McRae M, Taylor S J, Swain L, Sheldrake C
Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.
Rural Remote Health. 2008 Oct-Dec;8(4):946. Epub 2008 Dec 16.
The health of Indigenous Australians is exceptionally poor compared with that of non-Indigenous Australians. Cardiovascular diseases are the leading cause of death, the death rate being at least 2.7 times higher than the total Australian population. Indigenous Australians also experience underutilisation and reduced quality use of medicines. Aboriginal Health Workers (AHWs) are appropriate members of the healthcare team to provide information about medicines to the Indigenous community. However, despite having an expanding role in medicines management, AHWs have reported they do not have adequate appropriate education to support this role. Community pharmacists in localities with high Indigenous populations are well placed to provide medicines education to AHWs; however, to be successful in this role they need to develop their cultural awareness. The purpose of this study was to evaluate a culturally appropriate, pharmacist-led cardiovascular medicines education program for AHWs. Research questions included: What was the impact of the program on the pharmacists? What were the barriers and facilitators? Was the program useful and acceptable to the AHWs?
Four educational units were developed in collaboration with AHWs. A purposive sample of community pharmacists from western New South Wales (NSW) attended training involving instruction in the delivery of the program and cultural awareness training. The pharmacists then recruited local AHWs and delivered the program. Evaluation, with respect to the pharmacists, involved a repeated measures, three-phase questionnaire and semi-structured, face-to-face, in-depth interview post-program. Feedback was obtained from the AHWs in the form of a brief survey, and an audit of the attendance at each session was performed.
Twelve pharmacists in 10 localities throughout western NSW delivered the program to a total of 47 AHWs. Statistically significant differences in the questionnaire responses, as a result of delivering the education, indicated the pharmacists felt better equipped to deal with Indigenous health issues (p = 0.002, Mann-Whitney U-test); they knew more AHWs in their area (p = 0.005, Mann-Whitney U-test); they felt more confident as educators of AHWs (p = 0.007, Mann-Whitney U-test); and more confident that they had the necessary resources to deliver this education (p = 0.005, Mann-Whitney U-test). The semi-structured interviews revealed that the experience of delivering the education improved pharmacists' confidence as educators and motivated them to develop sustainable relationships with AHWs. A significant barrier lay in the challenges associated with organizing the AHW education sessions, while an important facilitator was prior established relationships with local Aboriginal health services. Evaluation with respect to the AHWs revealed the program reached 80% (n = 47/59) of AHWs within the western NSW region. In total, 46% (n = 27) of AHW participants attended all four educational units and attendance at each educational unit was above 78% (n = 37) throughout. The AHWs reported that they found the program interesting and relevant and were enthusiastic for future collaboration with the pharmacists.
The desire to develop sustainable relationships was seen by all participants as the most positive aspect of the program.
与非原住民澳大利亚人相比，原住民澳大利亚人的健康状况极其糟糕。心血管疾病是主要死因，其死亡率至少比澳大利亚总人口高出2.7倍。原住民澳大利亚人还存在药物利用不足和用药质量下降的情况。原住民健康工作者（AHW）是医疗团队中向原住民社区提供药物信息的合适成员。然而，尽管AHW在药物管理方面的作用不断扩大，但他们表示没有足够适当的教育来支持这一角色。原住民人口众多地区的社区药剂师很适合为AHW提供药物教育；然而，要成功履行这一职责，他们需要提高自己的文化意识。本研究的目的是评估一项针对AHW的、由药剂师主导的、符合文化习惯的心血管药物教育项目。研究问题包括：该项目对药剂师有何影响？有哪些障碍和促进因素？该项目对AHW是否有用且可接受？
与AHW合作开发了四个教育单元。从新南威尔士州西部（NSW）有目的地抽取社区药剂师样本，参加包括项目实施指导和文化意识培训的培训。药剂师随后招募当地AHW并实施该项目。对药剂师的评估包括一份重复测量的三阶段问卷以及项目结束后的半结构化面对面深度访谈。通过简短调查从AHW那里获得反馈，并对每次课程的出勤情况进行审核。
新南威尔士州西部10个地区的12名药剂师为总共47名AHW实施了该项目。由于开展了教育，问卷回复中存在统计学上的显著差异，表明药剂师感觉更有能力应对原住民健康问题（p = ）。
