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Keywords:

  • inequality and ethnic minorities;
  • medicine management;
  • medicine-related problems;
  • medicine use

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Implications for further research
  9. Declarations
  10. References

Objective

The aim of this review was to establish type(s) and possible cause(s) of medicine-related problems (MRPs) experienced by ethnic minorities in the UK and to identify recommendations to support these patients in the effective use of medicines.

Methods

A systematic search of studies related to problems with medicine use experienced by ethnic minorities in the UK was performed using the following databases: PubMed, Embase, International Pharmaceutical Abstract and Scopus from 1990 to 2011. A hand search for relevant citations and key journals was also performed.

Key findings

Fifteen studies were found. The MRPs identified across studies included lack of information, problems with not taking medicines as advised, concern of dependency or side effects, lack of regular monitoring and review, risk of adverse drug reactions, adverse events and problems in accessing healthcare services. Many problems are common in other groups, however, studies examining possible explanatory factors discussed how the cultural and religious beliefs, previous experiences, different expectations, language and communication barriers, lack of knowledge of the healthcare services and underestimating patients' desire for information may contribute to the problems. Some of the recommendations were made based on the problems that were found, but these have not been evaluated.

Conclusions

Little evidence is known of what influences MRPs among ethnic minorities, despite the increased diversification of populations in countries throughout the world. To support their entire populations in the use of medicines, we have to ensure that we understand their different perspectives and needs regarding the effective use of medicines.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Implications for further research
  9. Declarations
  10. References

The ethnic minority populations in the UK are growing substantially as a consequence of continued immigration, high birth rate and youthful age-structure.[1] The 1991 and 2001 UK census, which both included a mandatory question on ethnic identity, revealed that the proportion of the UK population classifying themselves as belonging to a non-white minority group increased by 53% over this 10-year period, from 3 million to 4.6 million (or 7.9% of the UK population).[2, 3] The proportion of ethnic minority groups is expected to rise from 8% of the population, as recorded in the 2001 census, to 27% by 2031 and to 43% by 2056.[4] Not only the UK but countries all over the world are diversifying in terms of ethnic makeup.[3] Therefore, the needs and perspectives of different minority groups are of increasing importance to many countries, including the UK.

The term ‘ethnicity’ refers to a group or community that is assumed to share common cultural practices, history, religion, language and territory.[5] Ethnicity is a concept that refers to all population groups.[5] The ‘majority ethnic group’ is sometimes used to refer to the principal group in any society such as white British in the UK.[5] The concept ‘ethnic minority’ refers to many diverse ethnic groups of extreme heterogeneity.[6, 7] The concept is used for groups that share minority status in their country of residence due to ethnicity, place of birth, language, religion, citizenship and other cultural differences.[6, 7] It sets apart a particular group in both numerical and (often) socioeconomical terms. Members of these groups are considered to practise different cultural norms and values from the majority culture and (often) speak a different mother tongue.[6, 7] Ethnic minority groups vary in duration of stay, extent of acculturation and degree of access to the majority culture. Ethnic minority groups include newly arrived immigrants and (minority) groups that have been a part of a country's history for hundreds of years.[7] Unlike race, which is seen as inherited and thought to be visible in physical differences,[5] ethnicity is concerned with cultural identity which is the focus of this review in relation to the use of medicines.

The ethnic minority groups as identified in the UK census 2011 include ‘Asian/Asian British’ ‘Black/African/Caribbean/Black British’, in addition to those identifying as ‘Mixed/multiple ethnic group’ and ‘Other ethnic group’.[8] Although the patterns of ethnic minority distribution may differ between groups, they tend to be more concentrated in urban areas.[9]

People from many ethnic minorities tend to perceive themselves as less healthy than those in the general UK population.[10] In particular, those from the Indian subcontinent reported ‘bad’ or ‘very bad’ health when they were asked to self-report their health status.[10] Despite their heterogeneity, ethnic minorities in general often have a higher prevalence of chronic diseases including diabetes, cardiovascular disease, rheumatoid and respiratory disease for which effective management depends on the use of medicines.[1, 11-13]

