Cultural competence in pharmacy practice

American Journal of Pharmaceutical Education, Summer 2002 by Zweber, Ann

PROLOGUE

Cultural issues are recognized as important components of the provision of effective health care. This lecture and corresponding discussion provides students with the opportunity to explore their own cultural heritage, begin to examine how culture affects health care choices and outcomes, and develop strategies to overcome cultural barriers. The learning takes place during spring quarter of the first year pharmacy practice lab. A nonprescription product topic, such as cold and allergy treatments, is easily integrated into the discussion. Although this is written as a lecture, it is important to engage participants in discussion. This paper will focus on developing cultural competence in a pharmaceutical care practice.

LEARNING OBJECTIVES FOR STUDENTS

1. Recognize the need for cultural competence in pharmacy practice.

2. Describe ways in which bridging cultural gaps can improve pharmacy practice.

3. Describe cultural aspects of health care.

4. Identify cultural factors in one's own health care decisions.

5. Identify health beliefs and perceptions that may affect pharmaceutical care.

6. Recognize traditional therapies and how they may affect conventional western treatments.

7. Describe types of language barriers.

8. Develop strategies to achieve cultural competence.

INTRODUCTION

As pharmacists, we have a broad range of responsibilities to the people we serve. We need to integrate many factors and experiences into our knowledge base and decision-making processes. In addition to our understanding of drug action, metabolism and economics, we need to understand how individuals make health care choices. Our commitment to providing pharmaceutical care to the communities we serve would be incomplete if we did not incorporate the cultural influences in our patients' lives.

The 2000 U.S. Census data illustrate the diversity of our population (see Table I, adapted from http://quickfacts.census.gov January 15, 2002). It is important to note that there are vast differences among the cultures and individuals within each racial/ethnic group as defined by the U.S. Census. The data provided by the census can help identify patterns and needs in specific areas. Data from individual cities and counties can also be extracted from the U.S. Census(l). This information can help health care professionals develop practices that may better serve their communities. Most pharmacists will already be able to describe the predominant cultures in the communities they serve.

The pharmaceutical care model, as described by Hepler and Strand, defines a desirable outcome of drug therapy as improvement in quality of life(2). To achieve this outcome it is essential to involve the patient, as well as the physician and pharmacist, in decisions involving drug therapy. An individual's definition of quality of life is strongly influenced by culture. Similarly, culture will also affect choices regarding drug therapy. For example, a Muslim patient observing Ramadan may not be able to take erythromycin three times daily with food. If she attempts to take the medication during the daytime (in which she is fasting) she may suffer nausea and vomiting commonly associated with taking erythromycin on an empty stomach, and fail to complete treatment. To fully achieve the goals described in this mission, a pharmacist must incorporate a variety of patient factors, including personal and cultural influences on health care decisions.

Anne Fadiman's book, The Spirit Catches You and You Fall Down, reveals the tragic story of how our advanced health care system did not meet the needs of a Hmong child. In this factual account, a Hmong child with a seizure disorder failed to receive effective treatment not only because of language barriers, but also because of a lack of understanding of the cultural influences on treating such disorders. The Hmong family perceived the disorder as "a gift which qualified her to be a shaman." In addition, the family employed traditional remedies and treatment strategies of which the physicians were unaware(3). The award-winning book makes a strong case for the need for cultural competence in the health care system.

In community pharmacy cultural barriers can occur from both a pharmacist's and a patient's perspective. Pharmacists are often frustrated with counseling non-English speaking patients. The development of a more welcome environment, one that recognizes cultural needs and preferences of individuals, brings the potential for generating business. Marketing strategies throughout the Unites States have evolved to target specific ethnic and cultural groups in an effort to increase awareness of products and services. In a community pharmacy it makes sense to develop ways to make a pharmacy inviting and comfortable for the communities you serve.

HEALTH DISPARITIES

Data provided by the U.S. Census illustrate disparities in education, family structure, and income levels among various groups. Table II illustrates some examples. Although it is vital to avoid making generalizations, it can be useful to consider the impact of these factors.