Journal of primary health care最新文献

Introduction Polypharmacy increases the risk of medicines-related harm, including falls, in older adults. Falls have a significant impact on quality of life and health system resources. Little is known about medicine use in retirement village (RV) residents in Aotearoa New Zealand (NZ). Aim Our study aimed to describe medicine use and the point prevalence of polypharmacy among a cohort of RV residents in Auckland, NZ. Methods Data collection occurred from July 2016 to June 2018. Eligible participants (those residing permanently in a RV) were recruited from RVs in Auckland, New Zealand. Medicines use data were collected using an interRAI assessment tool. Descriptive statistics, t -tests and Chi-squared tests were used for analysis. Results A total of 578 residents were recruited from 33 RVs and the median age was 81.6 years. Participants took a mean of 4.8 regular medicines (standard deviation = 2.9) and 0.7 'as required' medicines. Anti-hypertensives (68.5%), lipid-lowering medicines (45.2%), antacids (39.4%) and antiplatelet agents (37.9%) were the most prescribed medicine classes. Polypharmacy (five-plus medicines; 51.8%) was common and hyperpolypharmacy (10-plus medicines; 5.7%) occurred infrequently. Discussion This study provides insight into medicines use by RV residents in Auckland, NZ. Medicines used for primary and secondary prevention of cardiovascular disease were used most commonly and polypharmacy was common. Active review of RV residents' medicines is warranted, based on these findings and increasing evidence regarding the use of medicines, including those for primary prevention of cardiovascular disease. Trial registration Australia and New Zealand Clinical Trials Registry: CTRN12616000685415. Registered 25.5.2016. Universal Trial Number (UTN): U111-1173-6083.

Introduction The provision of palliative care is central to primary health care delivery. In this setting, community pharmacies often act in a medication supply role, yet their broader involvement in supporting people in the last year of life is less well understood. Aim This study aimed to review the literature on community pharmacies supporting adults with palliative care needs in their last year of life, emphasising challenges to optimising their role and improving equity and service accessibility. Methods A five-stage scoping review using a comprehensive literature search was conducted using MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, and grey literature up to 30 April 2024. Eligible articles were charted, descriptively analysed, and mapped to a bicultural and holistic health care model, Te Whare Tapa Whā Older Person's Palliative Care model. Results Twenty-five studies from seven countries were reviewed, revealing that community pharmacies provide a range of services to support people with palliative care needs. The main role of community pharmacies resides in Tinana, the physical health domain of Te Whare Tapa Whā Older Person's Palliative Care model. Challenges experienced by pharmacy staff include communication with palliative care service providers and users, integrating their role into palliative care provision, addressing their educational needs, and managing palliative medication stock. Discussion The role of community pharmacy in providing palliative care is not widely understood. If the challenges identified in these studies can be addressed, there is potential for community pharmacies to offer a more proactive palliative care approach to their communities.

Introduction This study explored the experiences of students and their supervisors undertaking a medication review activity during a 6-week general practice module in their final year of medical school at University of Otago, Wellington, Aotearoa New Zealand. Aim The study sought the self-reported value of the activity in learning about prescribing, reflecting on polypharmacy, deprescribing, and changes to future practice for both student and supervisor. Methods All students in the final year general practice module were invited to complete a survey over a 12-month period, as were their supervisors. An abductive thematic analysis of survey results was performed. Results Fifty-eight percent (48/87) of students and 30% (10/33) of supervisors completed surveys. Five themes were identified in the analysis of qualitative data: value of the medication review, complexities of medicines, importance of monitoring, value of resources, and supervisor reflections on value to the student. Student and supervisor responses reflected on prescribing practice beyond what medication to give when. All responses described benefit to patients and the majority expressed thoughts on how it would change their future prescribing. Discussion The medication review activity in the final year general practice module provides learning opportunities for both student and general practitioner supervisor. This activity emphasises the risks of polypharmacy and how to deprescribe. This study underlines the value of medication reviews as intraprofessional communication activities, allowing reflection beyond what medication to prescribe and for what condition. The results underline the importance of reflecting on practice and aids quality improvement benefit to patients.

Introduction The integration of pharmacists into general practice settings is increasingly common internationally. Within Aotearoa New Zealand, the role has evolved variably in different regions. Recent health policy and professional guidance support further development. Aim To describe the current status of pharmacists working in primary healthcare settings other than community pharmacy. Methods An online survey of all pharmacists in Aotearoa New Zealand primary healthcare settings was conducted in 2022, and covered employment, current services, patient consultations, relationships with other health professionals, and service costs and benefits. Descriptive statistical analyses were performed. Results Responses from 39 pharmacists (~35% response rate) working in primary healthcare practice roles are reported. Most were female (84%), New Zealand European (81%), and 45% had Discussion Practice pharmacists have both patient- and practice-facing roles. The proportion with a prescribing qualification has increased over time. There is some capacity for additional consultations, but this requires funding, space and time spent in a service/setting.

Introduction Optimal use of the workforce in primary care is critical due to increasing complexity and demand resulting from multi-morbidity in ageing populations. Improving public access to medicines by making them available via a pharmacist without prescription can support self-care while ensuring oversight by a health professional. Aim The aim of this paper was to identify and explore key differences between New Zealand and Australia in medicines classified nationally for pharmacist-only non-prescription supply. Methods Medicines legally classified to allow sale by a pharmacist without a prescription were identified and compared between the two countries as of 1 February 2024. Based on consensus among the research team, notable differences were subjected to qualitative consideration about how medicines classification may be used to extend the role of pharmacists in primary care. Results Overall, New Zealand has a less restrictive approach to classification than Australia providing New Zealanders increased access to medicines via a pharmacist in two key therapeutic areas: sexual and reproductive health and infection. Oral contraceptives, sildenafil, antibiotics for urinary tract infection and two COVID-19 antivirals were classified for supply without prescription via pharmacists in New Zealand but not nationally in Australia, although some alternative legislative mechanisms are emerging at state level. Discussion Medicines classification has an ongoing role in enabling pharmacist contribution to primary care. Medicines classification needs to be considered alongside commissioning of services and other policy to facilitate integration of community pharmacy-provided care within the wider primary care environment. Digital tools supporting information sharing, collaboration and communication are key.

