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International Journal of Clinical
Pharmacy
International Journal of Clinical
Pharmacy and Pharmaceutical Care
ISSN 2210-7703
Int J Clin Pharm
DOI 10.1007/s11096-014-0030-y
Attitudes of pharmacists to provision of
Home Medicines Review for Indigenous
Australians
Lindy Swain, Claire Griffits, Lisa Pont &
Lesley Barclay
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RESEARCH ARTICLE
Attitudes of pharmacists to provision of Home Medicines
Review for Indigenous Australians
Lindy Swain •Claire Griffits •Lisa Pont •
Lesley Barclay
Received: 27 March 2014 / Accepted: 5 October 2014
Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014
Abstract Background Home Medicines Reviews could
improve the quality use of medicines and medicines
adherence among Aboriginal people. Despite high level
of chronic disease very few Home Medicines Review are
currently being conducted for Aboriginal and Torres
Strait Islander people. Objective The aim of this research
was to explore the barriers and facilitators from the
pharmacists’ perspective for the provision of Home
Medicines Review to Aboriginal people attending
Aboriginal Health Services. Setting A cross sectional
survey was used to gather demographic, qualitative and
quantitative data from 945 Australian pharmacists
accredited to undertake Home Medicines Review.
Method The survey consisted of 39 items which included
both closed, open ended and Likert scale questions. Data
was extracted from the online survey tool and analysed.
Descriptive statistics were used to explore the quantita-
tive data while qualitative data was thematically analysed
and coded for emergent themes. Main outcome measure
Number of Home Medicines Review conducted for
Aboriginal and Torres Strait Islander patients. Results A
total of 187 accredited pharmacists responded to the
survey. They reported that barriers to Home Medicines
Review to Aboriginal patients may include lack of
understanding of cultural issues by pharmacists; lack of
awareness of Home Medicines Review program by
Aboriginal Health Service staff; difficulties in imple-
mentation of Home Medicine Review processes; bur-
densome program rules; the lack of patient–pharmacist
relationship, and the lack of pharmacist–Aboriginal
Health Service relationship. Conclusion Changes to the
medication review processes and rules are needed to
improve the accessibility of the Home Medicine Review
program for Aboriginal and Torres Strait Islander people.
Improved relationships between pharmacists and
Aboriginal health service staff, would increase the like-
lihood of more Home Medicines Reviews being con-
ducted with Aboriginal and Torres Strait Islander
patients.
Keywords Aboriginal Aboriginal and Torres Strait
Islander Aboriginal Health Service Australian Barriers
Home Medicines Review Indigenous Interprofessional
Medication adherence Medicines Medication review
Pharmacist Relationships
Impacts of findings on practice
•The access of Aboriginal Australians to home medi-
cation review needs to be improved.
•Pharmacists and their staff need assistance and training
on dealing with the Aboriginal health service and
workers.
•Government policies should support and encourage
pharmacists to conduct medication reviews for Aborig-
inal and Torres Strait Islander patients.
L. Swain (&)L. Barclay
University Centre for Rural Health, School of Public Health,
University of Sydney, 55-61 Uralba Street, Lismore, NSW 2480,
Australia
e-mail: Lindy.Swain@ucrh.edu.au
C. Griffits
Faculty of Pharmacy, The University of Sydney, Lismore, NSW,
Australia
L. Pont
Pharmacology and Clinical Pharmacy, Sydney Nursing School,
The University of Sydney, Lismore, NSW, Australia
123
Int J Clin Pharm
DOI 10.1007/s11096-014-0030-y
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Introduction
The Australian Home Medicine Review (HMR) is a profes-
sional pharmacy service that aims to achieve safe, effective
and appropriate use of medicines and to improve the health
outcomes and knowledge of medicines in participating
patients [1]. Studies show that HMRs can improve medica-
tion suitability, reduce adverse drug events, increase patient
medication knowledge and improve adherence rates [2,3].
