Multilingual Medicine: A Pharmacist’s Impact on Inclusive Health Care

As the United States experiences increasing diversity in its communities, projections indicate that by 2050, 50% of the US population will consist of racial and ethnic minority individuals.¹ The readiness of our health care system to equitably serve all patients and address their personalized health care needs is a subject of ongoing debate. With well-documented decreases in access to preventive care and treatment for chronic conditions among racial and ethnic minority populations, Patricia Gutierrez, PharmD, BCACP, CDE, clinical pharmacist at Cook County Health in Chicago, Illinois, aims to combat these challenges. Her practice focuses on ambulatory care, specializing in the management of diabetes, hypertension, and hyperlipidemia with Spanish-speaking patients and anticoagulation with all patients. As the most racially inclusive hospital in Illinois and second most inclusive hospital in the nation by the Lown Institute Hospitals Index,² John H. Stroger, Jr. Hospital of Cook County in Chicago has continued to see a spike in diversity both culturally and linguistically.

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Gutierrez is uniquely positioned in her role. She is one of the approximately 4.5% of pharmacists employed in the United States who are Hispanic.³ She uses not only her language ability but her knowledge of the culture and love for her community to ensure her patients feel heard and that their culture, most importantly, is understood.

“I grew up eating the same foods as my patients. I focus on making the patient care experience as practical as possible and incorporating personal experiences that I have faced with family members,” Gutierrez said. With these personal anecdotes, patients trust her with their care and open up more than with other providers regarding their foods in relation to diabetes control, their extent of medication adherence, and their traditions, especially those surrounding holidays.

Patients are more forthcoming, allowing Gutierrez to acquire an accurate picture of the changes necessary for their medication therapy or whether changes are required solely to their diet and lifestyle. Although cultural identity and representation are incredibly important in all avenues of life and health care, so is health literacy, which is at the forefront of her practice.

In her weekly Spanish diabetes class, she reviews the basic pathophysiology of type 1 and type 2 diabetes; complications; basic instruction on how diabetes medications work, which is individualized to the patients in the class that day; how best to take them; basics on glucose level and blood pressure goals; hypo- and hyperglycemia symptoms and how to correct them; and extensive counseling on proper diet with props and other visuals to aid her patients in being their own advocates.

“Unfortunately, patients may not know how to take their medications appropriately, which may lead to serious consequences such as hyperglycemia For example, not pairing certain insulin with meals or skipping meals. In addition, patients may have misconceptions regarding medication that may lead to noncompliance and worsening diabetes,” Gutierrez said. The “lightbulb moment” is one that she sees often and that she admits makes her job the most rewarding.

Gutierrez has been employed by Cook County Health for over 14 years and says she stays because she knows she makes a difference through her role as a representative for her community, being most proud of serving the patients of Cook County. “I have gotten so many hugs, tears of joy and sadness, and it makes it worthwhile for me at this point in my career…. Going home at the end of the day, I feel good about what I do. I take great pride in what I do,” she said.

When asked whether she could provide any advice for those seeking to be more culturally aware, she advises being open to learning about new cultures, being respectful, and trying your best to learn what is important in your patient’s culture—to respect it and include it in your treatment plan. In her anticoagulation clinic, she has learned to probe into a patient’s diet to gauge vegetable intake. The focus is to make patients comfortable and to embrace differences. “Ultimately, when things are part of a patient’s culture, you don’t want to take that away. You want them to continue to thrive in their culture and in their health as well,” she said.

In response to identifying changes she would like to see within the health care system for addressing language barriers, she hopes that other institutions will follow the significant steps that Cook County Health has taken to hire providers representative of the community in which they practice. She notes that targeting high schools in neighborhoods with students who do not typically apply to such health care programs and showing the impact that can be made may be helpful in increasing overall representation.

Lastly, she cautioned that although many institutions have translators via iPads and other resources, there are still barriers everywhere. In her practice, she has found that some translations are not accurate or some communication is lost in translation. She has also found in-person translators offer her patients more reassurance than speaking to a computer. Ultimately, her wish is for everyone to have access to health care at the same level. As she said, “Providing written education material in Spanish is not merely enough. Patients need to be able to communicate and ask questions in order to gain further insight into their health Communication in their preferred language is key.”

Research has identified strategies aligning with Gutierrez’s recommendations. A review of culturally competent health care systems highlighted 5 interventions for improved cultural competence: gearing programs to recruit and retain diverse staff members, offering cultural competency training for health care providers, using interpreter services to ensure individuals from different backgrounds can effectively communicate, providing culturally appropriate health education materials to inform staff of different cultural backgrounds, and providing culturally specific health care settings.¹

In a 2014 meta-analysis of 25 studies within the health care industry examining race, ethnicity, cultural competence, and language diversity across entire organizations and health care teams, improvements were observed in patient adherence and satisfaction scores. Additionally, clinical uncertainty, both in diagnoses and treatment options, was notably reduced.⁴ Regarding health literacy, a 2020 systematic review emphasized that intervention, incorporating cultural appropriateness, tailoring, building skills, setting goals, and active discussions were more likely to succeed in improving health-related outcomes among individuals with lower incomes.⁵

In conclusion, Gutierrez underscores that language, representation, and health care equity are indispensable for enhancing patient outcomes, although they remain formidable challenges for many institutions. It is our collective responsibility to bridge these gaps in health care. Ensuring linguistic services in the patient’s native language is fundamental for safety, satisfaction, and quality of care. The combination of representation and cultural competence nurtures meaningful patient-provider relationships. When all these crucial elements are integrated uniformly into practice, a more equitable health care system becomes a tangible reality.

References

1. Nair L, Adetayo OA. Cultural competence and ethnic diversity in healthcare. Plast Reconstr Surg Glob Open. 2019;7(5):e2219. doi:10.1097/GOX.0000000000002219

2. Think tank identifies America’s most inclusive hospitals. Lown Institute. Accessed March 22, 2024. https://lowninstitute.org/press-release-think-tank-identifies-americas-most-inclusive-hospitals/

3. Empowering pharmacists to improve Hispanic health. CVS Health. February 7, 2019. Accessed March 1, 2024. https://www.cvshealth.com/news/pharmacy/empowering-pharmacists-to-improve-hispanic-health.html

4. Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc. 2019;111(4):383-392. doi:10.1016/j.jnma.2019.01.006

5. Stormacq C, Wosinski J, Boillat E, Van den Broucke S. Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review. JBI Evid Synth. 2020;18(7):1389-1469. doi:10.11124/JBISRIR-D-18-00023