title: Medication reviews are useful, but the model needs to be changed: Perspectives of Aboriginal Health Service health professionals on Home Medicines Reviews.
abstract: BACKGROUND
  The Australian Home Medicines Review (HMR) program consists of a pharmacist reviewing a patient's medicines at his or her home and reporting findings to the patient's general practitioner (GP) to assist optimisation of medicine management. Previous research has shown that the complex HMR program rules impede access to the HMR program by Aboriginal and Torres Strait Islander clients. This study explores the attitudes and perceptions of health professional employees working within Aboriginal Health Services (AHSs) towards the HMR program. The goal was to identify how the HMR program might better address the needs of Aboriginal and Torres Strait Islander people.
  
  
  METHODS
  Thirty-one semi-structured interviews were conducted with health professionals at 11 diverse AHSs. Fourteen Aboriginal Health Workers (AHWs), five nurses, one manager and 11 GPs were interviewed. Interviews were recorded, de-identified and transcribed verbatim. Transcripts were coded and analysed for themes that recurred throughout the interviews.
  
  
  RESULTS
  This study identified a number of barriers to provision of HMRs specific to Aboriginal and Torres Strait Islander clients. These included paternalistic attitudes of health professionals to clients, heightened protection of the GP-client relationship, lack of AHS-pharmacist relationships, need for more culturally responsive pharmacists and the lack of recognition of the AHS's role in implementation of culturally effective HMRs. Changes to the HMR model, which make it more effective and culturally appropriate for Aboriginal and Torres Strait Islander people, were recommended. Improved relationships between GPs and pharmacists, between pharmacists and AHSs, and between pharmacists and Aboriginal and Torres Strait Islander clients were identified as key to increasing HMRs for Aboriginal and Torres Strait Islander people.
  
  
  CONCLUSIONS
  Aboriginal Health Services are well-placed to be the promoters, organisers, facilitators and implementers of health programs, such as HMR, for Aboriginal and Torres Strait Islander clients. Embedding a pharmacist within an AHS addresses many of the barriers to HMRs. It ensures pharmacists are culturally mentored and that they build strong relationships with health professionals and clients. The HMR program rules need to be changed significantly if medication review is to be an effective tool for improving medication safety and adherence for Aboriginal and Torres Strait Islander people.
authors.affiliation: University Centre for Rural Health, University of Sydney, 55-61 Uralba Street, Lismore, NSW, 2480, Australia. Lindy.Swain@ucrh.edu.au.
authors.forename: Lindy
authors.initials: L
authors.lastname: Swain
authors.affiliation: University Centre for Rural Health, University of Sydney, 55-61 Uralba Street, Lismore, NSW, 2480, Australia. Lesley.barclay@sydney.edu.au.
authors.forename: Lesley
authors.initials: L
authors.lastname: Barclay
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D054521:Cultural Competency; D006282:Health Personnel / Q000523:psychology*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006303:Health Services, Indigenous / Q000458:organization & administration*; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D059065:Medication Reconciliation / Q000458:organization & administration*; D010595:Pharmacists / Q000523:psychology*