The HMR program [1] was introduced in Australia in
2001 by the Commonwealth Government. On a referral
from the GP, an HMR trained and accredited pharmacist
will visit the patient at home, and interview the patient
about their medication and lifestyle. The pharmacist
explains the medications and provides appropriate medi-
cation information to the patient. The pharmacist then
prepares a report of their findings, using information pro-
vided by the patient, medical information provided by the
GP and the patient’s dispensing history from the pharmacy.
The accredited pharmacist reports the findings and their
recommendations to the referring GP. This report forms the
basis of the Medication Management Plan which the GP
may implement with the patient on their next visit. The GP
and pharmacist claim payment from Medicare Australia.
Indigenous Australians have poorer health, higher rates
of chronic disease and lower average life expectancy than
non-Indigenous Australians [4]. Despite a higher burden of
acute infections and chronic diseases, under-use of medi-
cines is evident in Australian Aboriginal populations [5].
Poor control of chronic disease states and subsequent
higher hospital admissions, morbidity and mortality may be
directly attributable to poor medicine management in
Indigenous communities [6].
Qualitative, interview based studies have explored per-
spectives of Aboriginal patients and Aboriginal Health
Workers (AHW) as to why medications are underutilised
by Aboriginal and Torres Strait Islander people. They have
identified lack of knowledge and understanding about
medicines and ineffective engagement with health profes-
sionals as the two biggest barriers to appropriate medica-
tion use [7–11].
Complex medicine regimens result in some Aboriginal
and Torres Strait Islander patients finding medicines con-
fusing and difficult to manage. Greater understanding and
empowerment about medicine choices seem to be likely to
improve medicine adherence [10]. Pharmacists through
cognitive pharmacy services, such as Home Medicines
Review, have an opportunity to build relationships,
increase patients’ knowledge about their medicines, and
assist Aboriginal and Torres Strait Islander patients with
medication understanding and treatment choices [10].
Aboriginal and Torres Strait Islander patients have
identified some of the reasons why the HMR program is
underutilised by Aboriginal people. These include the need
for a GP to write HMR referrals, lack of relationship with
pharmacist, the inappropriateness of a pharmacist visiting
an Aboriginal patient’s home and lack of understanding of
benefits of the HMR program [12,13].
This study explored pharmacists’ attitudes to the deliv-
ery of HMRs to Aboriginal and Torres Strait Islander
people and contributed to knowledge of the processes and
supports needed to enable increased HMR delivery to
Aboriginal and Torres Strait Islander people.
Aim
The aim of this research was to explore the barriers and
facilitators, from pharmacists’ perspectives, for the provi-
sion of HMRs and other pharmacy services to Aboriginal
people, attending the Aboriginal Health Service (AHS).
Ethical approval
Ethical approval was granted from The University of
Sydney, Human Research Ethics Committee (approval
number: 11504).
Methods
Data collection
A cross sectional survey was used to gather demographic,
qualitative and quantitative data on the barriers and facil-
itators to the provision of professional pharmacy services
and HMRs to Indigenous Australians. A literature review
and results from preliminary qualitative studies [10,13]
were used to guide the survey design.
The survey was sent to pharmacists accredited to
undertake HMRs in September 2012. At that time email
contact details were listed for 983 HMR accredited phar-
macists across Australia on the online database of the
accredited pharmacists’ credentialing body, the Australian
Association of Consultant Pharmacists [14]. The researcher
successfully contacted 945 of those listed online, with the
other 38 having incorrect email addresses. Thus, the
majority of accredited pharmacists listed were invited to
participate in the study. They were each emailed an invi-
tation to participate in the study, containing a hyperlink to
an online survey.
The survey consisted of 39 items which included both
closed, open ended and Likert scale questions. Survey
questions explored types of services provided by respon-
dents to Aboriginal Health Services (AHSs), pharmacist
attitudes to working with AHSs, and the barriers and
Int J Clin Pharm
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facilitators impacting on the provision of HMRs to
Aboriginal and Torres Strait Islander people. The respon-
dents were also asked a range of general demographic
questions. The survey was piloted on eight accredited
pharmacists, working in community pharmacy, hospital
pharmacy and academia. As a result of the pilot the
question order was changed slightly to make question
progression more relevant and the wording of one question
was altered to clarify meaning. The results of the pilot were
included in the analysis.
