Pharmacists Play Essential Role in Addressing Health Care Disparities

Although we tend to think of pharmacy in the context medication management, many health problems plaguing the United States may be solvable without prescriptions.

Pharmacists are the medication experts, but pharmacy must also focus on the holistic patient approach. Practices such as Medication Therapy Management show pharmacists’ commitment to treating the patient as a whole and the ability look not only at half-life and clinical benefits of drugs, but other aspects of the patient, will allow pharmacists and other health care providers to reach better health outcomes.

This holistic approach starts with recognizing racial and ethnic disparities in your patient population, building awareness of our unconscious biases as health care providers, and evaluating if preferred standards of practice should be the standard of how you practice as a pharmacist and a health care provider. To begin to evaluate these, we must understand what disparities are. The Institute of Medicine defines disparities as “racial or ethnicdifferences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention.”¹

Keeping a patient’s social determinants of health in mind during every interaction will allow pharmacists and other health care providers to care for patients more holistically, while working to minimize unconscious biases. Social determinants of health are the non-medical factors that affect health outcomes such as the neighborhood and built communities, access to quality education, economic stability, social and community context, and access to quality health care.

At the most basic level, we begin with language; all medical care is best when it is in the patient’s preferred language. According to a study that evaluated whether language barriers are associated with serious medical events, “Spanish-speaking patients whose families had a language barrier had significantly increased risk for serious medical events during pediatric hospitalizations compared with patients whose families do not have a language barrier.”² The benefits of having a diverse workforce in the pharmacy and health care overall cannot be understated; increased provider and patient comfort level and espousing diversity in health care can lead to cultural competency and the ability of pharmacists to offer services that meet the unique social, cultural, and linguistic needs of their patients.

Economic disparities also have significant impacts on patients’ lives and access to health care. When considering some of the root causes of health disparities, it is apparent that community features such as poverty can limit patients’ access to healthy food options, adequate medication, and access to better health care.

So, how are pharmacists positioned to address health disparities? To start, if we are more aware, we’ll be able to provide better care. According to a journal article analyzing DEI in pharmaceutical spaces from an employer standpoint, it was deduced that “groups who have been economically and socially marginalized experience adverse impacts on their mental health, work attitude, and job satisfaction.”³ When considering the ripple effect brought on by a lack of diversity amongst staff, DEI initiatives are critical to improving the patient experience. As patients become more comfortable in health care environments, their apprehension might ease, leading to better health outcomes.

Now to an even more important question: How is this attainable? Aside from raising awareness and calling attention to these issues, pharmacists must also be committed to addressing disparities head-on. According to a behavioral analysis of nurses’ and pharmacists’ roles in addressing treatment hesitancy amongst patients, “A key barrier identified was the relationship nurses and pharmacists had with their patients. Patients felt like they were unable to discuss their concerns with health care providers due to fear of dismissal and judgment.”⁴ Through the incorporation of DEI initiatives, we aim to bridge this gap.

As a practice, pharmacy must strive to cultivate an atmosphere where individuals from diverse backgrounds feel respected, supported, and valued. Pharmacy departments should be urged to implement racial bias testing with current staff, and the outcomes of these tests can provide a clearer picture of how people perceive those in other groups. Case managers and social workers within the health system should work closely with the discharge and transitions of care pharmacists to make sure they understand the situation the patient will be leaving and going into post-discharge.

Additionally, pharmacies can consider using communication aids and prioritizing outreach and educational health fairs in these communities to improve patient awareness of lifestyle modifications and risk factors for disease. Build a rapport with local leadership and commit to cutting through misinformation about things like vaccines and cancer screenings. Become an advocate who fosters relationships with families and is intentional about outreach efforts to lessen patient resistance and fear surrounding treatments. Personalize each interaction and genuinely get to know your patients while providing them with the same opportunity to get to know you, too. The list goes on.

All of these opportunities have 1 common goal—to achieve better health outcomes for patients, regardless of background. There is no transformation without first acknowledging the problem. Through a diverse, equitable, and inclusive approach to fostering relationships between patients and pharmacists, DEI initiatives will hopefully build medical trust within marginalized communities while fostering necessary progress within pharmaceutical health care.

References

1. Stith AY, Nelson AR. Institute of Medicine. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Board on Health Policy, Institute of Medicine.Washington, DC: National Academy Press; 2002. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

2. Cohen AL, Rivara F, Marcuse EK, McPhillips H, Davis R. Are language barriers associated with serious medical events in hospitalized pediatric patients? Pediatrics. 2005 Sep;116(3):575-9. doi: 10.1542/peds.2005-0521. PMID: 16140695.

3. Anthony Scott, PharmD, MBA, Richard Ogden, PharmD, MBA, BCPS, FACHE, Leading diversity, equity, and inclusion efforts within the pharmacy department, American Journal of Health-System Pharmacy, Volume 79, Issue 21, 1 November 2022, Pages 1938–1944, https://doi.org/10.1093/ajhp/zxac215

4. Christine Cassidy, Jodi Langley, Audrey Steenbeek, Beth Taylor, Natalie Kennie-Kaulbach, Hilary Grantmyre, Lillian Stratton & Jennifer Isenor (2021) A Behavioral analysis of nurses’ and pharmacists’ role in addressing vaccine hesitancy: scoping review, Human Vaccines & Immunotherapeutics, 17:11, 4487-4504, DOI: 10.1080/21645515.2021.1954444