Developing Medication Reviews to Improve the Aruban Healthcare System: A Mixed-Methods Pilot Study

Abstract

This study investigated whether and how medication reviews (MRs) conducted by pharmacists and general practitioners (GPs) with patient involvement can be performed on the island of Aruba (Dutch Caribbean). In this mixed-methods pilot study (both qualitative and quantitative), constructive and observational methodologies were combined. Healthcare providers' and patients' views on MRs and aspects of Aruban healthcare and culture relevant to MRs were examined. These insights were used to develop a protocol for conducting and implementing MRs in Aruba. Surveys were distributed and semi-structured interviews were held among Aruban community pharmacists and GPs, and a pilot program was created in which MRs were carried out with four Aruban patients and their GPs. According to the included healthcare providers, the main purpose of MRs is to optimize the patient experience and achieve concordance. Even though pharmacists and GPs consider their partnership equal, they have different views as to who should bear which responsibility in the MR process in matters regarding patient selection and follow-up. Common Aruban themes that were mentioned by the healthcare providers and deemed relevant for conducting MRs included behaviour/culture, healthcare, lifestyle, and therapy compliance. Anamnesis should be concise during the MR, and questions about medication storage, concerns, beliefs, and practical problems, as well as checks for limited health literacy, were considered important. In the pilot, at least three to, maximally, eight pharmacotherapy-related problems (PRPs) were detected per MR consultation, such as an incorrect dosage of acetylsalicylic acid, an inappropriate combination tablet for blood pressure regulation, and the absence of important laboratory values. All patients considered their consultation to be positive and of added value. In addition, it was observed that an MR can potentially generate cost savings. The information obtained from the healthcare providers and patients, together with the basic principles for MRs, as applied in the Netherlands, led to a definitive and promising MR format with practical recommendations for community pharmacists in Aruba: in comparison with the Dutch MR approach, GPs and pharmacists in Aruba could collaborate more on patient selection for MRs and their follow-up, because of their specific knowledge regarding the medications patients are taking chronically (pharmacists), and possible low levels of health literacy (GPs). Taking into account the Aruban culture, pharmacists could ask extra questions during MRs, referring to lifestyle (high prevalence of obesity), readability of medication labels (limited literacy), and herbal product use (Latin American culture). GPs and medical specialists sometimes experience miscommunication regarding the prescription of medication, which means that pharmacists must carefully take into account possible duplicate medications or interactions.

Keywords: Aruba; community pharmacy; general practitioner; healthcare; medication review; patient; pharmacist.

Figure 1

Design of the mixed-methods pilot study on implementing medication reviews in Aruban pharmaceutical healthcare.

Figure 2

The main purposes of an MR, according to GPs and pharmacists, measured before education about MRs (T = 0) and after education about MRs (T = 1). The shares of the different answers are shown in percentages (%).

Figure 3

Attitude towards and knowledge about MRs of Aruban GPs and pharmacists, measured before education about MRs (T = 0) and after education about MRs (T = 1) in terms of the scores on the Likert-scale questions. The number of maximum answer options per question is represented by the brown line.

Figure 4

Overview of the opinions about the overall responsibility while conducting an MR. Average percentages are shown that reflect the degree of responsibility of the GP, pharmacist, and patient in an MR, as described by the participating pharmacists and GPs. (a) Opinions of the pharmacists before the education about MRs (T = 0). (b) Opinions of the pharmacists after the education about MRs (T = 1). (c) Opinions of the GPs before the education about MRs (T = 0). (d) Opinions of the GPs after the education about MRs (T = 1).

Figure 5

Description of main impediments in conducting MRs, according to the participating GPs and pharmacists. Each GP and pharmacist was only allowed to indicate the one impediment which they considered most relevant. (a) Opinions of the pharmacists before education about MRs (T = 0) and immediately after education (T = 1). (b) Opinions of the GPs before education about MRs (T = 0) and immediately after education (T = 1).

Figure 6

Overview of themes that may play a role during MRs in Aruba, according to the participating GPs, pharmacists, and pharmacy owner.

Figure 7

The number of interventions detected during the pharmacotherapeutic anamnesis of the pilot MRs.

Figure 8

The experiences of the patients participating in the pilot MR, measured by means of a survey. Experiences are displayed by means of a Likert-scale score. The number of maximum answer options per question is represented by the brown line.