The higher prevalence of chronic diseases among ethnic minority populations may lead to co-morbidities and multiple drug therapies and consequently medicine-related problems (MRPs).[14, 15] Patients from different cultural backgrounds may be expected to have their own perceptions and beliefs which will affect their use of medicines. In addition, ethnic minority groups are associated with communication and language barriers, and different experiences, needs and expectations than the wider UK population which may also influence their ability to manage their medicines effectively.[16-18] Moreover, it is acknowledged in most healthcare systems that ethnic minority groups have experienced inequalities in health and in accessing healthcare services.[7, 17, 18] There has been extensive research on health problems of ethnic minority groups, especially access to care which can result in differences in health outcomes, but there has been little research which specifically examines medicines use.[19] Also, evidence suggests that medicines-related needs may be poorly met for these groups.[14, 15, 20-23]

Because the definitions of MRPs are wide and include problems ranging from prescribing errors through to obtaining supplies, monitoring for appropriateness and patient behaviours which influence their use, a broad definition of MRPs by Gordon et al.[16] was used in this review to include all these aspects. Gordon et al. defined a MRP as ‘any problem experienced by a patient that may impact on their ability to manage or take their medicines effectively’.[16] The aim of this review was to establish type(s) and possible contributing factor(s) of MRPs experienced by ethnic minority populations in the UK and to identify interventions or recommendations to support these groups in their use of medicines.

Methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Implications for further research
  9. Declarations
  10. References

Data sources

Electronic databases of PubMed, Embase, International Pharmaceutical Abstract and Scopus were searched for the period from 1990 to 2011. Reference lists of retrieved articles and relevant review articles were manually examined for further relevant studies. A hand search of key journals: the International Journal of Pharmacy Practice, Pharmacy World and Science and the Annals of Pharmacotherapy was also performed.

Search terms and search strategy

Identifying studies of MRPs experienced by ethnic minorities in the UK presented challenges. The review commenced with three main keywords: ‘medicine-related problem’, ‘ethnicity’ and ‘United Kingdom’. Lists of search terms associated with each keyword were generated from MeSH (medical subject heading) terms in PubMed and term-mapping database in Embase. The MeSH terms and map terms provide a consistent way to retrieve information that may use different terminology for the same concepts. Relevant terms were also handpicked from the literature during the course of the review.[24, 25] Keywords not listed as MeSH or map terms were searched as phrases using the free text search mode.

‘Medicine-related problem’ or ‘drug-related problem’ are not key words, MeSH terms or map terms. Thus, a number of terms were required to describe problems related to the use of medications such as adverse drug reaction, adverse drug event, drug therapy problem and medication error. A further list of search terms was generated by referring to two key papers. The first article was a review on MRP classification systems by Van Mil et al.[24] which provided an overview and appraisal of classification of medicine-related problems for use during the pharmaceutical care process and research in pharmacy. The second article by AbuRuz et al.[25] aimed to develop and validate a tool to classify and assess MRPs in which an MRP was referred to as ‘treatment related problem’. These two articles had also reported difficulties in identifying previous literature on MRPs from databases. Each article suggested a list of search terms for ‘medicine-related problems’. The search terms reported by these articles include drug related problem,[24, 25] medicine related problem,[24, 25] drug therapy problem, treatment related problem, therapy related problem, medication error and pharmaceutical care issue.[25] The different keywords used to search for relevant articles in this review are presented in Table 1.

