Pills often ignored because of cost

Fionna Bell says health matters are complicated for Pacific people. Photo / Richard Robinson

Some Pacific Island families are missing out on medication because they believe illness is caused by their family relationships, a Pacific doctor says.

Dr Fionna Bell, clinical director of the country's biggest Pacific primary health organisation, TaPasefika, says doctors are often frustrated when Pacific patients don't pick up the medicines they prescribe.

But equally, many Pacific patients are frustrated when their doctors don't take time to talk through what may have led to their illness and feel "fobbed off with just another piece of paper".

"Some people might think, 'Well, diabetes is something that affected my grandmother, it affected my mother, I'm named after my grandmother, so for me to get it must be part of my identity'," Dr Bell said.

"Pacific people are relational. I am defined by my relationships: I'm a daughter, a grand-daughter, and so on. If there were chronic illnesses that were part of the family identity, then the perception of where this sickness fits into your identity is more complicated than saying, 'You've got A, if you take B it will get rid of A'."

She was commenting on Otago University research that found Pacific and Maori people were almost three times as likely as Europeans to fail to collect prescribed medicines at least once in the past year because of the cost.

Economic hardship had an even bigger effect than ethnicity. More than half (56.8 per cent) of people reporting at least five out of eight hardship factors, such as staying cold to save heating costs or not being able to afford fresh fruit and vegetables, said they did not collect prescribed medicines at least once in the year because of cost.

But the researchers found that even after adjusting for economic hardship and other factors, Pacific people were still more than twice as likely, and Maori people were 1.3 times as likely, to fail to pick up prescription items as Europeans in comparable circumstances.

Lead researcher Dr Santosh Jatrana said she could only speculate on the possible reasons.

"It might be possible that Maori and Pacific people receive greater numbers of prescriptions because they experience more ill-health and therefore have to pay more co-payments [prescription charges]," she said.

The findings are based on a survey in 2004 when prescription charges were up to $15 an item.

The maximum charge in most cases now is $3.

But Dr Bell said even $3 quickly added up for large families with several items on each prescription.

She said the size of families could partly explain the ethnic differences.

She and Maori health researcher Dr Lorna Dyall also pointed to research led by Auckland University sociologist Peter Davis showing that most doctors had less rapport with Maori and Pacific patients than with Europeans, were less likely to order tests for their Maori and Pacific patients and were more likely to prescribe drugs for them.

Dr Bell said: "I'd encourage clinicians who feel that they don't have a good sense of rapport, or feel that maybe they are prescribing more quickly, to actually spend a bit more time listening to patients and hearing what reality is like for them."

Scared off

Percentage who did not pick up a prescribed medicine because of cost (figures from 2004):

* Pacific: 15.4

* Maori: 13.6

* European: 5

* Asian: 3.3


* 5+ hardship factors: 56.8

* 3-4 hardship factors: 32.1

* 2 hardship factors: 20.3

* 1 hardship factor: 8.4

* 0 hardship factors: 1.7

- Source: Otago University