Aims: Hepatitis C, and its associated life-limiting sequalae, disproportionately affect Māori. De... more Aims: Hepatitis C, and its associated life-limiting sequalae, disproportionately affect Māori. Despite availability of fully funded effective and well-tolerated oral direct-acting anti-viral agents (DAA), many in New Zealand remain untreated. This service evaluation aimed to explore the experiences of Māori who have received DAA treatment for hepatitis C, and their ideas for service improvement. Methods: This qualitative service evaluation recruited eligible participants (Māori, 18 years+, DAA treatment since February 2019) through health care providers. Semi-structured interviews were undertaken over the telephone with consenting participants. General inductive analysis was used to generate themes contextualising findings within cultural contexts for Māori, as aligned with Māori methodological research practices. Results: Twelve participants were interviewed. The physical and mental impact hepatitis C can have, and that treatment with DAA leads to improvement in these domains, were highlighted. Proactivity by health professionals was valued, including the benefit of wrap-around services to keep people connected throughout the treatment journey, with participants articulating the ability to self-advocate when needs were not met by other services. Conclusion: Findings can be used to enhance the development of further hepatitis C treatment services, based on Māori experiences of treatment and self-identified solutions for improvement in hepatitis C care.
Background: Maternal vaccinations for influenza and pertussis are recommended in New Zealand to p... more Background: Maternal vaccinations for influenza and pertussis are recommended in New Zealand to protect mothers and their infant from infection. However, maternal immunisation coverage in New Zealand is suboptimal. Furthermore, there is unacceptable inequitable maternal immunisation rates across the country with Māori and Pacific women having significantly lower maternal immunisation rates than those of other New Zealanders. Methods: This research set out to explore what pregnant/recently pregnant Māori and Pacific women knew about immunisation during pregnancy and what factors influenced their decision to be vaccinated. A semi-structured interview guide was developed with questions focusing on knowledge of pertussis and influenza vaccination during pregnancy and decision-making. Māori and Pacific women aged over 16 years were purposively sampled and interviewed in Dunedin and Gisborne, New Zealand between May and August 2021. Interviews were analysed following a directed qualitative content approach. Data were arranged into coding nodes based on the study aims (deductive analysis) informed by previous literature and within these participant experiences were inductively coded into themes and subthemes. Results: Not all women were aware of maternal vaccine recommendations or they diseases they protected against. Many underestimated how dangerous influenza and pertussis could be and some were more concerned about potential harms of the vaccine. Furthermore, understanding potential harms of infection and protection provided by vaccination did not necessarily mean women would choose to be vaccinated. Those who decided to vaccinate felt well-informed, had vaccination recommended by their healthcare provider, and did so to protect their and their infant's health. Those who decided against vaccination were concerned about safety of the vaccines, lacked the information they needed, were not offered the vaccine, or did not consider vaccination a priority. Conclusions: There is a lack of understanding about vaccine benefits and risks of vaccine-preventable diseases which can result in the reinforcement of negative influences such as the fear of side effects. Furthermore, if vaccine benefits are not understood, inaccessibility of vaccines and the precedence of other life priorities may prevent uptake. Being well-informed and supported to make positive decisions to vaccinate in pregnancy is likely to improve vaccine coverage in Māori and Pacific Island New Zealanders.
This study investigates the usage of diclofenac potassium (Cataflam®) purchased as a Pharmacist O... more This study investigates the usage of diclofenac potassium (Cataflam®) purchased as a Pharmacist Only Medicine (requiring personal sale by a pharmacist) from New Zealand pharmacies. Consenting user-purchasers were recruited from 175 pharmacies over four months. Purchasers received a questionnaire for completion seven days post-purchase. Those 'at risk' of adverse events were re-surveyed 30 days post-purchase. The 1 240 purchasers recruited returned 990 valid questionnaires (80% response); these purchasers represented an estimated 40% of all eligible sales. The second questionnaire was sent to 557 respondents with 480 valid responses (86% response). The mean maximal daily dose taken was 90 mg and median duration of use was 3.5 days. The great majority of purchasers reported satisfactory relief of symptoms. Side-effects (mostly minor) were reported by 130 (14%) respondents. Possible contraindications were present in 66 (7%) respondents. This study has allowed insights into the 'real-life' usage of a reclassified medicine in New Zealand.
