How Pharmacists Can Cross Cultural Barriers to Medication Adherence

To ensure medication adherence among ethnically diverse elderly patients, senior care pharmacists must consider their cultural perspectives, according to an article published in The Consultant Pharmacist.

Noting that roughly half of all older adults who take at least 1 medication find adherence challenging, Cynthia X. Pan, MD, FACP, AGSF, and Wing Fun Leo-To, BS, PharmD, of New York Hospital Queens, aimed to better understand the influence that cultural background has on the adherence needs of aging patients in minority groups.

“For pharmacists, cultural factors are not generally considered when counseling patients about drug adherence, drug interactions, or drug-herb and drug-food interactions,” Dr. Pan told Pharmacy Times in an email. “There are many personal factors that influence how patients manage medications, but often, we do not think of them as cultural factors. The benefit of thinking from a cultural perspective is that you can better understand where the patient is coming from, and start from some common ground.”

The 2 investigators reviewed case vignettes of minority patients with African-American, Asian, Hispanic, Jewish, Middle Eastern, Russian, and Southeast Asian cultural backgrounds. Their conclusions were broken down into a number of considerations and tips for treating such ethnically diverse patients, including:

• Making generalizations about cultural trends is not the same as stereotyping. Further information is always needed to determine what is appropriate for particular individuals, but broadly applied common behaviors can suggest the proper next steps.
• Reasons for compliance must be stressed, so avoid questions that only require a “yes” or “no” response. Instead, use reflective-listening and open-ended questions. Brief eye contact is important, though it is seen as disrespectful to the elderly in some cultures.
• During medication management discussions, find out whether the culture allows for family involvement in the patient’s treatment. Sometimes the answer is yes, but other times, it is no; however, family members can aid in decision-making and adherence compliance.
• Don’t shy away from complementary and alternative therapies that may aid the relief of side effects of Western medicine.
• Preventative medicine and follow-up care may be ignored by some cultures, so it is important to stress the need for both.
• Patients who are present-time conscious may need to be introduced to the importance of taking medications at specific hours, since they may not understand the reasons behind it.

“Especially for elderly patients, it is always important to take the time, listen actively, and connect at a personal level to build a trusting relationship,” Dr. Pan continued. “Physicians should pay attention to the same issues that we mentioned about time orientation, cultural perspectives, listening, taking time, and connecting. We cannot treat everyone the same way, because we are not all the same. In today’s fast-paced world and remote access, we all tend to spend less face time, which is what is the most important.”