Introduction Antimicrobial stewardship (AMS) is a global initiative aimed at promoting the responsible use of antimicrobials to combat antimicrobial resistance (AMR), a critical global health threat. In New Zealand, over 95% of antibiotics are prescribed in the community, with estimates suggesting that half of these prescriptions are for self-limiting respiratory infections, contributing significantly to AMR. Registered nurses (RNs), especially nurse practitioners and designated nurse prescribers, are well-positioned to play a pivotal role in AMS efforts due to their accessibility and broad skill set. However, their potential remains underutilised in AMS programmes. Aim This study aimed to explore the role of New Zealand Māori and non-Māori registered nurses as antimicrobial stewards within the New Zealand health care system. Methods The current knowledge and involvement in activities that mitigate the risks of infectious diseases and AMR of registered nurses was assessed. The educational and organisational support needed to enhance their leadership and engagement in AMS initiatives were identified. Results Findings highlight the need for targeted AMS education, greater participation in stewardship activities, and clarity in RN roles in collaboration with other health care professionals. This research underscores the importance of empowering registered nurses through education and organisational support to strengthen AMS and mitigate the growing threat of AMR. Discussion This study provides key insights into the leadership potential of RNs in AMS and offers recommendations for future policy and education strategies to optimise their role in New Zealand's health care.

Introduction Continuity of care is considered vital to achieving high-quality health care. Traditionally, general practitioners have played a key role in managing continuity of care and have largely been accountable for prescribing decision-making in primary care. Following prescribing legislation changes, a range of health disciplines make decisions regarding medicines in the general practice setting. To date, few studies have investigated how different prescribing disciplines view the management of medicines-related continuity of care. Understanding the views of these clinicians is important to achieving safe, effective and equitable outcomes from medicines. Aim The purpose of this study was to explore the views of general practitioners, nurse prescribers and pharmacist prescribers about their role in managing medicines-related continuity of care. Methods Qualitative, semi-structured in-depth interviews were undertaken with 16 prescribers based in eight North Island (New Zealand) general practices. Interviews were transcribed verbatim and analysed thematically using an inductive approach. Results Three key themes were identified from data analysis: a patient-focused approach; interdisciplinary teamwork; and optimising the medicine regimen. Discussion Prescribers in this study identify the important connection between continuity of care and achieving good outcomes from medicines. Good patient-prescriber relationships and ongoing interdisciplinary relationships across all health settings are considered essential to medicines-related continuity of care. Prescribers experience challenges associated with increasing multimorbidity, medicines complexities and fragmentation of clinical records.

Introduction Mental health conditions, such as depression, anxiety, and psychological distress in the adult population significantly increased during the COVID-19 pandemic. However, the rates of prescribing psychotropic medications in adults during the COVID-19 period have not been well explored. Aim The aim of this study was to examine the association between demographic characteristics and rates of prescribing psychotropic medications to general practice patients during 2018-2022. Methods A total of 154 528 general practice patients aged 20 years and above were included in the study. A mixed effects negative binomial regression model was employed and incidence risk ratios (IRRs) with corresponding 95% confidence interval (CI) are presented to measure the association of demographic characteristics with rates of prescribing psychotropic medication. Results Over half (56.2%) of study subjects were female and 41.4% were aged between 20 and 39 years. Males had lower prescribing rates of antidepressants (IRR = 0.95; 95% CI: 0.94, 0.97) and hypnotics and sedatives (IRR = 0.97; 95% CI: 0.96, 0.99) than females. People in the age group 60+ years (compared with age group 20-39 years) and those in low and middle socio-economic status (SES) categories (compared with high SES) had higher rates of prescribing psychotropic medication. Conclusion Females, people aged 60+ years, and people with low and middle SES had higher prescribing rates of psychotropic medication. A consistent increase in prescribing rates over time, particularly during the COVID-19 pandemic, was observed. It is important that health care planners and policy makers monitor and account for population diversity and equity.

Introduction Existing research has established that some people struggle with prescription charges. This paper reports on the experiences of a sub-sample of people who participated in the FreeMeds study (a randomised controlled trial of prescription charges) about their problems paying for medicines. Aim The aim of this study was to explore participants' previous experiences with paying for medicines, and the impact of receiving free medicines through the Free Meds study. Method Semi-structured interviews were carried out with 23 people (21 were available for analysis), purposefully selected from the 1061 participants in the FreeMeds trial. Trial participants had to live in an area of high socio-economic deprivation (NZDep 7-10), either take medicines for diabetes and/or take anti-psychotics and/or have chronic obstructive pulmonary disease. Transcripts were analysed thematically. Results Prior to being enrolled in the study, prescription charges were an important issue for many of the participants, who faced multiple health challenges. Some reported having to go without medicines until they could afford them, and many reported having to make hard choices, such as choosing which of their medicines to pick up, or choosing between medicines and other expenses like food. Echoing the quantitative results from the trial, some participants reported previous hospitalisations because of their inability to pay for and hence take, their medicines. Few participants had discussed the affordability of medicines with their doctor. Participants reported that being exempted (through the FreeMeds trial) had reduced their stress and allowed them to afford medicines they would normally have gone without. Discussion The study supports the government's decision to eliminate prescription charges, to remove one barrier to health and wellbeing for people facing significant disadvantages.