Pharmacy practice and First Peoples health equity: A scoping review

Abstract

First Peoples health inequity is observed globally in higher rates of chronic disease compared to non-First Peoples. Pharmacy practice is an essential component of chronic disease management; achieving a good health-related quality of life and the best clinical outcomes requires optimal pharmaceutical care. To identify pharmacy practice strategies and interventions, across the globe, contributing to achieving First Peoples health equity; including reported outcomes, impact, implementation barriers/enablers and identification of practice gaps. PRISMA-ScR followed for reporting and review protocol is published. Inclusion criteria comprised First Peoples, reported strategies and/or interventions aligned to international conceptual model for pharmaceutical practice, study motive to achieve First Peoples equitable healthcare. Included articles mapped to a contemporary framework and underwent inductive content analysis. Thirty-six studies were reviewed from Australia (39 %), the United States of America (36 %), New Zealand (17 %), Canada (5 %) and Brazil (3 %). Three main strategies emerged, clinical pharmacy practice, medicines access and managing medicines. Advanced pharmacy practice improved clinical outcomes with significant decreases in specific chronic disease target indicators along with reductions in emergency department visits and hospitalizations reported; social needs screening and referral highlighted as a major gap. Advanced pharmacy practice models of care are urgently required to maximize the pharmacy professions contribution to achieving First Peoples health equity. Culturally appropriate, innovative, flexible models incorporating social requirements will generate the greatest impact. Pharmacists require high level communication/leadership skills and an understanding of First Peoples health determinants to build authentic patient-practitioner partnerships, increase community engagement and lead transformative change.