Table 1. A list of search terms used for this review (in PubMed, Embase, International Pharmaceutical Abstract and Scopus)
Search terms for ‘Medicine-related problem’AndSearch terms for ‘Ethnicity’AndSearch terms for ‘United Kingdom’

‘Drug related problem(s)’

OR

‘Drug therapy problem(s)’

OR

‘Drug self medication’

OR

‘Drug self administration’

OR

‘Drug toxicity’

OR

‘Adverse drug reaction’

OR

‘Drug interaction’

OR

‘Drug intoxication’

OR

‘drug contraindication’

OR

‘Adverse drug effect’

OR

‘Overdose’

OR

‘Polypharmacy’

OR

‘Drug evaluation’

OR

‘Drug dose’

OR

‘Drug monitoring’

OR

‘Drug safety’

OR

‘Drug screening’

OR

‘Drug seeking behaviour’

OR

‘Drug tolerability’

OR

‘Drug tolerance’

OR

‘Drug use’

OR

‘Drug monitoring’

OR

‘Drug utilisation’

OR

‘Medicine related problem(s)’

OR

‘Medication error(s)’

OR

‘Medication adherence’

OR

‘Medication compliance’

OR

‘Medication therapy management’

OR

‘Therapy related problem(s)’

OR

‘Treatment related problem(s)’

OR

‘Pharmaceutical care issue(s)’

 

‘Ethnicity’

OR

‘Ethnic group(s)’

OR

‘Race’

OR

‘Racial group(s)’

OR

‘Religion’

OR

‘Religious group(s)’

OR

‘Minority group(s)’

 

‘United Kingdom’

OR

‘Great Britain’

OR

‘England’

A further difficulty was the limited reporting of the ethnic profile of participants in previous studies. It has been argued that the under-representation of minority ethnic groups in studies may be because participants of ethnic minorities fail to understand the importance of the research process or they are unable to participate because of language barriers.[26] However, another possible explanation would be that some researchers have not received training or do not recognise the complexity or importance of incorporating the perspective of minority populations into their research and thus assume the cultural perspective or need of the majority in the conduct of their research.[27]

Selection criteria

The articles were selected through titles and abstracts by the first author of this paper (FA). The criteria for relevant studies were: (1) involving people from an ethnic minority background and aged over 18; (2) those reporting types and/or potential causes of MRPs and/or interventions or recommendations made to address the problems or to support ethnic minorities in the use of medicines; (3) studies reported in English and conducted in the UK; and (4) original research employing quantitative and/or qualitative methods as well as literature reviews.

Process of data extraction

Electronic databases were searched and duplicate articles were removed. All articles were reviewed manually by title, abstract and/or full text for relevance. The reference lists of retrieved articles and relevant review articles were manually examined for further applicable studies. The key journals were also manually screened for further relevant articles. Full-text manuscripts were retrieved either electronically or as hard copy for assessment. Information was extracted into a pro forma which included: primary author name and date of publication, study design and study duration, participants' age, setting, sample, type(s) and possible cause(s) of MRPs, intervention or recommendations to address the problems or to support ethnic minorities in the use of medicines. Studies of MRPs experienced by ethnic minority patients in the UK are shown in Table 2.

Table 2. Studies on medicine use and medicine-related problems experienced by ethnic minority patients in the UK
Primary author (date)Study design and study durationAge (years)SettingSampleTypes of problems identifiedPotential causes of problemsInterventions or recommendations to support patients in the use of medicines
  1. ADRs, adverse drug reactions; ANS, autonomic nervous system; CHF, chronic heart failure; CVS, cardiovascular system; DMARDs, disease-modifying anti-rheumatic drugs; GP general practitioner; MRP, medication-related problems; SIMS, Satisfaction with Information about Medicines.

Wheatly (1993)[32]Not stated.Not stated.Intensive care unit.Not stated.Problems with not taking medicines as advised.Religious beliefs and lack of information provided to patients on the use of medicines.Not stated.
Chan (2000)[20]Structured and semi-structured face-to-face interviews.20–45; Chinese mothers.GP surgeries and patients' homes.38 GPs, 26 health visitors and 30 Chinese mothers of preschool children.Problems with access to health services, problems with poor compliance as well as problems with late in seeking antenatal care.

Communication and language barriers;

problems with interpretation provided;

problems with non-prescription medicine;

limited knowledge of the medical and healthcare system;

lack of belief in the treatment they received.

Increased involvement of ethnic minority groups in healthcare provision and utilisation.