International Journal of Clinical Pharmacy, Dec 23, 2016
Background In 2012, New Zealand reclassified trimethoprim to allow specially trained pharmacists ... more Background In 2012, New Zealand reclassified trimethoprim to allow specially trained pharmacists to supply it without a prescription to women with symptoms suggesting uncomplicated cystitis, under strict criteria for supply. Objective To assess how this policy change allowing pharmacist supply of trimethoprim affected overall antibiotic supply. Setting Randomly selected community pharmacies throughout New Zealand. Methods Data were collected in pharmacies before the implementation ('baseline') and 1 year later ('post-implementation'). Pharmacy staff recorded prescription and nonprescription supplies for treatment or prevention of suspected urinary tract infections. Women with a prescription for treatment or prevention of presumed urinary tract infection or purchasing a non-prescription medicine for this purpose were invited to self-complete a questionnaire. National prescribing data were extracted for trimethoprim, nitrofurantoin and norfloxacin. Main outcome measure Antibiotic use in women with UTIs from dispensed prescriptions (baseline and post-implementation) and pharmacist-supplied trimethoprim (post-implementation), particularly focusing on women aged 16-65 years with an antibiotic for presumed cystitis without complicating features. Results Baseline data were provided by 139 pharmacies, 120 of which provided post-implementation data. In women with presumed cystitis without complicating features, prescriptions before and after the implementation were primarily for trimethoprim. Overall antibiotic use, and use of secondline agents did not increase post-implementation. Pharmacist-supplies of trimethoprim were modest nearly 1 year after the service started. Conclusion Supply of trimethoprim by specially trained pharmacists working within strict criteria for supply appeared to have little overall effect on antibiotic use. Further research on patient outcomes, resistance and changes over time is recommended. Keywords Anti-bacterials Á Antimicrobial stewardship Á General practice Á New Zealand Á Non-prescription drugs Á Pharmacy Á Trimethoprim Impacts on practice • A practice model of pharmacist-supply with additional training and a screening tool in treating cystitis did not appear to be associated with excessive use of antibiotics or adverse changes in prescribing. Such a practice model could be used more to aid appropriate healthcare consumer access to medicines and reduce pressure elsewhere in the health system.
This study investigates the usage of diclofenac potassium (Cataflam®) purchased as a Pharmacist O... more This study investigates the usage of diclofenac potassium (Cataflam®) purchased as a Pharmacist Only Medicine (requiring personal sale by a pharmacist) from New Zealand pharmacies. Consenting user-purchasers were recruited from 175 pharmacies over four months. Purchasers received a questionnaire for completion seven days post-purchase. Those 'at risk' of adverse events were re-surveyed 30 days post-purchase. The 1 240 purchasers recruited returned 990 valid questionnaires (80% response); these purchasers represented an estimated 40% of all eligible sales. The second questionnaire was sent to 557 respondents with 480 valid responses (86% response). The mean maximal daily dose taken was 90 mg and median duration of use was 3.5 days. The great majority of purchasers reported satisfactory relief of symptoms. Side-effects (mostly minor) were reported by 130 (14%) respondents. Possible contraindications were present in 66 (7%) respondents. This study has allowed insights into the ...
Journal of Health Services Research & Policy, Jul 6, 2015
To identify factors associated with differences between developed countries in reclassifying (swi... more To identify factors associated with differences between developed countries in reclassifying (switching) medicines from prescription to non-prescription availability. Cross-national qualitative research using a heuristic approach in the US, UK, Japan, Australia and New Zealand, supplemented by data from Canada, Denmark, the Netherlands and Singapore. In-depth interviews with 80 key informants (65 interviews) explored and compared factors in terms of barriers and enablers to reclassification of medicines in each country. Document analysis supplemented interview data. Each country had a unique mix of enablers and barriers to reclassification. Enablers included government policy (particularly in UK), pharmacist-only scheduling (particularly in Australia and New Zealand) and large market size (particularly in the US and Europe). Local barriers included limited market potential in small countries, the cost of a reclassification (particularly in the US), competition from distributors of generic medicines, committee inconsistency and consumer behavior. UK had more enablers than barriers, whereas in Australia the opposite was true. Different factors limit or enable reclassification, affecting consumer access to medicines in different countries. For countries attempting to reduce barriers to reclassification, solutions may include garnering government support for reclassification, support and flexibility from the medicines regulator, having a pharmacy-only and/or pharmacist-only category, providing market exclusivity, ensuring best practice in pharmacy, and minimizing the cost and delays of reclassification.