Interactions and relationships between pharmacists and
AHSs were explored in this study as AHSs have been
identified as playing a key facilitating role in the successful
organisation and implementation of HMRs for Aboriginal
people [13].
Data analysis
Data was extracted from the online survey tool (Survey
Monkey) and analysed using Excel 2007. Descriptive sta-
tistics were used to explore the quantitative data while
qualitative data was thematically analysed and coded for
emergent themes.
Results
This study explored the pharmacist perspective of the
provision of HMRs to Aboriginal Australians to inform
better understanding of the underutilisation of HMRs and
to gain insight into strategies for increasing HMR
provision.
Participants
Of the eligible participants, 187 pharmacists responded to
the survey, representing a response rate of 19.7 %. Not all
respondents answered all questions. Only 88 respondents
(n =88/945, 9.3 %) answered the specific questions
around working with AHS staff and conducting HMRs for
Aboriginal patients. This appears to reflect the small
sample of pharmacists who are engaged with delivering
services to AHSs.
Approximately 23 % of Australia’s pharmacists reside
and work in non-urban areas, mainly in rural areas and
their regional towns. The number of pharmacists decreases
with increasing rurality and only 1 % of Australia’s phar-
macists work in areas classified as remote [15]. Over 50 %
of the survey participants were from rural areas and
regional towns, 4 % identifying their workplace as remote,
and approximately 40 % from urban areas. The higher
level of rural than urban responses may reflect the higher
percentage of Aboriginal and Torres Strait patients in rural
and remote areas, and thus a greater interest in completion
of this survey by pharmacists in those areas.
Over 40 % of respondents were community pharmacists
and 46.7 % identified themselves as consultant pharma-
cists, thus implying that their primary occupation was to
conduct medication reviews.
Most of the respondents regularly conducted HMRs,
with over half conducting over five HMRs per month and
about a third conducting more than ten HMRs per month.
However only a quarter of respondents had conducted more
than five HMRs for Aboriginal patients in the last 3 years
and about half of respondents had not conducted any
HMRs for Aboriginal people in the last 3 years. Demo-
graphics and HMR activity of respondents is summarised
in Table 1.
Pharmacist engagement with Aboriginal Health
Services
More than half of the respondents (59.1 %, n =97/164)
indicated they worked within 30 km of an Aboriginal
Health Service . However, close to one-third of respondents
(28.7 %, n =47/164) did not know how far they were
from their local AHS. This may be indicative of limited
interaction with their local AHS.
Despite the close geographical proximity to AHSs, most
respondents and their staff (72.6 %, n =119/164) had not
Table 1 Demographic and HMR profile of respondents
Demographic Options % of respondents
Location Remote 3.7 (n =7/187)
Rural 20.3 (n =38/187)
Regional 34.8 (n =65/187)
Urban 41.2 (n =77/187)
Primary role Community pharmacy
owner
15.5 (n =29/187)
Pharmacist in charge 11.8 (n =22/187)
Community Pharmacist 12.3 (n =23/187)
Hospital Pharmacist 8.0 (n =15/187)
Consultant Pharmacist 46.0 (n =86/187)
Other 6.4 (n =12/187)
HMRs per month 0 6.7 (n =11/164)
1–4 35.4 (n =58/164)
5–10 26.2 (n =43/164)
[10 31.7 (n =52/164)
HMRs over last
3 years
For Indigenous
Australians
0 47.6 (n =78/164)
1–4 27.4 (n =45/164)
5–10 11.0 (n =18/164)
11–20 6.7 (n =11/164)
[20 7.3 (n =12/164)
Int J Clin Pharm
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visited an AHS in the previous 12 months and 55.5 %
(n =91/164) had had no contact with the AHS. For the
45 % of the respondents who had had a contact with the
AHS, the contact was most commonly by phone (47.7 %,
n=42/88). The main purpose for contact was medication
supply and dispensing queries. Their most common contact
was with the prescribing GP. Only 17 % (n =15/88) of
respondents indicated that their engagement with the AHS
related to patient medication counselling and 63 %
(n =55/88) of respondents identified that they had not
provided any Quality Use of Medicine Services to AHSs.
