“They not only value a patient but a person”: exploring the views of Samoan, Tongan and Niuean people receiving heart healthcare and families, on the role of community pharmacists
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Keywords
Pharmacist, Pacific people, Cultural competency, equity, cardiovascular diseases
Abstract
Background: In Aotearoa New Zealand, cardiovascular disease (CVD) is the leading cause of differences in life expectancy between Pacific and non-Māori non-Pacific people. Pharmacists have expertise in medicine management and are often described as one of the most accessible healthcare providers. However, their role in supporting equity in heart health outcomes is not well explored.
Objectives: This research explored the experiences and perspectives of Pacific people and families living with CVD regarding how community pharmacists did and could support them to manage their CVD, as well as their ideas for improving this support.
Methods: Interpretive description framed this research. Ethnic-specific focus groups and individual interviews with Samoan, Tongan and Niuean people and their families were used to generate data. Template analysis was used to generate themes.
Results: Three focus groups and seven interviews were conducted with 14 Samoan, 10 Tongan and 11 Niuean participants. Overall, participants found pharmacists to be supportive of their heart health through the provision of in-depth explanations of medications and safety and opportunities to ask questions. Five overarching themes arose from the data analysis: i) relationships and roles in the healthcare system, ii) cultural congruence, iii) facilitating an accessible system, iv) expectations of a complex and disconnected healthcare system on service users, and v) a negligent and exploitative healthcare system. Suggestions for service improvement included more accessible knowledge that was easy to navigate and translate.
Conclusion: Most of the participants reported having a positive therapeutic relationship with their community pharmacist. These relationships supported and improved people’s access to a healthcare system that could at times be culturally unsafe and place unrealistic expectations on the knowledge that service users have about heart healthcare. The system was also perceived as exploiting power imbalances and Pacific values to provide sub-optimal services that failed to meet the needs of Pacific peoples.
References
2. Ministry of Health. Pacific people’s health [Internet]. Wellington (NZ): Ministry of Health; 2011 [cited 2022 Jul 12]. Available from: https://www.health.govt.nz/strategies-initiatives/programmes-and-initiatives/pacific-health
3. Ministry for Pacific Peoples. Pacific Aotea-roa Status Report. A snapshot [Internet]. NZ: Ministry for Pacific Peoples; 2020 [cited 2022 Aug 26]. Available from: https://www.mpp.govt.nz/assets/Reports/Pacific-Peoples-in-Aotearoa-Report.pdf
4. Kerr AJ, McLachlan A, Furness S, et al. The burden of modifiable cardiovascular risk factors in the coronary care unit by age, ethnicity, and socioeconomic status--PREDICT CVD-9. N Z Med J. 2008;121(1285):20-33.
5. Grey C, Jackson R, Wells S, et al. Ethnic Dif-ferences in Coronary Revascularisation fol-lowing an Acute Coronary Syndrome in New Zealand: A National Data-linkage Study (ANZACS-QI 12). Heart Lung Circ. 2016;25(8):820-8.
6. Ministry of Health. Cardiovascular Disease Risk Assessment and Management for Pri-mary Care. JACC: Cardiovascular Imaging. 2018;8:83-99.
7. Williams WM. Racial Inequities in Cardio-vascular Disease in New Zealand. Divers Equal Health Care. 2017;14(1):23-33.
8. Ryan D, Grey C, Mischewski B. Tofa Saili: a review of evidence about health equity for Pacific peoples in New Zealand. Wellington (NZ): Pacific Perspectives Limited; 2019 [cited 2022 Aug 11]. Available from: https://www.pacificperspectives.co.nz/tofa-saili
9. Jeffreys M, Smiler K, Ellison Loschmann L, et al. Prevalence and Consequences of Barriers to Primary Health Care [Internet]. Welling-ton (NZ): Ministry of Social Development; 2021 [cited 2022 May 20]. Available from: https://www.msd.govt.nz/about-msd-and-our-work/publications-resources/research/barriers-to-primary-health-care/index.html
10. Sousa Pinto G, Bader L, Billberg K, et al. Beating non-communicable diseases in pri-mary health care: The contribution of pharmacists and guidance from FIP to sup-port WHO goals. Res Social Adm Pharm. 2020;16(7):974-7.
11. Pharmacy Council of New Zealand. Compe-tence Standards for the Pharmacy Profes-sion [Internet]. NZ: Pharmacy Council of New Zealand; 2015 [cited XXX]. Available from: https://pharmacycouncil.org.nz/wp-con-tent/uploads/2021/04/CompStds2015Web.pdf
12. de Barra M, Scott CL, Scott NW, et al. Phar-macist services for non-hospitalised pa-tients. Cochrane Database Syst Rev. 2018;2018(12). doi: 10.1002/14651858.CD013102.