Introduction Uptake of maternal vaccinations (MVs) is suboptimal in Aotearoa New Zealand, particu... more Introduction Uptake of maternal vaccinations (MVs) is suboptimal in Aotearoa New Zealand, particularly for Māori. Aim To describe Māori women’s journeys regarding maternal pertussis and influenza vaccinations and explore influences on uptake. Methods Semi-structured interviews were conducted in Waikato, Aotearoa New Zealand, with pregnant or recently pregnant Māori women, and separately with Māori healthcare professionals (HCPs) to understand women’s decisions regarding MVs and enablers and barriers to uptake. Results Nine women and nine HCPs were interviewed. Verbal communications from midwives, general practice and pharmacy strongly influenced women’s journeys. Women’s decisions appeared largely straight-forward, with influences including awareness, knowledge, underlying beliefs and previous MVs. Enablers for MV uptake included HCPs’ discussions, pro-vaccination beliefs, and accessibility. Barriers for MV uptake included poverty (and transport), lack of awareness, insufficient kno...
BACKGROUND Adequate maternal vaccination coverage is critical for the prevention and control of i... more BACKGROUND Adequate maternal vaccination coverage is critical for the prevention and control of infectious disease outbreaks such as pertussis, influenza, and more recently COVID-19. To guide efforts to increase vaccination coverage this study examined the extent of vaccination coverage in pregnant New Zealand women over time by area-level deprivation and ethnicity. METHODS A retrospective cohort study was used consisting of all pregnant women who delivered between 01 January 2013 and 31 December 2018, using administrative health datasets. Outcomes were defined as receipt of influenza or pertussis vaccination in any one of the relevant data sources (National Immunisation Register, Proclaims, or Pharmaceutical collection) during their eligible pregnancy. Ethnicity was prioritised as Māori (NZ indigenous), Pacific, Asian, and Other or NZ European and deprivation was defined using New Zealand Index of Multiple Deprivation (IMD). RESULTS Between 2013 and 2018, Asian women had the highest maternal vaccination coverage (36%) for pertussis, while Māori and Pacific women had the lowest, 13% and 15% respectively. Coverage of pertussis vaccination during pregnancy in low deprivation Māori women was 24% and 28% in Pacific women. This is in comparison to 30% and 25% in high deprivation Asian and European/Other women, respectively. Similar trends were seen for influenza. CONCLUSION Between 2013 and 2018 maternal vaccination coverage increased for pertussis and influenza. Despite this coverage remains suboptimal, and existing ethnic and deprivation inequities increased. There is an urgent need to focus on equity, to engage and support ethic communities by creating genuinely accessible, culturally appropriate health services.
Although maternal pertussis vaccination is recommended, uptake is suboptimal in New Zealand (NZ),... more Although maternal pertussis vaccination is recommended, uptake is suboptimal in New Zealand (NZ), despite full funding in general practice and hospitals. We determined whether funding maternal pertussis vaccination in community pharmacy increases its uptake. Pertussis vaccination during pregnancy was compared between non-contiguous, demographically similar regions of NZ. The pertussis vaccine was funded at pharmacies from Nov 2016 in one NZ region (Waikato), but not in comparator regions (Northland, Hawkes Bay). Vaccinations during pregnancy were determined from the National Immunisation Register, general practice and pharmacy claims data, and a maternity database. Comparisons were made using adjusted odds ratios (OR) and 95% confidence intervals (CI) for Nov 2015 to Oct 2016 versus Nov 2016 to Oct 2019. The odds of pregnancy pertussis vaccination increased in the post-intervention versus pre-intervention period with this increase being larger (p = 0.0014) in the intervention (35% v...
The uptake of maternal influenza and pertussis vaccinations is often suboptimal. This study explo... more The uptake of maternal influenza and pertussis vaccinations is often suboptimal. This study explores the factors influencing pregnant women’s and health care professionals’ (HCPs) behaviour regarding maternal vaccinations (MVs). Pregnant/recently pregnant women, midwives, pharmacists and general practice staff in Waikato, New Zealand, were interviewed. The analysis used the behaviour change wheel model. Interviews of 18 women and 35 HCPs revealed knowledge about MVs varied with knowledge deficiencies hindering the uptake, particularly for influenza vaccination. HCPs, especially midwives, were key in raising women’s awareness of MVs. Experience with vaccinating, hospital work (for midwives) and training increased HCPs’ knowledge and proactivity about MVs. A “woman’s choice” philosophy saw midwives typically encouraging women to seek information and make their own decision. Women’s decisions were generally based on knowledge, beliefs, HCPs’ emphasis and their perceived risk, with litt...