Thirty-two percent of respondents (n =28/88) provided
Dose Administration Aids (DAAs, often called Webster
packs) to their local AHS.
The vast majority of respondents (89.6 %, n =147/164)
indicated that they would like to have provided more ser-
vices to their local AHS. They indicated that they would
like to provide services such as HMRs (72.5 %, n =119/
164), AMS staff education (49.4 %, n =81/164) and
health promotion assistance (54.0 %, n =88/164).
The two largest barriers to working with an AHS were
identified as lack of relationship with the AHS (57.9 %,
n=95/164) and lack of financial viability for delivering
clinical services to the AHS (61.6 %, n =101/164).
Home Medicine Reviews for Aboriginal and Torres
Strait Islander people
Perceived Benefits
Respondents expressed high to very high agreement that an
HMR would result in an increased understanding of their
illness (72.7 %, n =64/88) and an increased understand-
ing of how to take medicines (84.1 %, n =74/88). Simi-
larly respondents agreed that an HMR would increase the
understanding of potential medication side effects (71.2 %,
n=62/88), improve medication adherence (69.3 %,
n=61/88), improve pharmacist-patient relationships
(77.7 %, n =66/88) and would encourage patients to ask
more questions about their medicines (68.2 %, 60/88).
Perceived Barriers
Lack of GP referrals (74.7 %, n =121/164), lack of
pharmacist time (40.5 %, n =66/164) and low financial
viability (16.6 %, n =27/164) were seen as barriers to
delivery of HMRs to all population groups.
Barriers to delivery of HMRs to Aboriginal patients also
included difficulties in organising HMR interviews
(57.4 %, n =51/88) and lack of understanding of cultural
issues (49.4 %, n =43/88). Over half the respondents
(52.8 %, n =47/88) also had a perception that Aboriginal
patients may not want ‘‘a stranger in their home’’ and
53.4 % (n =47/88) expressed some concern that the lack
of an existing patient-pharmacist relationship could cause a
barrier to the delivery of HMR services to Aboriginal
patients. By far the biggest perceived barrier (79.5 %,
n=70/88) was lack of awareness of the HMR program by
GPs and AHS staff. Barriers to the provision of HMRs for
Aboriginal patients are summarised in Table 2.
Respondents who had conducted an HMR with an
Aboriginal patient identified that the GP was responsible
for organising the majority of the referrals (77.5 %,
n=69/88) while the pharmacist was responsible for
organising the majority of the interviews (74.2 %, n =66/
88). Difficulty organising an HMR referral was rated, by
the majority of respondents to have a high or very high
impact on the provision of HMRs. A few respondents
comments indicated that they felt some GPs did not highly
rate HMRs. ‘‘Prescribers do not see the benefit in a HMR
and may not feel a pharmacist can add any more insight
than themselves’’.
Just over half of the respondents (56.1 %, n =92/164)
identified lack of professional relationships with their local
AHS as the greatest barrier to providing professional
pharmacy services to Indigenous communities. The phar-
macy-AHS relationship was identified by 39.0 % (n =64/
164) of the respondents to highly or very highly impact on
their ability to provide services to the AHS.