13. Nursing Council of New Zealand. Guidelines for cultural safety, the Treaty of Waitangi and Māori health in nursing education and practice. NZ: Nursing Council of New Zea-land; 2011 [cited 2022 June 21]. Available from https://www.nursingcouncil.org.nz/common/Uploaded%20files/Public/Nursing/Standards%20and%20Guidelines%20for%20Nurses/Guidelines-for-cultural-safety-TW.pdf
14. Pharmacy Council of New Zealand. Compe-tence standards [Internet]. NZ: Pharmacy Council of New Zealand; 2023 [cited 2023 Dec 04 ]. Available from: https://pharmacycouncil.org.nz/pharmacist/competence-standards/
15. Medical Council of New Zealand. Cultural safety [Internet]. NZ: Medical Council of New Zealand; 2019 [cited 2023 Dec 4]. Available from: https://www.mcnz.org.nz/our-standards/current-standards/cultural-safety/
16. Curtis E, Jones R, Tipene-Leach D, et al. Why cultural safety rather than cultural compe-tency is required to achieve health equity: a literature review and recommended defini-tion. Int J Equity Health. 2019;18(1):174. doi: 10.1186/s12939-019-1082-3.
17. Ramsden IM. Cultural Safety and Nursing Education in Aotearoa and Te Wai Pounamu [Internet]. Wellington (NZ): Victoria Univer-sity of Wellington; 2002 [cited 2022 Aug 10]. Available from: https://www.croakey.org/wp-content/uploads/2017/08/RAMSDEN-I-Cultural-Safety_Full.pdf
18. Anae DM, Coxon DE, Mara D, et al. Pasifika Education Research Guidelines [Internet]. Pasifika Education; 2001 [cited XXX]. Avail-able from: http://www.educationcounts.govt.nz/__data/assets/pdf_file/0010/7669/pacrsrch--guide.pdf
19. Hunt MR. Strengths and challenges in the use of interpretive description: Reflections aris-ing from a study of the moral experience of health professionals in humanitarian work. Qual Health Res. 2009;19(9):1284-92.
20. Health Research Council. Pacific health re-search guidelines [Internet]. NZ: Health Re-search Council of New Zealand; 2014 [cited 2022 June 21]. Available from: https://gateway.hrc.govt.nz/funding/downloads/Pacific_health_research_guidelines.pdf
21. King N. Using Templates in the Thematic Analysis of Text. In: Cassell C, Symon G, edi-tors. Essential Guide to Qualitative Methods in Organizational Research. London (UK): SAGE Publications Ltd; 2004. p. 256-70.
22. QSR International Pty Ltd. NVivo (released in March 2020). US: QSR International; 2020.
23. Tukimata NE. Tia E Lili Ke Mau Regenera-tion of Vagahau Niue: A case study of Niue youth through the Ekalesia in Niue and in Auckland, New Zealand. Auckland (NZ): Auckland University of Technology; 2017.
24. Holt E. Ear Disease and Hearing Loss in Young Children in Niue [dissertation]. Auck-land (NZ): The University of Auckland; 2020.
25. Granger K. #hello my name is... [Internet]. UK: hello my name is…; 2023 [cited 2023 Oct 25]. Available from: https://www.hellomynameis.org.uk/key-values/
26. Neville S, Wrapson W, Savila F, et al. Barriers to older Pacific peoples’ participation in the health-care system in Aotearoa New Zea-land. Goodyear-Smith F, editor. J Prim Health Care. 2022;14(2):124-9.
27. Gittell JH, Godfrey M, Thistlethwaite J. In-terprofessional collaborative practice and relational coordination: Improving healthcare through relationships. J Interprof Care. 2013;27(3):210-3. doi: 10.3109/13561820.2012.730564.
28. Taberna M, Gil Moncayo F, Jané-Salas E, et al. The Multidisciplinary Team (MDT) Ap-proach and Quality of Care. Front Oncol. 2020;10. doi: 10.3389/fonc.2020.00085/full.
29. Lorgelly PK, Exeter DJ. Health Reform in Ao-tearoa New Zealand: Insights on Health Eq-uity Challenges One Year On. Appl Health Econ Health Policy. 2023;21(5):683-7. doi: 10.1007/s40258-023-00823-7.
30. Pharmacy Council of New Zealand. Code of Ethics [Internet]. NZ: Pharmacy Council of New Zealand; 2018 [cited 2022 Aug 21]. Available from: https://www.nzdoctor.co.nz/sites/default/files/2018-03/Pharmacy%20Council%20Code%20of%20Ethics%202018%20FINAL%20V4.pdf
31. Healthify: He Puna Waiora. Translations [In-ternet]. NZ: Healthify; 2023 [cited 2023 Dec 12]. Available from: https://healthify.nz/translations/
32. Goodyear-Smith F, Ashton T. New Zealand health system: universalism struggles with persisting inequities. The Lancet. 2019;394(10196):432-42. doi: S0140673619312383.
33. Barnett R, Barnett P. Primary Health Care in New Zealand: problems and policy ap-proaches. Soc Policy J N Zeal. 2004;21(21):49-66.
34. The Royal New Zealand College of General Practitioners. Pharmacists in general prac-tice [Internet]. NZ: The Royal New Zealand College of General Practitioners; 2023 [cited 2023 Dec 18]. Available from: https://www.rnzcgp.org.nz/resources/advocacy/pharmacists-in-general-practice-report/
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