Pharmacists' views on Indigenous health: is there more that can be done?

Our previous study explored the views of Aboriginal health workers (AHWs) in mid western New South Wales (NSW), Australia, in relation to pharmacy and the access to, and use of medicines by Indigenous Australians. That study also explored suggestions made by AHWs to improve the situation. This research aimed to ascertain the readiness and willingness of community pharmacists in rural and remote NSW to take on a greater role in relation to Indigenous health by exploring their knowledge and opinions about Indigenous health, their current interaction with Indigenous people, and their views as to feasible and achievable ways to help. Pharmacists' views were compared with those of the AHWs elicited in the previous study and any differences in perceptions noted.

Twenty seven semi-structured, face-to-face, in-depth interviews were carried out with NSW community pharmacists working in areas with an Indigenous population. All except one of the 27 pharmacists were based in a rural or remote setting. A qualitative research method was used and the concepts explored in the interviews included pharmacists' current knowledge of Indigenous health, views on the feasibility of proposed new programs from the previous study, and any other ideas that may improve Indigenous health. The interviews were audio recorded, transcribed verbatim, then thematically content analysed.

Pharmacists identified chronic diseases as the main health concerns and many felt their Indigenous customers experienced these at a high rate, at a young age of onset and generally had poor management of the condition. They were aware that AHWs were available in their community but interaction varied. Almost all pharmacists felt that Indigenous people were comfortable shopping in their pharmacies, and identified lack of money as the major barrier to access to medicines. Many pharmacists felt that Indigenous patients would be best served in the pharmacy if medications were available at no charge; however, they seemed to be unaware that Indigenous people often feel uncomfortable entering their pharmacies. The majority felt the AHWs' ideas, such as periodically having an AHW in the pharmacy, cultural awareness training and increased collaboration between pharmacists and AHWs, may be of benefit.

Despite the potential for expansion of the role of the pharmacist in Indigenous health, the majority of participants in this study were reluctant to commit themselves more than at present unless the financial barriers were removed. In addition, although they expressed an openness to undergoing training in cultural safety, and a willingness to have a greater understanding of Indigenous culture, they were very conscious of a lack of time to do so, a situation generally resulting from a shortage of pharmacists. Their awareness of and current interactions with AHWs were limited, but all participants could see the potential value of working more closely with these important members of the healthcare team. If the proposed extension of Section 100 of the Australian Pharmaceutical Benefits Scheme goes ahead and financial barriers are removed, it then remains for pharmacists to take up the challenge to increase their own understanding of Indigenous health issues and form collaborative partnerships with their AHW counterparts. Then a real change for the better in mainstream pharmacy services may be achieved.