Medication management reviews for people from the former Yugoslavia now resident in Australia • Jasmina Bajramovic Fejzic and Susan E. Tett Pharm World Sci 2004; 26: 271–276. © 2004 Kluwer Academic Publishers. Printed in the Netherlands. J. Bajramovic Fejzic, S.E. Tett (correspondence, e-mail: s.tett@pharmacy.uq.edu.au): School of Pharmacy, The University of Queensland, Brisbane, QLD 4072, Australia Keywords Australia Medication management Medication review Multicultural Pharmaceutical needs Quality use of medicines Abstract Aim: The objective of this prospective study was to conduct medication management reviews (MMR) in people from a non-English speaking background (NESB) (Bosnian/Serbian/ Croatian, from former Yugoslavia, currently residing in Australia) in their native language in order to identify medication-related problems (needs analysis) and implement appropriate therapeutic interventions, in collaboration with their general practitioners (GPs). Methods: Twenty-five participants entered the study. Each was interviewed and medication-related issues were identified by the health care team. Results: Various interventions (over 150 for the whole group, an average of 6 per participant), based on actual and potential medication-related problems, were designed to improve the use of medicines. The MMRs introduced effective changes into the participants’ health care. Psychological (e.g., feeling depressed) and sociological factors (e.g., costs of medicines, not understanding labels written in English) were identified as having significant impacts on medication management. Conclusions: These data confirmed there are avoidable medication-related problems in people from a NESB. GPs and pharmacists working in health care teams with a trained interpreter could greatly improve medication use through regular review and a team approach to problem identification and solving. Accepted November 2003 Introduction Medication management reviews (MMR) are a useful tool, designed to provide a total overview of a con- sumers’ medicines, considering whether each specific drug is necessary and still required, whether the dose is still optimal for that individual, how the person is progressing on that medication in the context of their environment, social situation or other relevant factors in their life, measuring both beneficial and adverse outcomes, and, in general, reviewing in a holistic way the place of their specific medicines in their life. These reviews are usually conducted in a consultative man- ner, using a health care team approach, often with a pharmacist and a doctor working collaboratively. A comprehensive literature search (PubMed, Medline, Australia’s Quality Use of Medicines Map (www. qummap.health.gov.au)) revealed no evidence of medication management reviews being conducted in people of non-English speaking background (NESB) in multicultural societies with English as the principal/ only official language, or of any research about the specific pharmaceutical care needs of this population. Australia has always had high immigration rates, but medication use and management for people from di- verse cultural backgrounds coming into an English- speaking environment with, probably, a very different health care system and certainly different expectations about medicines use, has not been a focus of atten- tion. Similar situations exist in many other countries around the world. It has, however, been recognised that immigrants from NESB face difficulties in the Australian health sys- tem, and specifically they are likely to have problems managing medicines 1, 2 . People from NESB are one important group in which to study the needs for med- ication services, to ensure that Australia’s National Medicines Policy, including quality use of medicines, is fulfilled 3 . Good communication between health providers and consumers is the essential requirement for the op- timal use of medicines. Interpreters are often under- used, especially at the interface between health pro- fessionals (e.g., general practitioners (GPs) and phar- macists both need to discuss medication related issues with consumers, but often the interpreter is only present for the doctor’s visit) 4 . Translated written in- formation about diseases or about medicines is not readily available. It has been reported that patients who do not speak English as their native tongue have twice the error rate of an English-speaking group in medication use 5, 6 . Communication problems due to language differ- ences are one of the major barriers to use of health services by people from NESB 7, 8 . In Australia, the Commonwealth Department of Immigration and Mul- ticultural Affairs bears the cost of some telephone in- terpreting services and face-to-face translating during Medicare (government reimbursed) medical consulta- tions, subject to availability of interpreters 8, 9 . Medica- tion counseling by a pharmacist is not covered by Medicare and interpreters are not reimbursed for pharmacy visits. Many problems related to interpreter services and understanding and complying with med- ications have been identified 8 . Patients managing their own medication who are at risk due to language difficulties are likely to benefit from MMRs 10 . There is no evidence, in the published literature, of MMRs being done in this population. The Australian QUM mapping project does not include any such projects 11 . One small study identified language barriers as significant in pharmacy settings 4 . The specific aims of this project were to: 1. Conduct MMRs in people from NESB (specifically in Bosnian/Serbian/Croatian speakers from the former Yugoslavia) now residing in Australia; 2. Conduct a needs analysis and implement appropri- ate therapeutic interventions, in collaboration with the participants’ GPs; 3. Record outcomes resulting from the interventions and recommendations; 4. Determine specific characteristics and needs of this population in relation to quality use of medicines and suggest ways to improve current practice. Research article 271