Cultural Diversity in Pharmacy: Opening Minds, Doors
By, Jeri J. Sias, PharmD; Caroline A. Gaither, PhD; Vibhuti Arya
Source: Journal of American Pharmacists Association
While attending pharmacy school and completing a residency, I remember the great impressions that my mentors in community pharmacy left with me. Their pharmacies were in the heart of each neighborhood and the pharmacists could often walk to work. They knew each patient who passed through the pharmacy entrance, where their children went to school, and what religious affiliations each family had. These pharmacy mentors were a part of the fabric of the community, working with local physicians and businesses, supporting local events, and serving as a trusted health care professional and community leader who could be accessible at almost any moment.
As I continued through my studies and began my professional career, I realized that these models of practices did not, and could not, exist in every neighborhood. Virtually every community in the United States has undergone changes in demographics, education and income levels, and health care/pharmacy access. Simply put, each ZIP Code looks different today than it did in the past. Many pharmacists face busy days of “doing pharmacy work” rather than “being” a pharmacist. Many commute to work, walk into the pharmacy, work all day, and then leave the neighborhood. They often have difficulty getting to know the patients, community members, and organizations that shape the neighborhoods in which they work.
U.S. census data show that the country has a rich diversity of races/ethnicities, income and education levels, and languages. Unfortunately, numerous health disparities also persist—often disproportionately in racial/ethnic minority communities. As such, the two primary Healthy People 2010 goals are to increase quality and years of healthy life and eliminate health disparities. Furthermore, the U.S. Department of Health and Human Services has identified six focus areas of health disparities for racial/ethnic minorities: infant mortality, cancer screening/management, cardiovascular disease, diabetes, human immunodeficiency virus (HIV) infections and acquired immunodeficiency syndrome (AIDS), and immunizations. Working in almost every neighborhood in our country, pharmacists have an opportunity to reclaim their role as community leaders and engage members of their communities in improving health care.
Getting Information Online
But how do you start? You may feel unsure of where to begin and how to open your pharmacy doors to changing neighborhoods. Or, you may have recently moved to a new community and are faced with patients who may not share your cultural experiences and values. During the past few years, one way that I have encouraged pharmacists and student pharmacists to relearn their communities is to use census data and the Internet. In these searches, modern technology can be used to gain information about local neighborhoods.
Here are a few steps to get started on a virtual search.
Step 1: Use U.S. Bureau of the Census search engines (http://factfinder.census.gov) to obtain demographic information. Go to the Web page and enter the address or ZIP Code of the pharmacy. Analyze the demographics, languages, education, and other socioeconomic indicators. Compare these results with information about the rest of the town or city where the pharmacy is located.
After evaluating the collected information, determine how to strengthen pharmacy services. For example, Table 1 lists demographics for three urban, midwestern ZIP Codes. If you practice in a pharmacy in or near ZIP Code 1, you may determine that you may need to hire an interpreter and translator for your pharmacy because more than 25% of the community speaks a language other than English at home. If you practice at a pharmacy in ZIP Code 2, you will likely encounter patients who are have lower incomes, are less educated, and are slightly older, and these facts have implications for your pharmaceutical care and medication therapy management plans.
Because each ZIP Code includes unique racial/ethnic populations, the pharmacists working in these environments may need to learn more about the unique cultural values and health beliefs and practices for that community. For example, an Asian American pharmacist working in ZIP Code 2 may want to learn more about the African American culture.
Assess whether you believe your patient population is representative of census data information. If not, perhaps you need to reengineer your services to cater to the patient population in your neighborhood.
Step 2: Use an Internet search engine to map businesses and organizations located in close proximity to the pharmacy. Identify community centers, schools, businesses, physicians, religious and cultural centers, and other sites that may be potential partners for pharmaceutical and public health initiatives.
For example, if you practice in a pharmacy in or near ZIP Code 1 (Table 2), you have no nearby pharmacy competitors. ZIP Code 2 has numerous religious associations (churches, synagogues, temples) that may serve as crucial points of contact. You may be able to create a niche market in this neighborhood with the senior center or public school.
ZIP Code 3 has numerous clinics and beauty salons. While some of these businesses and organizations may not be usual partners in health care, they may provide crucial points of contact for reaching patients. Keep an open mind about new areas of collaboration. To help limit your search, you may want to look for agencies within 1 mile of the pharmacy. Conducting this informal survey of your neighborhood may help you to pinpoint places for collaboration.
Step 3: Use city, county, and/or state health department data on the Internet to identify major health problems of the community. Sometimes these data—divided into districts within a town or city—can provide more specific health data about your neighborhood. If possible, compare and contrast your data with local health goals for your county or state or to the Healthy People 2010 goals for the nation (www.healthypeople.gov). These comparisons can provide markers pharmacists can use in determining how best to help improve the community's health.
For example, in the selected Midwest city (Table 3), health data from a telephone survey reveal that a slightly higher percentage of the county self-reports diabetes (6%) as compared with the state and country (5.6%). Furthermore, the county has the highest number of cases of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in the state. Diabetes or HIV medication management may be areas of focus for pharmacies in this county. You can identify other unique health problems in your neighborhood by contacting local community and mobile clinics, which can also be found through the county health Web sites. These clinic sites also provide areas for potential partnership for the pharmacy. Develop a list of how the community pharmacy can help address these varying health needs (or have a student intern help you).
Step 4: This may be the most crucial step because it requires active public relations with your community. Visit the community sites you have identified by your searches to locate potential partners for pharmacy and public health initiatives. Make connections in the neighborhood with religious leaders, local business owners, and community centers. Involve your staff by discussing findings with them and brainstorming to develop appropriate adaptations in your pharmacy. Hold pharmacy brown-bag meetings or health screenings at these various sites to show that you are concerned about the welfare of the community. Reevaluate your pharmacy business plan to see if you need to make new investments in your services or identify unique niche markets.
Reaping Benefits for Patients
The first three steps of this brief community pharmacy assessment can be completed in a short morning or afternoon. The final step requires some leg work and community relations. This background community assessment may provide valuable insight to understanding your role in the neighborhood you serve and opening your pharmacy doors to new and diverse community members. You can then begin to compare and evaluate the demographic and community information to adapt current pharmacy services.
With patience, an open mind, and a willingness to continue learning about the cultures and neighborhoods served, you can take small steps to serve diverse populations and reclaim your role as a community pharmacist.