Lip

(2002)[21]

Cross- sectional survey and questionnaire-based interviews, (11 months).Mean age 69 ± 9.Anticoag-ulation clinics.44% White European, 33% Indo-Asian, 23% Afro-Caribbean.

Some patients had limited knowledge of atrial fibrillation as well as its consequences and therapy;

problems with not taking medicines as advised.

Ethnic, cultural and religious differences;

communication and language barriers;

poor amount of counselling and information given to patients by healthcare professionals.

Not stated.

Horne

(2004)[33]

Exploratory, cross-sectional study using the Beliefs about Medicines Questionnaire and the Sensitive Soma scale.Mean age: European 24.2; Asian 22.Not stated500 UK undergraduate students of Asian (n = 83) or European (n = 417) origin.

High risk of not taking medicines as advised.

Students of South Asian origin had higher General Harm score than those of European origin (i.e. they perceived medicines as being intrinsically harmful, addictive substances that should be avoided (P < 0.001) and they were significantly (P < 0.001) less likely to endorse the benefits of modern medication).

Cultural beliefs;

current and previous experience of taking medication.

Not stated.
Lip (2004)[22]Cross-sectional survey and questionnaire-based interviews, (3 months).Mean age of total cohort 71.Heart failure clinics.103 Patients with CHF: 42 white, 34 Indo-Asian, 22 Afro-Caribbean and five ‘Oriental’.

Indo-Asians and Afro-Caribbeans were less aware of CHF as well as its consequences and therapy;

problems with not taking medicines as advised.

Ethnic, cultural and religious differences;

communication and language barriers;

poor amount of counselling and information given to patients.

Not stated.
Pardhan (2004)[34]Survey (22 months).> 40.Diabetic clinics.500 Patients (268 South Asians and 232 Europeans).

South Asians were less aware of diabetes as well as its consequences;

problems with not taking medicines as advised and missing clinical appointments.

Cultural and religious influences;

language and communication barriers;

problems with interpretation provided.

Using pictorial flashcards to provide information for illiterate people instead of providing written information in a native language;

providing bilingual link-workers.

Morgan (2005)[23]Focus-group interviews.18–68.Community centres.44 Africans.

Health service barriers;

intentional and unintentional non-adherence with drug regime;

cognitive problems affecting use of medicines;

lack of knowledge of illness as well as its therapies;

concern of side effects of the drugs;

problems with accessing healthcare services.

Cultural beliefs of illness, prescribed treatment and healthcare providers;

poor amount of counselling and information given to patients.

Providing patients' education;

improve provider–patient communication.

Lawton (2005)[35]Observational cross sectional study using in-depth interviews.30 to ≥71.Patients' homes.32 Patients from Pakistan and India.

problems with not taking medicines as advised;

fear of dependency.

Cultural beliefs of prescribed treatment and healthcare providers.

Providing patient education and counselling;

improve provider–patient communication;

providing bilingual link workers.

McDowell (2006)[28]Systematic review and meta-analysis.Not stated.Not statedEast Asian and black.Risk of ADRs to cardiovascular drugs.Ethnic differences which are believed to affect response to drugs such as different distribution of cytochrome P450 genotype in different ethnic groups.Not stated.
Gordon (2007)[36]Face-to-face in-depth interviews.≥18.Patients' homes.83% White and 17% black.

Perceptions of side effects and methods of coping;

views and actions regarding the use of medicines;

cognitive, physical and sensory problems affecting use of medicines;

lack of information or understanding about use of medicines;

problems in services access.

Underestimating patients' desire for information.

Involve patients in evidence-informed decision making for safer and more effective disease and medicine managements.

Encourage pharmacists and patients to work together and share their experiences regarding the use of medicines and exchange information that will support patients in achieving optimal outcomes from their medications.

Encourage effective communication between secondary and primary care and patients for the continuity of safe and effective therapy.

