Ethnicity-in-prescribing study sheds light on inequity for older Māori

Health sector figures are hailing a study by an Auckland pharmacist as a starting point for addressing inequities in prescribing, especially for Māori.

“Ethnic Variations in the Quality Use of Medicines in Older Adults: Māori and Non-Maōri in Aotearoa New Zealand” was published in the pharmacological journal Drugs & Aging last month.

Funded by the Health Research Council of New Zealand, the 13-page narrative review shows that, compared with non-Māori, older Māori adults enjoy less access to appropriate medicines but also experience greater risk of adverse effects, from being prescribed inappropriate medicines.

Study lead and University of Auckland PhD candidate Joanna Hikaka says she undertook the research because there was next to no international or domestic prescribing by ethnicity data.

The problem of inappropriate prescribing experienced by ethnic groups can’t be addressed until research proves there is a problem, says Ms Hikaka (Ngāruahine), a pharmacist at Waitematā DHB.

She hopes the study will also prod researchers into incorporating ethnicity into future prescribing studies.

Because of the absence of similar research here or overseas, Ms Hikaka and her team were forced to improvise.

The study analysed nearly 2400 word-search hits from three biomedical databases, looking for leads to uncover prescribing data which may hold useful information including ethnicity and age, Ms Hikaka says.

“I had to get a whole lot of studies that weren’t similarly designed or were reporting on similar things, but as a collective they paint the same picture; there’s inequities in access…”

Eventually, 22 studies met review criteria and from their data results were extrapolated.

Analysing studies of prescribing patterns across several medical condition groups for Maōri 55 years or older, Ms Hikaka’s study found several discrepancies by ethnicity.

For anticoagulants, Māori were found to be prescribed older, higher-risk medicines such as warfarin, instead of newer and less risky dabigatran.

It was also found, despite Māori experiencing higher rates of depression and anxiety, older Māori were less likely than Pākehā to be prescribed WHO-endorsed, best-practice psychotropic medications.

Health sector figures working on finding ways to reduce prescribing inequities, especially for Māori, welcome the new study.

Pharmac Māori chief adviser Trevor Simpson (Tuhoe, Ngāti Awa) says the finding are valuable for the agency, which has begun “significant” work looking at the many factors influencing access to and prescription of suitable medicines.

The drug-funding agency has a six-member medicines access equity team helping to formulate policy to drive greater medicines access.

Auckland GP and National Hauora Coalition clinical director Rawiri Jansen (Ngāti Raukawa) say the “awesome” report reinforces the need for change.

In recommending the future direction of assessing patients and the medication they should be prescribed, the report says further investigation is needed on how doctor/patient relationships can evolve to culturally safe partnerships, a goal Dr Jansen supports.

Pharmac has commissioned clinical education and data services provider Matui to provide its He Ako Hiringa programme to raise awareness among primary care clinicians about equitable access to medicines.

Matui custom education lead Andrea Copeland says Ms Hikaka’s study is timely and will help inform its readership.

Apart from producing its own material, along with other outside resources, Matui plans to share Ms Hikaka’s work.

Ms Hikaka is also on the expert advisory board for He Ako Hiringa.

Declaration of interest: New Zealand Doctor|Rata Aotearoa publisher The Health Media Ltd is a partner in Matui, the provider of He Ako Hiringa.

Written by Simon Maude - Reporter for New Zealand Doctor Rata Aotearoa