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9.
Cultural Differences in Pharmaceutical Care and Research
 There is a
growing recognition of the critical importance of racial, ethnic,
linguistic, socioeconomic, and other cultural factors
in pharmaceutical care and research. There are significant
differences in:
- Patients’ beliefs
and practices related to role of medications in treatment.
- Efficacy
based on such variables
as race, ethnicity, gender and age.
- Provider
attitudes, knowledge and skills related to cultural and linguistic
diversity and pharmaceutical care.
Additionally
there is a limited body of evidence that explores how these factors
are interrelated
and what solutions can be brought to bear for this nation’s
multicultural populations.
Research has
expanded the knowledge of pharmacogenomics – the study of the effects of the
entire genome on drug response, and pharmacogenetics – the
study of genetically determined variations in drug response.
Selected
examples from the literature are listed below:
- In Unequal
Treatment (2002), IOM states that “Participants
were concerned that they may receive a lower standard of care
because health care providers make assumptions about the type of treatment
or medication that they can afford because they are racial
or ethnic minorities” (p. 568).
- In a survey
of pharmacists in Atlanta, nearly two-thirds reported having
recently counseled
a Spanish-speaking patient, but only
one-fourth reported considering the interaction effective
(Muzyk, Muzyk, & Barnett, 2004).
- Reed & Hargraves
(2003) found that 10% of Whites, 17% of Latinos, and 20% of Blacks
did
not purchase all of their prescriptions
due to cost – most vulnerable were uninsured adults under 65
with chronic conditions, half of whom reported cost-related
problems with access to medications.
- A recent focus
group of African Americans’ beliefs
regarding hypertension treatment found distrust of pharmaceutical
companies and perceptions of medication as harmful and ineffective (Lukoschek,
2003).
- There are
population-specific patterns to be addressed in the use of
herbal and non-prescription
medications. (Harrison
et al, 2004, Mazur et al, 2001, Rivera, Hughes & Stuart, 2004, Mull,
Nguyen & Mull,
2001).
- Donnelly
(2004) states that since there are “interindividual,
race-specific, and age-related responses to chemotherapeutic
agents”,
pharmacogenetics holds promise to avoid both
overtreatment and undertreatment among diverse populations” (abstract).
 These are
convincing reasons why public health needs to focus on the multicultural
aspects throughout
pharmaceutical care
and research.
This focus has a high degree of relevance in achieving
the goals of Healthy People 2010 and the President’s
New Freedom Commission on Mental Health, particularly
to eliminate racial and ethnic disparities
in health and mental health.
Resources
National
Pharmaceutical Council website has resources
on cultural diversity.
American Society of Health-System Pharmacists has a policy
statement and resources on cultural competence training for pharmacists.
National Association of Advisors for the Health Professions has resources
on
advising diverse students.
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