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Ethnic Variations in the Quality Use of Medicines in Older Adults: Māori and Non-Māori in Aotearoa New Zealand

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Abstract

In Aotearoa New Zealand (NZ), ethnic inequities in health outcomes exist. Non-Māori experience better access to healthcare than Māori, including access to the quality use of medicines. Quality medicines use requires that medicines provide maximal therapeutic benefit with minimal harm. As older adults are more at risk of harm from medicines, and, because inequities are compounded with age, Māori older adults may be at more risk of medicines-related harm than younger and non-Māori populations. This narrative review examined ethnic variation in the quality use of medicines, including medicines utilisation and associated clinical outcomes, between Māori and non-Māori older adult populations in NZ. The review was structured around prevalence of medicine utilisation by medicine class and in particular disease states; high-risk medicines; polypharmacy; prevalence of potentially inappropriate prescribing (PIP); and association between PIP and clinical outcomes. 22 studies were included in the review. There is ethnic variation in the access to medicines in NZ, with Māori older adults often having reduced access to particular medicine types, or in particular disease states, compared with non-Māori older adults. Māori older adults are less likely than non-Māori to be prescribed medicines inappropriately, as defined by standardised tools; however, PIP is more strongly associated with adverse outcomes for Māori than non-Māori. This review identifies that inequities in quality medicines use exist and provides a starting point to develop pro-equity solutions. The aetiology of inequities in the quality use of medicines is multifactorial and our approaches to addressing the inequitable ethnic variation also need to be.

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Authors and Affiliations

  1. School of Pharmacy, University of Auckland, Auckland, New Zealand

    Joanna Hikaka & Nataly Martini

  2. Waitematā District Health Board, Auckland, New Zealand

    Joanna Hikaka & Martin J. Connolly

  3. Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand

    Rhys Jones

  4. School of Pharmacy, Queen’s University, Belfast, UK

    Carmel Hughes

  5. Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand

    Joanna Hikaka & Martin J. Connolly

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  1. Joanna Hikaka
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Correspondence to Joanna Hikaka.

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JH was funded by a Health Research Council of NZ, Clinical Research Training Fellowship (HRC: 17/134). The funders had no role or influence over study design; the collection, analysis and interpretation of data; in the writing of the report; or the decision to submit the article for publication.

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JH developed the methodology, performed the literature search and data analysis, drafted, edited and finalised the manuscript. NM, RJ, CH and MJC provided input to the structure of the report and interpretation and critical review of the findings. All authors provided comprehensive, critical reviews of the manuscript and approved the final draft of the manuscript.

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Hikaka, J., Jones, R., Hughes, C. et al. Ethnic Variations in the Quality Use of Medicines in Older Adults: Māori and Non-Māori in Aotearoa New Zealand. Drugs Aging 38, 205–217 (2021). https://doi.org/10.1007/s40266-020-00828-0

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