Implementation And Evaluation Framework For Equitable Pharmacy Minor Ailment Services In Aotearoa New Zealand

• By: HIKAKA, Joanna (Ngā Kaitiaki o Te Puna Rongoā - The Māori Pharmacists' Association, New Zealand)
• Co-author(s): Dr Joanna Hikaka (Ngā Kaitiaki o Te Puna Rongoā - The Māori Pharmacists' Association, Taupō, New Zealand)
  Ms Nora Parore (Ngā Kaitiaki o Te Puna Rongoā - The Māori Pharmacists' Association, Taupō, New Zealand)
  Mr Kevin Pewhairangi (Ngā Kaitiaki o Te Puna Rongoā - The Māori Pharmacists' Association, Taupō, New Zealand)
  Dr Anneka Anderson (National Hauora Coalition, Auckland, New Zealand)
  
• Abstract:

  Background
  Access to medicines for both minor, self-limiting conditions and chronic conditions in Aotearoa New Zealand (NZ) is inequitable. Māori, the Indigenous people of NZ, have reduced access to medicines across a spectrum of clinical conditions compared to non-Māori. Internationally, pharmacist minor ailment services have been developed with the expectation that they will improve equity of access to medicines yet robust mechanisms to implement and evaluate equitable pharmacist minor ailment services are lacking. Although pilot work is occurring in some regions of NZ, pharmacist minor ailment services are not available nationally. There is opportunity to centre Māori in the development of these services from the outset, to facilitate the design and implementation of services that deliver equity.
  Purpose
  To develop an implementation and evaluation framework for equitable pharmacy minor services in Aotearoa New Zealand.
  Method
  In this mixed methods study, 64 Māori adults who access medicines from pharmacy and 12 stakeholders involved in the commissioning, designing, development and/or provision of medicines-related services were interviewed. Audio recorded semi-structured interviews were transcribed. Themes were developed using general inductive analysis with the application of kaupapa Māori theory. Kaupapa Māori theory situates the findings within the political, social, historical and cultural contexts for Māori and aims for positive transformative benefits. During an in-person, full day meeting, six research team members used both deductive and iterative approaches to map themes and develop an implementation framework. An advisory group comprising national pharmacy and health sector stakeholders supported the work.
  Results
  The pharmacist minor ailment service implementation framework consists of four focus areas: community partnership, cultural centredness, enabling ecosystems, and action from shared knowledge. Overarching all the focus areas was the need for Māori-identified and Māori-led solutions that fostered self-determination, autonomy and equity. Actions included in the implementation framework include development of relationships between pharmacists, community members and Māori health providers, suggested regulatory changes to support care delivery outside the pharmacy, and methods for assessing and designing physical, technology, and professional environments. Methods for evaluating services, including equity of access, are also included in the framework.
  Conclusion
  Indigenous voices were centred in the development of an implementation framework for pharmacist minor ailment services in NZ. The methodology and implementation framework have potential for international relevance, particularly for other marginalised groups.