Objectives To explore pharmacists’ views and experiences of pharmacist-administered vaccinations,... more Objectives To explore pharmacists’ views and experiences of pharmacist-administered vaccinations, motivators and barriers to pharmacists administering vaccinations and their preferences for expansions to such services. Methods All practising pharmacist members (n = 3400) of the Pharmaceutical Society of New Zealand were invited to participate in an online survey in 2017. Key findings A total of 468 pharmacists completed the survey (14%). Most (86%) strongly agreed/agreed that pharmacists should provide vaccinations, primarily citing patient benefit, for example, convenience, potential for increased vaccination uptake, easing general practice burden and better utilisation of the pharmacist. Half had completed vaccinator training, mainly for professional satisfaction, to help public or community health and/or to provide a new service for their community. Trained pharmacists had administered influenza (95%), pertussis (47%), zoster (45%) and/or meningococcal vaccines (13%), with patien...
Background Austria has high health resource use compared to similar countries. Reclassifying (swi... more Background Austria has high health resource use compared to similar countries. Reclassifying (switching) medicines from prescription to non-prescription can reduce pressure on health resources and aid timely access to medicines. Since Austria is less progressive in this area than many other countries, this research aimed to elucidate enablers and barriers to it reclassifying medicines and make recommendations for change in the context of similar research conducted elsewhere. Methods Qualitative research using a heuristic approach was conducted in Austria in 2018. Informed by their own “insider” and “outsider” knowledge, the authors identified themes from personal interviews with 24 participants, including reclassification committee members, government officials and stakeholders, before comparing these themes with earlier research findings. Results Significant barriers to reclassification included committee conservatism, minimal political support, medical negativity and few company a...
Background Since the 1980s, many countries have reclassified medicines from prescription-only sup... more Background Since the 1980s, many countries have reclassified medicines from prescription-only supply to nonprescription, e.g. to widen access to medicines and help manage health resources. However, countries vary in the medicines they have available without prescription. Having a pharmacy-only or pharmacist-only classification of medicines has been suggested to help medicines reclassify but no research has considered the range of factors contributing to international variation in reclassification. Aims The primary aim of this thesis was to understand why developed countries vary in reclassifying medicines from prescription to non-prescription. A second aim was to assess the variation in reclassification between selected countries. Methods The research used a heuristic qualitative methodology, which engaged the researcher as a key component of the research. Five core countries (New Zealand, Australia, the United Kingdom, the United States and Japan), and four supplementary countries (Singapore, Canada, Denmark and the Netherlands) were selected for study. Semi-structured interviews were conducted in these countries with key informants on medicines reclassification. Document analysis supplemented analysis of the interview transcriptions. A tool was developed and implemented to compare countries' progressiveness in reclassification through 'innovative' reclassifications. Results Sixty-five interviews were conducted with 79 key informants. A unique blend of factors contributed to each country's reclassification progressiveness, but particular barriers or enablers typically occurred in two or more countries.
AIMS To ascertain the feasibility and outcomes of point-of-care testing for hepatitis C virus (HC... more AIMS To ascertain the feasibility and outcomes of point-of-care testing for hepatitis C virus (HCV) antibodies in people with risk factors screened in community pharmacies. METHODS Ten pharmacies in the Waitematā District Health Board piloted point-of-care antibody HCV screening with consenting participants. Individuals with a positive HCV antibody result had a confirmatory HCV RNA test performed at a local laboratory, with pharmacist follow-up to discuss the result. RNA positive individuals were referred to their general practitioner for further follow-up including antiviral therapy. Number of tests, number of positives and number treated were collected. Pharmacists completed a survey about their experiences. RESULTS Of 192 participants, seven (3.6%) had positive tests on screening, four of whom had a positive RNA assay and received HCV medication, and one of whom had a positive RNA assay but has not yet received treatment. Two had negative RNA results. Pharmacist feedback was very...
