title: Exploration of Aboriginal and Torres Strait Islander perspectives of Home Medicines Review.
abstract: BACKGROUND
  In Australia, Home Medicines Review (HMR) has been found to be an important tool to raise awareness of medication safety, reduce adverse events and improve medication adherence. Aboriginal and Torres Strait Islander people are 'underserviced' by the HMR program and are the most likely of all Australians to miss out on HMRs despite their high burden of chronic disease and high rates of hospitalisation due to medication misadventure. The goal of this study was to explore Aboriginal and Torres Strait Islander perspectives of the Home Medicines Review program and their suggestions for an 'improved' or more readily accessible model of service.
  
  
  METHODS
  Eighteen semi-structured focus groups were conducted with 102 Aboriginal and Torres Strait Islander patients at 11 Aboriginal Health Services (AHSs). Participants who were multiple medication users and understood English were recruited to the study by AHS staff. Seven focus groups were conducted for people who had already used the HMR program (User, n=23) and 11 focus groups were conducted for people who had not had an HMR (Non User, n=79). Focus groups were recorded, de-identified and transcribed. Transcripts were coded and analysed for themes. Focus groups continued and concepts were explored until no new findings were being generated and thus saturation of data occurred.
  
  
  RESULTS
  Focus group participants who had not had an HMR had little or no awareness of the HMR program. All the participants felt that lack of awareness and promotion of the HMR program were contributing factors to the low uptake of the HMR program by Aboriginal and Torres Strait Islander people. Most participants felt that an HMR would assist them to better understand their medicines, would empower them to seek information about medicines, would improve relationships with health professionals and would increase the likelihood of medication adherence. Most of the User participants reported that the HMR interview had been very useful for learning more about their medicines. However, many reported that they found the process confusing and confronting. The majority of participants felt HMRs for Aboriginal and Torres Strait Islander patients should be organised by AHS staff, with patients being offered a choice of location for the HMR interview. Participants identified that Aboriginal Health Workers should play a key role in communication, knowledge translation, referral and follow-up.
  
  
  CONCLUSIONS
  Current HMR rules impede rather than facilitate HMRs for Aboriginal and Torres Strait Islander people. Tailoring and remodelling of the HMR program is needed to increase the awareness, accessibility, acceptability and effectiveness of the HMR program for Aboriginal and Torres Strait Islander people.
authors.affiliation: University Centre for Rural Health, Lismore, New South Wales, Australia. lindy.swain@ncahs.health.nsw.gov.au.
authors.forename: Lindy S
authors.initials: LS
authors.lastname: Swain
authors.affiliation: University Centre for Rural Health, Lismore, New South Wales, Australia. lesley.barclay@sydney.edu.au.
authors.forename: Lesley
authors.initials: L
authors.lastname: Barclay
mesh_terms: D000328:Adult; D001315:Australia; D003157:Community Pharmacy Services / Q000458:organization & administration; D054626:Consumer Health Information / Q000458:organization & administration; D054521:Cultural Competency; D005260:Female; D017144:Focus Groups; D006303:Health Services, Indigenous / Q000458:organization & administration*; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D010353:Patient Education as Topic / Q000458:organization & administration; D063046:Patient Medication Knowledge / Q000458:organization & administration*; D017060:Patient Satisfaction; D019338:Polypharmacy; D011369:Professional-Patient Relations; D012017:Referral and Consultation / Q000458:organization & administration; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Allied Health; Australia/Pacific; Community-Controlled Health Services; Consumer perspectives; Cross-cultural Safety; Health Service reform; Indigenous Health Worker; Medical; Nursing; Pharmacology/Drugs; Primary Health Care; Procedures; Public Health; Qualitative Research; Researcher