Kumar (2008)[31]Face-to-face interviews using the Beliefs about Medicine Questionnaire, the SF-36 health survey and the Health Assessment Questionnaire, (9 months).Not stated.Outpatient Rheumatology Departments.100 Patients of South Asian origin and 100 patients of white British/Irish origin.Patients of South Asian origin had high Specific Concern, General Overuse and the General Harm scores (i.e. Asian patients believed that drugs in general were more overused and more harmful than white participants and they were also more concerned about their DMARDs).Cultural beliefs.Not stated.
Ormerod (2008)[29]Systematic review and meta-analysis.Not stated.Not stated.Different ethnic groups.High risk of ADRs in patients treated with antipsychotics.Not stated.Not stated.
Sidi (2009)[14]Face-to-face interviews using general health status (SF-36), MRP screening tool and SIMS scale.18–85.Community pharmacy.32 South Asians.

Lack of information on medicines;

intentional non-compliance;

lack of monitoring and review of medicines.

Pharmacy lack of information or opportunity to discuss medication-related issues or concerns;

language issues.

Not stated.
Opara (2010)[15]Face-to-face interviews using MRP screening tool and SIMS scale.18–85.Community pharmacies.South Asian.Intentional non-adherence and lack of regular monitoring or review.

Cultural and language issues;

‘blind belief’ and not recognising the pharmaceutical role of pharmacist;

limited understanding of patients' medicines.

Not stated.
Tsang (2010)[30]Descriptive analyses; 12 months.0–104.GP practices.White and Asian.Adverse events, ADRs and adverse effects.

Cut, puncture, perforation or haemorrhage during medical care;

systemic antibiotic affecting ANS and CVS.

Not stated.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Implications for further research
  9. Declarations
  10. References

The electronic database search retrieved a total of 145 titles, of which two were duplicates. Screening of titles, abstracts and/or full texts for the remaining 143 identified that six were related to MRPs.[15, 20, 23, 28-30] Manual screening of the journals retrieved one article[31] and a hand search of citations retrieved articles from the electronic database, and journals, which led to a further eight articles.[14, 21, 22, 32-36] Thus, 15 articles in total were included in this review. The summary of the literature review search process is illustrated in Figure 1.

figure

Figure 1. Summary of the literature review search process for medicines-related problems (MRPs). The databases searched were: PubMed, Embase, International Pharmaceutical Abstract and Scopus.

Download figure to PowerPoint

Twelve of the 15 studies examined patients' perspectives on, and experiences of, the use of medicines in terms of views and actions regarding illness and the use of medicines.[14, 15, 20-23, 31-36] The remaining studies (n = 3) examined MRPs in terms of adverse drug reactions (ADRs)[28, 29] or adverse events (AEs).[30]

The studies included: quantitative studies (n = 6);[21, 22, 30, 31, 33, 34] qualitative studies (n = 4);[20, 23, 35, 36] studies that combined quantitative and qualitative methods (n = 2);[14, 15] and systematic reviews (n = 2).[28, 29] Data were collected in surveys,[21, 22, 33, 34] semi-structured interviews[14, 15, 20, 35, 36] or focus-group interviews.[23] Fourteen of the studies were conducted among adult populations and one included all ages.[30] The settings of these studies were GP practices (n = 2),[20, 30] clinics (n = 4),[17, 18, 27, 30] community pharmacies (n = 2),[14, 15] community centres (n = 1)[23] and patients' homes (n = 3).[20, 35, 36] The studies were carried out in the UK and a great number of ethnic minorities were involved such as South Asian,[14, 15, 28-30] Afro-Caribbean[21-23, 28, 29, 35, 36] and Chinese.[20] Five of the 15 studies evaluated MRPs among patients with a specific long-term condition.[21-23, 32, 34]

Type(s) and possible cause(s) of medicine-related problems identified across studies