Aims: Hepatitis C, and its associated life-limiting sequalae, disproportionately affect Māori. De... more Aims: Hepatitis C, and its associated life-limiting sequalae, disproportionately affect Māori. Despite availability of fully funded effective and well-tolerated oral direct-acting anti-viral agents (DAA), many in New Zealand remain untreated. This service evaluation aimed to explore the experiences of Māori who have received DAA treatment for hepatitis C, and their ideas for service improvement. Methods: This qualitative service evaluation recruited eligible participants (Māori, 18 years+, DAA treatment since February 2019) through health care providers. Semi-structured interviews were undertaken over the telephone with consenting participants. General inductive analysis was used to generate themes contextualising findings within cultural contexts for Māori, as aligned with Māori methodological research practices. Results: Twelve participants were interviewed. The physical and mental impact hepatitis C can have, and that treatment with DAA leads to improvement in these domains, were highlighted. Proactivity by health professionals was valued, including the benefit of wrap-around services to keep people connected throughout the treatment journey, with participants articulating the ability to self-advocate when needs were not met by other services. Conclusion: Findings can be used to enhance the development of further hepatitis C treatment services, based on Māori experiences of treatment and self-identified solutions for improvement in hepatitis C care.
Background: Maternal vaccinations for influenza and pertussis are recommended in New Zealand to p... more Background: Maternal vaccinations for influenza and pertussis are recommended in New Zealand to protect mothers and their infant from infection. However, maternal immunisation coverage in New Zealand is suboptimal. Furthermore, there is unacceptable inequitable maternal immunisation rates across the country with Māori and Pacific women having significantly lower maternal immunisation rates than those of other New Zealanders. Methods: This research set out to explore what pregnant/recently pregnant Māori and Pacific women knew about immunisation during pregnancy and what factors influenced their decision to be vaccinated. A semi-structured interview guide was developed with questions focusing on knowledge of pertussis and influenza vaccination during pregnancy and decision-making. Māori and Pacific women aged over 16 years were purposively sampled and interviewed in Dunedin and Gisborne, New Zealand between May and August 2021. Interviews were analysed following a directed qualitative content approach. Data were arranged into coding nodes based on the study aims (deductive analysis) informed by previous literature and within these participant experiences were inductively coded into themes and subthemes. Results: Not all women were aware of maternal vaccine recommendations or they diseases they protected against. Many underestimated how dangerous influenza and pertussis could be and some were more concerned about potential harms of the vaccine. Furthermore, understanding potential harms of infection and protection provided by vaccination did not necessarily mean women would choose to be vaccinated. Those who decided to vaccinate felt well-informed, had vaccination recommended by their healthcare provider, and did so to protect their and their infant's health. Those who decided against vaccination were concerned about safety of the vaccines, lacked the information they needed, were not offered the vaccine, or did not consider vaccination a priority. Conclusions: There is a lack of understanding about vaccine benefits and risks of vaccine-preventable diseases which can result in the reinforcement of negative influences such as the fear of side effects. Furthermore, if vaccine benefits are not understood, inaccessibility of vaccines and the precedence of other life priorities may prevent uptake. Being well-informed and supported to make positive decisions to vaccinate in pregnancy is likely to improve vaccine coverage in Māori and Pacific Island New Zealanders.
This study investigates the usage of diclofenac potassium (Cataflam®) purchased as a Pharmacist O... more This study investigates the usage of diclofenac potassium (Cataflam®) purchased as a Pharmacist Only Medicine (requiring personal sale by a pharmacist) from New Zealand pharmacies. Consenting user-purchasers were recruited from 175 pharmacies over four months. Purchasers received a questionnaire for completion seven days post-purchase. Those 'at risk' of adverse events were re-surveyed 30 days post-purchase. The 1 240 purchasers recruited returned 990 valid questionnaires (80% response); these purchasers represented an estimated 40% of all eligible sales. The second questionnaire was sent to 557 respondents with 480 valid responses (86% response). The mean maximal daily dose taken was 90 mg and median duration of use was 3.5 days. The great majority of purchasers reported satisfactory relief of symptoms. Side-effects (mostly minor) were reported by 130 (14%) respondents. Possible contraindications were present in 66 (7%) respondents. This study has allowed insights into the 'real-life' usage of a reclassified medicine in New Zealand.