Other barriers to HMR delivery to Aboriginal patients
were also suggested by respondents in their answers to the
open-ended qualitative questions. These included, difficulty
Table 2 Respondents’ perceptions of barriers to the provision of
HMRs to Aboriginal and Torres Strait Islander patients
Respondent perceptions
(n =164)
Percentage of respondents
Not at
all
Small to
moderate
degree
High to
very
high
degree
Lack of awareness of HMRS by
GPs/AHSs
6.8 38.6 54.5
Organising an HMR referral 15.9 39.8 44.3
Lack of patient interest 14.8 57.9 27.3
Patient not wanting a stranger in
their home
20.5 53.4 26.1
Difficulties in organising
appointments
13.6 62.5 23.8
Liaising with AHW/AHS 31.0 49.4 19.5
Understanding cultural issues 19.5 60.9 19.5
Liaising with patient’s doctor 30.7 47.7 19.3
Effectively communicating with
patient s
28.7 54.0 17.2
Providing feedback to patient 28.7 63.2 8
HMR Home Medicines Review, AMS Aboriginal Medical Service
Int J Clin Pharm
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allocating time for HMRs due to current work commitments,
difficulty coordinating pharmacy opening times and visits to
the AHS, excessive amounts of paper work, restrictive
program rules and inconsistent HMR demand.
While some respondents indicated that they felt visiting
Aboriginal patients’ homes was not always culturally
appropriate, most of the HMRs (83 %, n =73/88) that had
been conducted by respondents had been performed in the
home of the patient, and were by appointment (88.6 %,
n=78/88), as per the HMR program regulations. However
a few respondents indicated that as regulations make it very
difficult to conduct HMRs in a venue other than the home
that many patients were opting not to use the service.
By far the main barrier to doing HMRs in this area is
the unwillingness of Aboriginal people to have visi-
tors in their homes. The only viable method of doing
HMRs for Aboriginal people in this community is on
an opportunistic basis in the pharmacy. But this is not
allowed.
The majority of respondents (69.5 %, n =114/164)
indicated that they had never received any form of cultural
awareness training or training relating to Aboriginal health
or engagement with Aboriginal patients. Approximately
half (49.4 %, n =43/88) of respondents felt that their lack
of understanding of cultural issues impacted to a moderate
to high degree on their ability to conduct HMRs for
Aboriginal patients.
Facilitators to HMR
Greater involvement of AHS staff in the HMR process was
seen as a facilitator for HMR delivery to Aboriginal
patients. Although AHWs played no role in close to half of
the HMRs (46.6 %, n =41/88) which had been conducted
with Aboriginal patients study participants expressed their
desire for greater AHW or AHS nurse involvement, stating.
‘‘ It would be great to have the nurse and a health
worker present during interview and involved in
follow-up discussions, especially regarding disease
management and continuity of care.’’
When AHWs were involved in HMRs it was to liaise
with pharmacists and patients (38.6 %, n =34/88), to help
organise HMR (22.7 %, n =20/88), to help in the follow
up process (17 %, n =15/88) or to act as an interpreter
(10.2 %, n =9/88).
The majority of respondents (90.8 %, n =79/88)
believed that allowing an AHW or AHS nurse to write
HMR referrals would facilitate more HMRs being per-
formed for Aboriginal patients, especially when GPs were
time poor and where there was high reliance on locum GPs.
Participants commented that.
The GPs want more HMRs done but don’t want to
have to do all the paperwork. It would be great if
AHWs and nurses could write the referrals as they
know which patients would benefit and usually have
more time than the GPs.
Most respondents felt that it was appropriate for AHS
nurses and AHWs to be involved in the referral process as
‘‘the nurses and AHWs are closer to the patient and are
more likely to identify medicine issues.’’
A small number of respondents reflected the opinion
‘‘working at the AHS would be a great job. I could make a
real difference. It is a pity that there is no funding to
support this.’’
Discussion
Although the respondents in this study were HMR
accredited pharmacists who conducted regular HMRs, over
70 % of respondents had conducted fewer than five HMRs
for Aboriginal people in the last 3 years. These findings
endorsed those in earlier government reports which iden-
tified that very few HMRs have been performed for
Aboriginal and Torres Strait Islander people [16,17]. In
2013 approximately 107,000 HMRs were conducted across
Australia [18]. However, there are no available statistics on
how many of these were conducted for Aboriginal and
Torres Strait Islander people.
