significantly under-represented in the surgical workforce in Aotearoa New Zealand. There needs to be more effort and initiative action to address this lack of diversity in order to ultimately achieve proportionality so that more Maori surgeons are available to help treat and care for their communities. METHODS: An independent kaupapa Maori wananga (course) initiative, using a 'by Maori, for Maori' approach, and adhering to tikanga Maori (Maori lore and protocols) was developed to support and prepare Maori Non-Training Surgical Registrars for the Royal Australasian College of Surgeons Surgical Education and Training (SET) interviews. This paper reviews the inception of the wananga, its content, and shares experiences had by attendees. RESULTS: Those who attended this wananga agreed unanimously that this initiative dramatically improved their preparation for SET interviews. In 2020, the wananga produced a significant success rate amongst attendees with 80% of wananga attendees selected for SET training positions. CONCLUSION: This kaupapa Maori initiative illustrates a successful active measure that can be taken to support Maori doctors seeking selection in surgical training programmes. The initiative seeks to address inequity in the surgical workforce in Aotearoa New Zealand.