International Journal of Clinical Pharmacy, Dec 23, 2016
Background In 2012, New Zealand reclassified trimethoprim to allow specially trained pharmacists ... more Background In 2012, New Zealand reclassified trimethoprim to allow specially trained pharmacists to supply it without a prescription to women with symptoms suggesting uncomplicated cystitis, under strict criteria for supply. Objective To assess how this policy change allowing pharmacist supply of trimethoprim affected overall antibiotic supply. Setting Randomly selected community pharmacies throughout New Zealand. Methods Data were collected in pharmacies before the implementation ('baseline') and 1 year later ('post-implementation'). Pharmacy staff recorded prescription and nonprescription supplies for treatment or prevention of suspected urinary tract infections. Women with a prescription for treatment or prevention of presumed urinary tract infection or purchasing a non-prescription medicine for this purpose were invited to self-complete a questionnaire. National prescribing data were extracted for trimethoprim, nitrofurantoin and norfloxacin. Main outcome measure Antibiotic use in women with UTIs from dispensed prescriptions (baseline and post-implementation) and pharmacist-supplied trimethoprim (post-implementation), particularly focusing on women aged 16-65 years with an antibiotic for presumed cystitis without complicating features. Results Baseline data were provided by 139 pharmacies, 120 of which provided post-implementation data. In women with presumed cystitis without complicating features, prescriptions before and after the implementation were primarily for trimethoprim. Overall antibiotic use, and use of secondline agents did not increase post-implementation. Pharmacist-supplies of trimethoprim were modest nearly 1 year after the service started. Conclusion Supply of trimethoprim by specially trained pharmacists working within strict criteria for supply appeared to have little overall effect on antibiotic use. Further research on patient outcomes, resistance and changes over time is recommended. Keywords Anti-bacterials Á Antimicrobial stewardship Á General practice Á New Zealand Á Non-prescription drugs Á Pharmacy Á Trimethoprim Impacts on practice • A practice model of pharmacist-supply with additional training and a screening tool in treating cystitis did not appear to be associated with excessive use of antibiotics or adverse changes in prescribing. Such a practice model could be used more to aid appropriate healthcare consumer access to medicines and reduce pressure elsewhere in the health system.
This study investigates the usage of diclofenac potassium (Cataflam®) purchased as a Pharmacist O... more This study investigates the usage of diclofenac potassium (Cataflam®) purchased as a Pharmacist Only Medicine (requiring personal sale by a pharmacist) from New Zealand pharmacies. Consenting user-purchasers were recruited from 175 pharmacies over four months. Purchasers received a questionnaire for completion seven days post-purchase. Those 'at risk' of adverse events were re-surveyed 30 days post-purchase. The 1 240 purchasers recruited returned 990 valid questionnaires (80% response); these purchasers represented an estimated 40% of all eligible sales. The second questionnaire was sent to 557 respondents with 480 valid responses (86% response). The mean maximal daily dose taken was 90 mg and median duration of use was 3.5 days. The great majority of purchasers reported satisfactory relief of symptoms. Side-effects (mostly minor) were reported by 130 (14%) respondents. Possible contraindications were present in 66 (7%) respondents. This study has allowed insights into the ...
Journal of Health Services Research & Policy, Jul 6, 2015
To identify factors associated with differences between developed countries in reclassifying (swi... more To identify factors associated with differences between developed countries in reclassifying (switching) medicines from prescription to non-prescription availability. Cross-national qualitative research using a heuristic approach in the US, UK, Japan, Australia and New Zealand, supplemented by data from Canada, Denmark, the Netherlands and Singapore. In-depth interviews with 80 key informants (65 interviews) explored and compared factors in terms of barriers and enablers to reclassification of medicines in each country. Document analysis supplemented interview data. Each country had a unique mix of enablers and barriers to reclassification. Enablers included government policy (particularly in UK), pharmacist-only scheduling (particularly in Australia and New Zealand) and large market size (particularly in the US and Europe). Local barriers included limited market potential in small countries, the cost of a reclassification (particularly in the US), competition from distributors of generic medicines, committee inconsistency and consumer behavior. UK had more enablers than barriers, whereas in Australia the opposite was true. Different factors limit or enable reclassification, affecting consumer access to medicines in different countries. For countries attempting to reduce barriers to reclassification, solutions may include garnering government support for reclassification, support and flexibility from the medicines regulator, having a pharmacy-only and/or pharmacist-only category, providing market exclusivity, ensuring best practice in pharmacy, and minimizing the cost and delays of reclassification.