More than half of the respondents had no contact with
their AHS and very few had been involved in Aboriginal
patient interaction, yet many of the pharmacists who par-
ticipated in this study wanted to interact with their local
AHS and staff. This reflects similar studies which indicate
that pharmacists are keen to work more closely with
mainstream GP practices and deliver inter-professional
healthcare, yet are unsure as to how to facilitate the process
[19,20]. Studies have found that pharmacists are not
confident in clinical decision making, largely due to per-
sonality type and professional training [21–23]. More
investigation is needed to explore whether these factors
influence pharmacists’ ability to engage with other health
professionals and build relationships with other primary
health care organisations.
The respondents expressed an interest in delivering
clinical services to the AHS if they could make the services
financially viable. Respondents expressed the need for a
suite of services for which they could be remunerated or
the need for salaried position within an AHS or GP practice
to enable viability, sustainability and relationship building.
Currently the HMR program is the only clinical service in
Australia for which a pharmacist can claim financial
reimbursement from the Government.
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Pharmacists received $194.07 (AU) remuneration for an
HMR service (in 2014) [1] but have suggested in this study
and in other evaluations that HMRs are not financially
viable due to the large amount of time required for HMR
administrative costs [16,17]. This lack of financial via-
bility is exacerbated when the pharmacist has to travel
large distances to patients’ homes, especially in rural areas;
when a pharmacist has to apply for a prior approval so that
they can conduct an HMR outside a patient’s home; when a
patient has multiple co-morbidities, multiple health care
providers and complex medication regimens [24].
Discussions between the Pharmacy Guild of Australia
and the Australian Department of Health have commenced
in preparation for negotiation of the Sixth Community
Pharmacy Agreement (6CPA) by July 2015. These 5 year
Community Pharmacy Agreements provide remuneration
and guidelines to around 5,000 community pharmacies for
the dispensing of Pharmaceutical Benefit Scheme subsi-
dised medicines and the provision of pharmacy programs
and services. Revised remuneration levels and program
rules for HMR will be stipulated in 6CPA and it is hoped
that this study may influence policy makers that current
remuneration levels for clinical services are inadequate and
unsustainable. Pharmacy educators, organisations and
policy makers also need to be working with the Australian
Government to develop service delivery models where
pharmacists are remunerated for working in inter-profes-
sional primary health care settings, such as AHSs.
The majority of respondents found the main barrier to
delivery of clinical services, such as HMR to Aboriginal
patients, was their lack of relationship with the AHS,
despite dispensing and supplying DAAs, to the AHS and its
patients. This lack of relationship with the AHS may reflect
the lack of training of pharmacists in Aboriginal health and
cultural awareness. The National Australian Pharmacy
Student Association conducted a survey of students in 2012
which showed that students felt it was important to be
taught about Aboriginal and Torres Strait Islander health
issues yet many pharmacy school curricula include very
little or no content on Aboriginal health or cultural
awareness [25]. Respondents in this study indicated that
they would like more education in issues of Aboriginal
health and cultural awareness.
This study will be used to inform pharmacy schools of the
need for increased cultural awareness training and Aborig-
inal Health education for pharmacy students. As a result of
this study the main author is commencing work with the
Pharmaceutical Society of Australia to develop a guide and a
series of workshops for Australian pharmacists which will
assist them to be culturally responsive practitioners and
assist them to engage with Aboriginal Health Services.
The respondents in this study, similar to other HMR
studies with non-Indigenous Australians [26,27] indicated
that two significant barriers to HMR program uptake were
lack of awareness of the program by health professionals
and lack of GP referrals. Studies have also found that some
GPs often do not value the role of pharmacists in per-
forming medication management review [16,17]. Research
has also suggested that due to time constraints GPs often
find it difficult to fulfil the administrative requirements of
HMR referrals, as the current process is complex [16]. An
Urbis Keys Young evaluation (2005) of the HMR program
found that incomplete or unclear referral forms from the
GPs hindered the HMR process. This evaluation also found
that the majority of accredited pharmacists believed GPs
were unaware of HMRs and were reluctant to collaborate
professionally with pharmacists [17].