The MRPs identified by the literature search among ethnic minorities across the studies included limited knowledge of illness as well as its consequences and therapies,[14, 21-23, 33-36] problems with not taking medicines as advised,[14, 15, 20-23, 31-35] problems with missing clinical appointments,[34] high risk of ADRs,[28, 29] drug interactions and AEs,[30] concern or fear of dependency or side effects of the drugs,[23, 36] cognitive, physical and sensory problems affecting use of medicines,[36] language and communication barriers,[14, 20] lack of regular monitoring and review of medicines,[14, 15, 21, 36] problems with non-prescription medicines[15, 20] and problems in the use of, and access to, healthcare services.[20, 23, 36]

The most frequently reported types of MRPs were: limited knowledge of illness, its consequences and therapies,[14, 21-23, 33-36] and problems with not taking medicines as advised.[14, 15, 20-23, 31-35] These are common to other populations. However, in ethnic minority groups differing cultural perceptions or beliefs about health, illness, prescribed treatment and medical care may also impact on the use of medicines.[20-23, 31, 33-35] Ethnic minority groups have also been shown to have different experiences, needs, values and expectations of illness, prescribed treatment and medical care.[20, 23, 33] In addition, language and communication barriers have been identified in the literature as a possible contributory factor to MRPs[14] as well as affecting the use of health services.[7, 14, 20-22, 33, 34] This is because some authors believed that lack of language skills may affect communication between ethnic minority patients and healthcare personnel. It is suggested that the inability to communicate in what is not the ethnic minorities' mother tongue may lead to discrimination; because of the lack of a common language, ethnic minorities may struggle to express themselves and to feel comfortable asking questions.[7] Language difficulties can have a harmful effect upon the patient's ability to understand proposed treatments and remedies completely.[7] They also prevent the physicians' attempts at obtaining vital medical history easily, which may present medical risks if a misunderstanding with obtaining medical history occurs.[7]

Another factor identified in the literature as potentially causing MRPs included the difficulty in obtaining a suitable interpreter among friends or relatives,[20] or relying primarily on relatives or interpreters which may lead to information being lost or changed.[23] Religious influences,[21, 22, 32, 34] high expectations and negative perceptions and attitudes towards healthcare services and healthcare providers have also been identified across the studies as a potential cause of MRPs.[15, 20, 23] Lack of knowledge of the healthcare services and how to use them is also a further possible contributing factor for MRPs that has been identified; for example, some ethnic minority patients have no knowledge of the pharmaceutical care role of pharmacists which may lead to lack of regular monitoring and review of their medicines.[15, 20] According to the literature, underestimating patients' desire for information, which may be a consequence of a lack of awareness of the extent of patients' decision-making regarding the use of their medicines and/or poor appreciation of their experience of MRPs,[36] may well cause MRPs.

Recommendations made to support ethnic minority patients in the use of medicines

Some recommendations were made across the studies to support patients in the use of medicines. The recommendations involved providing patient counselling and education programmes about their disease, its management and medicines and the service available,[23, 35] providing an interpreter for ethnic minorities who cannot speak English, using pictorial flashcards to provide information for illiterate people,[34] providing bilingual link-workers who explain reasons for regular appointments and provide encouragement and a cultural bridge between healthcare professionals and patients,[34, 35] increasing involvement of ethnic minorities in decisions about healthcare provision and utilisation,[20] involving patients in evidence-informed decision making for safer and more effective disease and medicine managements.[32]

Further recommendations included not only improving provider–patients communication by understanding of cultural factors that inform their beliefs and practices but also ensuring that mechanisms are in place for the effective transfer of information,[35] encouraging pharmacists and patients to work together and share their experiences regarding the use of medicines as well as exchanging information that will support patients achieving optimal outcomes from their medicines,[36] encouraging effective reliable communication between secondary and primary care, surgeries, pharmacies and patients for the continuity of safe and effective therapy,[36] providing enhanced pharmaceutical services in areas of health inequalities and to such minority groups.[15]

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Implications for further research
  9. Declarations
  10. References

This review brings together the information in the current literature regarding medicine use and MRPs experienced by ethnic minority groups in the UK. Our findings suggest that there was variability seen in type(s) and possible cause(s) of MRPs identified across studies as well as recommendations made to support these groups in their use of medicines, which may be explained by differences in purpose of the study, ethnic group of participants, definition of a MRP, different disease condition, study setting, methodology used and the duration of follow-up for problem identification. However, common issues such as access to care and cultural perspective arise across different ethnic minority groups.