Introduction Uptake of maternal vaccinations (MVs) is suboptimal in Aotearoa New Zealand, particu... more Introduction Uptake of maternal vaccinations (MVs) is suboptimal in Aotearoa New Zealand, particularly for Māori. Aim To describe Māori women’s journeys regarding maternal pertussis and influenza vaccinations and explore influences on uptake. Methods Semi-structured interviews were conducted in Waikato, Aotearoa New Zealand, with pregnant or recently pregnant Māori women, and separately with Māori healthcare professionals (HCPs) to understand women’s decisions regarding MVs and enablers and barriers to uptake. Results Nine women and nine HCPs were interviewed. Verbal communications from midwives, general practice and pharmacy strongly influenced women’s journeys. Women’s decisions appeared largely straight-forward, with influences including awareness, knowledge, underlying beliefs and previous MVs. Enablers for MV uptake included HCPs’ discussions, pro-vaccination beliefs, and accessibility. Barriers for MV uptake included poverty (and transport), lack of awareness, insufficient kno...
BACKGROUND Adequate maternal vaccination coverage is critical for the prevention and control of i... more BACKGROUND Adequate maternal vaccination coverage is critical for the prevention and control of infectious disease outbreaks such as pertussis, influenza, and more recently COVID-19. To guide efforts to increase vaccination coverage this study examined the extent of vaccination coverage in pregnant New Zealand women over time by area-level deprivation and ethnicity. METHODS A retrospective cohort study was used consisting of all pregnant women who delivered between 01 January 2013 and 31 December 2018, using administrative health datasets. Outcomes were defined as receipt of influenza or pertussis vaccination in any one of the relevant data sources (National Immunisation Register, Proclaims, or Pharmaceutical collection) during their eligible pregnancy. Ethnicity was prioritised as Māori (NZ indigenous), Pacific, Asian, and Other or NZ European and deprivation was defined using New Zealand Index of Multiple Deprivation (IMD). RESULTS Between 2013 and 2018, Asian women had the highest maternal vaccination coverage (36%) for pertussis, while Māori and Pacific women had the lowest, 13% and 15% respectively. Coverage of pertussis vaccination during pregnancy in low deprivation Māori women was 24% and 28% in Pacific women. This is in comparison to 30% and 25% in high deprivation Asian and European/Other women, respectively. Similar trends were seen for influenza. CONCLUSION Between 2013 and 2018 maternal vaccination coverage increased for pertussis and influenza. Despite this coverage remains suboptimal, and existing ethnic and deprivation inequities increased. There is an urgent need to focus on equity, to engage and support ethic communities by creating genuinely accessible, culturally appropriate health services.
Although maternal pertussis vaccination is recommended, uptake is suboptimal in New Zealand (NZ),... more Although maternal pertussis vaccination is recommended, uptake is suboptimal in New Zealand (NZ), despite full funding in general practice and hospitals. We determined whether funding maternal pertussis vaccination in community pharmacy increases its uptake. Pertussis vaccination during pregnancy was compared between non-contiguous, demographically similar regions of NZ. The pertussis vaccine was funded at pharmacies from Nov 2016 in one NZ region (Waikato), but not in comparator regions (Northland, Hawkes Bay). Vaccinations during pregnancy were determined from the National Immunisation Register, general practice and pharmacy claims data, and a maternity database. Comparisons were made using adjusted odds ratios (OR) and 95% confidence intervals (CI) for Nov 2015 to Oct 2016 versus Nov 2016 to Oct 2019. The odds of pregnancy pertussis vaccination increased in the post-intervention versus pre-intervention period with this increase being larger (p = 0.0014) in the intervention (35% v...
The uptake of maternal influenza and pertussis vaccinations is often suboptimal. This study explo... more The uptake of maternal influenza and pertussis vaccinations is often suboptimal. This study explores the factors influencing pregnant women’s and health care professionals’ (HCPs) behaviour regarding maternal vaccinations (MVs). Pregnant/recently pregnant women, midwives, pharmacists and general practice staff in Waikato, New Zealand, were interviewed. The analysis used the behaviour change wheel model. Interviews of 18 women and 35 HCPs revealed knowledge about MVs varied with knowledge deficiencies hindering the uptake, particularly for influenza vaccination. HCPs, especially midwives, were key in raising women’s awareness of MVs. Experience with vaccinating, hospital work (for midwives) and training increased HCPs’ knowledge and proactivity about MVs. A “woman’s choice” philosophy saw midwives typically encouraging women to seek information and make their own decision. Women’s decisions were generally based on knowledge, beliefs, HCPs’ emphasis and their perceived risk, with litt...
