Closing the Cultural Gap in Health Care

Long-standing systemic and social issues have created health inequities among diverse communities. As the most accessible health care providers within their communities, independent pharmacists have an opportunity to help break down barriers to help reduce these disparities.

Addressing the cultural gap in health care is especially important during the coronavirus disease 2019 (COVID-19) pandemic, which has had a disproportionate effect on communities of color. According to the CDC, race and ethnicity are risk markers for other underlying conditions that affect health, including socioeconomic status, access to health care, and increased exposure to the virus due to occupation.¹ To create healthier futures for diverse patient populations, pharmacists can be empowered with greater understanding of how the health care system inadvertently creates and perpetuates different experiences for various communities. A history of medical experimentation among ethnic groups, coupled with poor quality of care, and mistrust in health care providers further widens the gap.

“One of the biggest opportunities is to understand that trust is earned, it’s not given,” Braheim Knight, RPh, Good Neighbor Pharmacy Business Coach at AmerisourceBergen, told Drug Topics® in an interview.

According to Knight, it’s crucial for pharmacists to recognize the unique experiences among individuals from different cultures, and how these experiences have been rooted in social injustice in the US health care system. “When we understand how these inequities have infiltrated the medical profession, we have to understand that individuals now are really mistrustful, they don’t trust medical professionals based on their history in this country,” Knight explained.

As a business coach, Knight encourages pharmacies to practice culturally competent care to strengthen trust and rapport with diverse communities. Of utmost importance is acknowledging a patient’s heritage, beliefs, and values during treatment, and incorporating nuanced knowledge of the medical conditions that may be more prevalent in those populations. To ensure cultural competency, pharmacists must take the time to get to know each patient that walks through the door. Exercising empathy and sensitivity to diverse backgrounds and identifying potential barriers is key, according to Knight.

Chichi Momah, PharmD, chief operating officer of Springfield Pharmacy in Springfield, Pennsylvania, agreed that building trust is crucial to closing the cultural gap in disparities of care. Springfield Pharmacy, which sits at the center of many diverse communities, serves patients from different socioeconomic backgrounds. The pharmacy offers a variety of services that expand beyond traditional dispensing, including a weight loss program, diabetes prevention program, and mobile vaccinations, as well as a focus on medication therapy management and medication adherence packaging to help patients stay compliant.

To effectively build trust, Momah emphasized the importance of educating pharmacy staff on the role of unconscious bias in health care, as well as the knowledge and tools to implement change and improve the way they care for diverse populations. Pharmacies should be present in the communities they serve to create and sustain relationships with influential organizations, such as faith-based organizations, employers, local government, and public health agencies. These community relationships build credibility for pharmacies and help inform effective engagement and adherence strategies. 

But bolstering patient trust in communities of color also requires a commitment to learning and listening. Training yourself and your staff to ignore stereotypes at the point of care and be more empathetic toward people of color can help patients feel seen and heard. “We have to be the voice. We have to meet these patients where they are,” Momah added. 

Furthermore, mistrust in providers and misunderstandings as it relates to medical care can be detrimental to the health of racially and ethnically minority patients. According to Momah, many patients often feel intimated to ask their physicians questions about their treatment. As a trusted point of access for these patients, pharmacists are uniquely positioned to bridge that gap and improve outcomes.

“I see us as the liaison between the patient and other health care professionals,” Momah told Drug Topics®. “And we have the ability to engage, educate, emphasize, and even encourage patients not only to advocate for themselves, but to ask questions and to speak up.”

Momah explained that her focus is always on the patient’s needs. One example she gave Drug Topics® is that when a patient is having difficulty articulating their questions to their doctor, Chichi often works with the patient to write down questions for their provider on a flashcard, so that when the patient visits their physician, they’re able to ask the question the way it’s written. Pharmacists should continue to go the extra mile by counseling, calling, and following up with their patients to ensure quality care.

“It’s time-consuming, I know that, but that is the difference between pharmacists and other health care providers. Our experience and dedication guide our staff in promoting the well being of our patients and their community. Continual investments in training, education, and technology allow us to provide our patients with the highest quality of service,” she said. 

Knight reiterated the importance of taking that additional step to ensure patients from minority backgrounds are receiving optimal care. He noted that pharmacists should be aware of potential linguistic barriers that could make communication difficult and work to break down these barriers. If a communication issue presents itself, he suggested that pharmacists ask patients for a potential intermediary who can help convey the right message and facilitate effective communication between the pharmacist and patient. 

“Acknowledging those cultural differences is very important, and not just acknowledging, but doing something about those cultural differences that are going to be solution-oriented,” Knight said. 

Knight also noted that AmerisourceBergen provides its Good Neighbor Pharmacy network with an array of resources and tools to meet some of the unmet patient needs in their communities. One example is its market analysis tool, which can provide demographic insights into a pharmacy’s community. Knight explained that data from the tool can equip independent owners to better understand the patients they serve so that they can adapt their business model to meet the community’s needs. For instance, if serving a large Hispanic population, the pharmacy may want to make sure that their medication labeling program can translate directions into Spanish. 

Another important step to reducing health disparities is increasing representation within the pharmacy profession to help diverse patients feel seen, understood, and respected during their interactions with health care providers.

“Having a diverse team helps represent the population that we serve and that helps engage the patient and helps them trust us because they see people that look like them, or people that sound like them,” Momah said.

Although progress has been made with diversity in the pharmacy profession, both Momah and Knight emphasized that there is more work to be done. According to Knight, Black pharmacists make up about 7% of the professionals in the field, and though the demand is high, Black students accounted for about 9% of those enrolled in pharmacy schools in 2018.

However, Knight noted that he believes the profession is recognizing the need for diversity. Knight highlighted the idea of exposure and accessibility to the field, which was discussed in a Drug Topics® article on minority representation in pharmacy. “My one takeaway was that diversity in pharmacy really starts with exposure to the field,” Knight said. He recalled his own experiences as a tenth grader visiting the University of Pittsburgh and having the opportunity to be exposed to the pharmacy industry during a weekend seminar for Black students.

And while lack of exposure to the field and barriers to pharmacy school admission can be deterrents for increasing diversity, Knight also expressed the need for individuals to show accountability and responsibility when it comes to achieving such goals. He cautioned that their own biases can further hinder diversity in the profession. 

“If we want to drive diversity in the independent pharmacy sector, or the retail pharmacy space, we need to view people truly for who they are and not subject them to our own stereotypical viewpoints or opinions,” Knight explained.

Additionally, pharmacists can support underrepresented groups within the profession by providing fellowship/internship opportunities for minority pharmacy students, engaging with historically Black colleges and universities and the Hispanic Association of Colleges and Universities, and building relationships within their own communities. 

For Momah, progress has taken the form of more women and minorities who are being given a platform to implement change and drive the profession forward. However, there is still a lot of work to do. Continued education and empowerment of the next generation will help further strengthen representation in years to come.

“No one should be left behind,” she said. “As soldiers, because I believe pharmacists are superheroes, we can’t accept the status quo. We have to keep fighting to move our profession forward because we are the ones that advocate for the underrepresented and the ones in the position to bridge that gap.”

Reference

1. CDC. COVID19 Hospitalization and Death by Race/Ethnicity. Last updated August 18, 2020. Accessed October 9, 2020. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html