Couzos, S., Smith, D., Buttner, P., and Biros, E. (2020) Assessment of medicines underutilisation in Aboriginal and Torres Strait Islander patients with chronic disease receiving integrated pharmacist support within Aboriginal Community-Controlled Health Services (IPAC project). External Commissioned Report. Australian Government, Canberra, ACT, Australia.

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Abstract

Objective: To assess the effect of integrated non-dispensing pharmacist interventions on medication underutilisation in Aboriginal and Torres Strait Islander adults with chronic disease attending Aboriginal Community Controlled Health Services (ACCHSs) enrolled in the Integrating Pharmacists within Aboriginal Community Controlled Health Services (ACCHSs) to improve Chronic Disease Management (IPAC) study, compared with usual care pre-intervention.

Design and participants: Consented participants enrolled in a non-randomised, prospective, pre and post quasi-experimental community-based, participatory, and pragmatic study that integrated a registered pharmacist within ACCHS in Qld, NT and Vic. Participants were recipients of the IPAC intervention which comprised a prescription quality review by pharmacists as part of 10 core integrated-pharmacist roles within ACCHSs. The review included the assessment of the underuse of medications (AoU). Deidentified participant data was electronically extracted from health records.

Outcome measures: Proportion of participants with at least one potential prescribing omission (PPO), and number and type of PPO from high-value pharmacotherapies predominantly for cardiovascular disease (CVD). Omission criteria were based on ten explicit evidence-based recommendations from clinical practice guidelines targeting chronic diseases responsible for Aboriginal and Torres Strait Islander health disparities. IPAC criteria for PPOs: underuse of blood pressure and lipid-lowering therapy in patients at high primary CVD risk; anti-platelet therapy for those with existing CVD; angiotensin-converting enzyme or angiotensin-2 receptor blocker (ACEI, ARB) in those with Type 2 diabetes mellitus (T2DM) and/or chronic kidney disease (CKD) with or without existing CVD; ACEI or ARB therapy in those with heart failure (low ejection fraction <0.4); metformin or other oral hypoglycaemic for T2DM; 23-valent polysaccharide pneumococcal vaccination (23vPPV); antibiotic chemoprophylaxis for acute rheumatic fever (ARF) or rheumatic heart disease (RHD); and ‘other’ implicitly identified omissions.

Results: Participants (n=1,456) from 18 ACCHSs involving 26 integrated pharmacists, with 390 participants selected (non-probabilistic) by IPAC pharmacists for prescribing quality (AoU) review at baseline and at the end of the study. Loss to follow-up (n=37 without repeat AoU) left 353 participants for paired data analysis (median interval of 266 days). Participants had CVD, T2DM, CKD, or other chronic disease (87.5% had co-morbidity); 93.2% were Aboriginal and/or Torres Strait Islander with a mean age of 57.2 years (SD±15.4) and a mean of 7.2 (SD±8.0) medications each. At baseline, 51.2% (181/353) of participants had at least one PPO from explicit and implicit criteria, totalling 256 PPOs or 0.73 (SD± 1.3) PPOs per participant. The most common PPO of the 10 criteria was for 23vPPV and blood pressure (BP) and/or lipid lowering therapy for those at high primary CVD risk. No chemoprophylactic PPOs for participants with ARF/RHD were identified. Other PPOs included symptomatic therapy for a range of chronic conditions. At follow-up (mean 267 days post-baseline), there was a significant (58%, p<0.001) reduction in the number of participants with potential prescription-based medication underutilisation, and a significant relative reduction in the mean number of PPOs per participant (60.3%%, p<0.001). The PPOs that were averted were for pneumococcal vaccination, BP and/or lipid lowering medication in those clinically at high primary CVD risk, ACEI or ARB for participants with T2DM and albuminuria, and metformin for those with T2DM.

Conclusion: PPOs were common in this cohort. Improvements in prescribing quality arising from non-dispensing pharmacists integrated within ACCHSs significantly averted PPOs to high-value pharmacotherapies. The magnitude of potentially undertreated Aboriginal and Torres Strait Islander patients with chronic disease and the magnitude of benefit observed following integrated pharmacists within ACCHSs, would at a population level, contribute to improved health outcomes for this target group. Generalisability of the outcomes observed from the integrated pharmacist intervention to the broader ACCHS adult patient population with chronic disease who are at risk of developing medication related problems, is supported.

Item ID:	87220
Item Type:	Report (External Commissioned Report)
Keywords:	Medication adherence, medication utilisation, medication appropriateness, Aboriginal, Torres Strait Islander, pharmacy, pharmacist, integrated care, primary health care, chronic disease
Additional Information:	Report to the Pharmaceutical Society of Australia for the IPAC Project. This report is publicly available at the following website: https://www.health.gov.au/resources/publications/integrating-practice-pharmacists-into-aboriginal-community-controlled-health-services-final-report
Funders:	Australian Government Department of Health & Ageing
Projects and Grants:	Pharmacy Trials Program
Date Deposited:	03 Oct 2025 03:37
FoR Codes:	42 HEALTH SCIENCES > 4203 Health services and systems > 420319 Primary health care @ 50% 32 BIOMEDICAL AND CLINICAL SCIENCES > 3214 Pharmacology and pharmaceutical sciences > 321403 Clinical pharmacy and pharmacy practice @ 50%
SEO Codes:	20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 50% 20 HEALTH > 2001 Clinical health > 200102 Efficacy of medications @ 50%
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