Identifying studies and key words on MRPs experienced by ethnic minority populations in the UK were challenging. Thus, there is a possibility that some relevant studies were not included despite a thorough investigation. Secondly, to ensure a scientific evidence base this review includes only peer-reviewed journal articles. Thirdly, as discussed above, some of the studies included in this review were either small with numbers of ethnic minority participants (ranging from 17–44, with a median of 32 patients),[14, 20, 23, 32, 35, 36] or did not report the sample size (n = 3).[15, 30, 32] The results are also limited by the short length of follow-up for problem identification.[14, 15, 20, 23, 33, 35, 36] A further limitation is that different terms and definitions were used to describe MRPs among the selected studies. For example, some studies used a wide holistic definition to identify MRPs[14, 15, 36] others used a narrow definition such as ADR,[28, 29] ADE[30] or adherence[23, 35] or used no universally accepted definition.[20-22, 31, 33, 34] Finally, this review focused on ethnic minority groups in the UK. Whilst some similarities and differences might be expected elsewhere, the extent to which findings are relevant to population groups in other countries, societies, settings and contexts is unclear.

There has been no holistic approach or systematic investigation of MRPs among ethnic minorities in the UK. This review highlights that ethnic minority patients have their own problems and needs with both medicine use and service access and also that some ethnic minority groups may be at higher risk of MRPs than the majority ethnic group.[21, 22, 28, 29, 34, 35] This is possibly because ethnic minority patients may experience more difficulties in accessing healthcare services, getting the correct diagnosis and medicine, being supported with the use of medicines and getting regular monitoring or review. The full body of evidence on the extent to which ethnic minorities have more or less MRPs than the majority ethnic group is lacking. However, we can anticipate that ethnic minorities have their own perspectives and needs because of cultural and religious issues, language and communication barriers, previous experiences and different expectations. Recommendations made in the literature to support ethnic minorities in the effective use of medicines have not been evaluated. The recommendations need to be addressed for all stages including diagnosis of disease, safe and effective use of medicines, monitoring or review of their chronic disease and medication regimens.

Differences in the use of medicines would be expected between different ethnic minority groups. However, this review clearly shows that articles on medicine use and MRPs experienced by ethnic minorities in the UK are limited in number. As a consequence, it is not possible to separately identify MRPs from the perspective of each ethnic minority group. Little evidence is known of what influences MRPs among ethnic minorities, despite the diversifying world in terms of ethnic makeup and expanding field of research in use of medicines. Therefore, there is a need for more studies that examine medicine-related needs for ethnic minority groups to ensure we effectively serve the requirements of all populations and that all groups are supported in their use of medicines.

Conclusion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Implications for further research
  9. Declarations
  10. References

There has been no holistic approach or systematic investigation of MRPs among ethnic minorities in the UK. However, this review highlights that ethnic minority patients have their own problems and needs with both medicine-use and service access. Therefore, there is a need for further research to be done in this area and for these patient groups.

Implications for further research

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Implications for further research
  9. Declarations
  10. References

The findings from this review have wide-ranging and important implications for the research community in the UK and beyond. For instance, researchers should include ethnic minority groups more in health research, and the research should be designed to identify and address the needs and perspectives of ethnic minority groups. Researchers should also ensure that ethnic minority groups fully understand what taking part involves, for example by generating translated materials and using interpreters when needed. Further research should be a priority internationally. Whilst many problems and solutions may be context specific, issues such as access to care and differing cultural perspectives, which are common among ethnic minority groups in the UK, may occur among ethnic minority groups living in other countries.

Declarations

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Implications for further research
  9. Declarations
  10. References

Conflict of interest

The Author(s) declare(s) that they have no conflicts of interest to disclose.

Funding

This is a privately funded PhD study.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Implications for further research
  9. Declarations
  10. References
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