Pharmac has today released the first of a series of reports investigating inequities in medicine access. The report looks specifically at prescribing and dispensing medicines for gout, estimating 10,400 more Māori need preventive treatment each year to achieve equity in access to these medicines.
Gout is a form of arthritis and a life-long condition. While the condition can be debilitating, the symptoms and risk of complications are preventable if people with gout take preventive uric acid medicines daily, such as allopurinol and probenecid.
“It is very important to raise awareness about gout and the need to have more equitable access to medication,” says Dr Bryan Betty, Medical Director of The Royal New Zealand College of General Practitioners.
“This report both raises awareness and highlights the equity issues around clinical management of gout in New Zealand, which differentially affects Māori and Pasifika.”
The research shows that Māori are 6.9 times more likely to be hospitalised with gout compared with non-Māori, non-Pacific peoples. Māori are also less likely to receive preventive medicine before or after hospital admission.
“Our research suggests more Māori need to be started on preventive gout medicine at a younger age to achieve better health outcomes,” says Pharmac’s Chief Medical Officer Dr David Hughes. “Making this happen will take all parts of the medicines system to understand the extent of the access equity issues and what they can do to address it.”
One of Pharmac’s top priorities is to advance Māori health and aspirations with the overall aim of equity of health outcomes. This work is guided through Te Tiriti of Waitangi principles of tino rangatiratanga, partnership, active protection, options, and equity.
“The insights are concerning but not surprising,” says Pharmac’s chief Māori advisor Trevor Simpson. “There are systemic and societal influences that we all need to address to achieve equitable outcomes. While research like this supports our goal for Māori to achieve their best health and wellbeing, we know we can’t achieve this alone.”
“We are using the data and insights and working with our partners across the health and disability sector to see real changes from policy to primary healthcare. We’re also examining our own processes for improving access to funded medicines.”
Gout is estimated to affect around 6 percent of adult New Zealanders aged 20 years and over. Males and Māori are disproportionately affected (males have approximately three times the prevalence of gout compared to females, and Māori are approximately two times more likely to live with gout compared to non‑Māori, non-Pacific peoples). Biological factors such as kidney disease and genetic variants mean Māori are also susceptible to experience severe gout, early-onset gout, and other complications.
“We will routinely and transparently report on Māori access to medicines and our own role in working to address equity gaps,” says Matua Simpson.
Pharmac expects to release gout insights about Pacific peoples shortly, and measures for cardiovascular disease, diabetes, asthma, and chronic obstructive pulmonary disease are being developed.
Gout Insights – Impact on Māori (report)
Medicine access equity monitoring and outcomes framework (methodology document)