Objectives To explore pharmacists’ views and experiences of pharmacist-administered vaccinations,... more Objectives To explore pharmacists’ views and experiences of pharmacist-administered vaccinations, motivators and barriers to pharmacists administering vaccinations and their preferences for expansions to such services. Methods All practising pharmacist members (n = 3400) of the Pharmaceutical Society of New Zealand were invited to participate in an online survey in 2017. Key findings A total of 468 pharmacists completed the survey (14%). Most (86%) strongly agreed/agreed that pharmacists should provide vaccinations, primarily citing patient benefit, for example, convenience, potential for increased vaccination uptake, easing general practice burden and better utilisation of the pharmacist. Half had completed vaccinator training, mainly for professional satisfaction, to help public or community health and/or to provide a new service for their community. Trained pharmacists had administered influenza (95%), pertussis (47%), zoster (45%) and/or meningococcal vaccines (13%), with patien...
Background Austria has high health resource use compared to similar countries. Reclassifying (swi... more Background Austria has high health resource use compared to similar countries. Reclassifying (switching) medicines from prescription to non-prescription can reduce pressure on health resources and aid timely access to medicines. Since Austria is less progressive in this area than many other countries, this research aimed to elucidate enablers and barriers to it reclassifying medicines and make recommendations for change in the context of similar research conducted elsewhere. Methods Qualitative research using a heuristic approach was conducted in Austria in 2018. Informed by their own “insider” and “outsider” knowledge, the authors identified themes from personal interviews with 24 participants, including reclassification committee members, government officials and stakeholders, before comparing these themes with earlier research findings. Results Significant barriers to reclassification included committee conservatism, minimal political support, medical negativity and few company a...
Background Since the 1980s, many countries have reclassified medicines from prescription-only sup... more Background Since the 1980s, many countries have reclassified medicines from prescription-only supply to nonprescription, e.g. to widen access to medicines and help manage health resources. However, countries vary in the medicines they have available without prescription. Having a pharmacy-only or pharmacist-only classification of medicines has been suggested to help medicines reclassify but no research has considered the range of factors contributing to international variation in reclassification. Aims The primary aim of this thesis was to understand why developed countries vary in reclassifying medicines from prescription to non-prescription. A second aim was to assess the variation in reclassification between selected countries. Methods The research used a heuristic qualitative methodology, which engaged the researcher as a key component of the research. Five core countries (New Zealand, Australia, the United Kingdom, the United States and Japan), and four supplementary countries (Singapore, Canada, Denmark and the Netherlands) were selected for study. Semi-structured interviews were conducted in these countries with key informants on medicines reclassification. Document analysis supplemented analysis of the interview transcriptions. A tool was developed and implemented to compare countries' progressiveness in reclassification through 'innovative' reclassifications. Results Sixty-five interviews were conducted with 79 key informants. A unique blend of factors contributed to each country's reclassification progressiveness, but particular barriers or enablers typically occurred in two or more countries.
AIMS To ascertain the feasibility and outcomes of point-of-care testing for hepatitis C virus (HC... more AIMS To ascertain the feasibility and outcomes of point-of-care testing for hepatitis C virus (HCV) antibodies in people with risk factors screened in community pharmacies. METHODS Ten pharmacies in the Waitematā District Health Board piloted point-of-care antibody HCV screening with consenting participants. Individuals with a positive HCV antibody result had a confirmatory HCV RNA test performed at a local laboratory, with pharmacist follow-up to discuss the result. RNA positive individuals were referred to their general practitioner for further follow-up including antiviral therapy. Number of tests, number of positives and number treated were collected. Pharmacists completed a survey about their experiences. RESULTS Of 192 participants, seven (3.6%) had positive tests on screening, four of whom had a positive RNA assay and received HCV medication, and one of whom had a positive RNA assay but has not yet received treatment. Two had negative RNA results. Pharmacist feedback was very...
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Papers by Natalie Gauld