In February 2014 a lack of funding for the HMR pro-
gram, under the Government-Pharmacy Guild agreement,
resulted in the number of HMRs a pharmacist being capped
at 20 HMRs per pharmacist per month [1]. This capping of
HMR program funding has negated the ability to promote
HMRs to a wider audience despite the evidence that indi-
cates the improved health outcomes and reduced prevent-
able hospitalisations that result from medication reviews
[2,3,28]. Respondents in this study strongly indicated that
they believed that HMRs could greatly assist Aboriginal
patients to better understand their medicines and health,
and could improve medication adherence.
The views of the pharmacists in this study reflected the
views of Aboriginal patients in a recent study [13]which
indicated that barriers to HMR for Aboriginal patients included
the ‘‘home setting’’, and the complex referral and interview
arrangements. The pharmacist respondents noted the need for a
closer relationship with the AHS and the AHS staff, to ensure
successful implementation of the HMR process. This confirms
previous studies which emphasise the important role the AHS
plays in delivering primary care to Aboriginal people [29–31].
Respondents acknowledged that GPs in AHSs are often
overloaded or are transitory, and thus nurses and AHWs are
often the primary contact with patients. Respondents
strongly endorsed greater involvement of AHS nurses and
AHW in the HMR process, from initial referral to follow
up post pharmacist intervention. The vast majority of
pharmacists surveyed suggested allowing AHWs or AHS
nurses to write HMR referrals and play a more key role in
the HMR process to help facilitate good communication
during the HMR interview and to aid in the administration
procedures of the interviews and follow ups [13].
The expanded role for AHS staff and the ability to
conduct an HMR in a setting other than the home, were
also identified as facilitators to increasing the number of
HMRs for Aboriginal by Aboriginal patient participants in
a previous study [13].
This study will be used to advise 6CPA negotiations of
the needs for changes to HMR program rules and suggest
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new and more appropriate medication review models for
Aboriginal and Torres Strait Islander people. The new
models will suggest that medication reviews for Aboriginal
and Torres Strait Islander people be uncapped in number,
allow referrals from nurses, AHWand doctors, and allow
flexibility of location.
The issues of financial viability, lack of GP referrals and
lack of program awareness were consistent with barriers
identified by pharmacists in HMR studies with other pop-
ulation groups. The lack of ability to build relationships
with Aboriginal health Services is a unique finding of this
study and needs further investigation.
Limitations
Some of accredited pharmacists who were not regularly
working with Indigenous patients were reluctant to par-
ticipate in the survey. Several pharmacists contacted the
authors to support the work but believed they could not
contribute to the survey as they did not work with
Aboriginal patients. Consequently there was a limited
sample and the results of this study may underestimate the
barriers to performing HMRs for Aboriginal Australians.
This study does not analyse the views of pharmacists
working with AHSs who are not accredited to perform
HMRs. Non-accredited pharmacists may be providing phar-
macy services to AHSs however their views on the barriers
and the facilitators to providing pharmacy services for
Aboriginal Australians have not been captured in this study.
Conclusion
This study showed that HMR accredited pharmacists are
currently providing very limited clinical pharmacy services
to Aboriginal Australians. Accredited pharmacists were
very keen to provide more services to AHSs. However, need
assistance and training to overcome the barriers which are
inhibiting them working more closely with AHSs and AHS
staff are needed. Pathways and mechanisms to facilitate
increased relationship building between pharmacists and
other health professionals, and with primary care organisa-
tions, such as AHSs, need to be further investigated.
Increased promotion of the HMR program, GP educa-
tion, increased and consistent financial remuneration to
pharmacists, changes to the HMR referral process,
improved relationships between pharmacists and AHS
staff, and increased involvement of AHS staff in the HMR
processes are needed, to increase HMR delivery to
Aboriginal and Torres Strait Islander peoples.
Future government policies need to support and
encourage pharmacists to conduct medication reviews for
Aboriginal and Torres Strait Islander patients.
Acknowledgments We would like to thank accredited pharmacists
who participated in this survey.
Funding This study was made possible by Sanofi Pamela Nieman
Grant funding from the Society of Hospital Pharmacists of Australia.
Conflicts of interest No conflict of interest exists for any of the
authors.
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