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Now available on iBooks!

“What Pharmacists Need to Know About Racial and Ethnic Health Disparities”, available on iBooks

Available on iBooks - What Pharmacists Need to Know About Racial and Ethnic Health Disparities

 

 

 

 

 


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A text for use in public health, health disparities, health services research, and related courses

for pharmacy students in their second, third, and fourth years of training. Discusses the concepts of race and ethnicity and the constructs used to classify and categorize them and provides an overview of the data collected regarding disparities in mortality, morbidity, provision of health care, and other health indicators and epidemiologic studies of mechanisms and pathways. Addresses racial and ethnic health disparities that can occur in real-world pharmacy care, such as differences in disease conditions, response to medication, access to care, health literacy, and understanding of health and medications.

As reviewed in the American Journal of Pharmaceutical Education

Print version available on Amazon.com

Pharmacy Deserts – An Emerging Concept

What are pharmacy deserts?

You’ve heard the term “food deserts” – defined by USDA as, “urban neighborhoods and rural towns without ready access to fresh, healthy, and affordable food”. Pharmacy or medication deserts are analogous. The researchers who coined the phrase note they are defined by

“the low availability of the most commonly dispensed prescription medications in these areas.” (Amstislavski et al, 2012).

The concept builds on earlier geographic work examining not only the location of pharmacies, but variations in how pharmacies are stocked in neighborhoods of lower socio-economic status, or neighborhoods with large African-American or Hispanic populations. Researchers (and pharmacy student research assistants) mapped pharmacies in neighborhoods throughout New York City, and obtained information about pricing and stock availability for 13 frequently prescribed medications. They found variability in pricing as well as the pharmacy’s stocking of the prescriptions, and concluded,

“In extreme cases, entire communities could be deemed ‘medication deserts’ because geographic access to pharmacies and the availability of the most prescribed medications within them were very poor.”

Pharmacy deserts

 

Awareness of the role of pharmacies in access to care is growing.

The journal, Health Affairs, just published an article on Pharmacy Deserts in Chicago, “‘Pharmacy Deserts’ Are Prevalent In Chicago’s Predominantly Minority Communities, Raising Medication Access Concerns” (Qato et al, 2014), and the National Community Pharmacists Association (NCPA) picked up on this issue in a commendable way, noting that,

“About 32 percent of Chicago’s 802 communities were “pharmacy deserts,” meaning their residents met the researchers’ criteria for both low pharmacy access and low income.”

They also noted that,

“Between 2000 and 2012, pharmacy disparities worsened. While the number of pharmacies (particularly chains) in majority-white communities increased 20 percent during that time period, there was no such expansion in minority communities.”

These recent studies underscore the importance of taking a broad approach when considering access to care and treatments. Patients with insurance coverage may have limited access to care if they live in neighborhoods without pharmacies, or if the pharmacies in their neighborhood don’t stock needed medications.

If you’re interested in the issue of access to pharmacies take a look at these earlier publications:

  1. Bernstein et al., Disparities in access to over-the-counter nicotine replacement products in New York City pharmacies. Am J Public Health. 2009 Sep;99(9):1699-704.
  2. Cooper H, Bossak B, Tempalski B, Friedman S, Des Jariais D. Temporal trends in spatial access to pharmacies that sell over-the-counter syringes in New York City health districts: relationship to local racial/ethnic composition and need. J Urban Health. 2009;86(6):929-945.
  3. Morrison RS, Wallenstein S, Natale DK, Senzel RS, Huang LL. “We don’t carry that”–failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics. N Engl J Med. 2000;342(14):1023-1026.

Pharmacy practice and health disparities

Pharmacy practice may affect racial and ethnic health disparities through any one of three pathways

The pharmacy and health disparities

When we think about the most frequent interactions in pharmacy practice – filling and dispensing prescriptions – it isn’t immediately obvious how racial and ethnic disparities might manifest themselves, or how the pharmacy can affect health disparities. Research about such disparities in pharmacy practice is in its early stages, and we are just beginning to learn about ways in which these disparities might occur.

Pharmacy and health disparities

infographic for Chapter 5, which highlights the three ways racial and ethnic health disparities may arise in pharmacy practice.

Chapter 5 of “What Pharmacists Need to Know About Racial and Ethnic Health Disparities” describes the research emerging in three areas:

Racial or ethnic differences in disease conditions, response to medication, or use of medication

Advances in genomics and pharmacogenomics have provided information about the genetic distribution of traits linked to disease and to drug metabolism. Pharmacists working with different populations may encounter different prevalences of certain conditions, as well as differences in patient responses to specific medications.

Racial and ethnic differences in health literacy or understanding about health and medications

Racial and ethnic groups vary in their understanding about their health and the medications prescribed for them. This variation may result from differences in education, language limitations, or cultural issues.

Racial and ethnic differences in access to pharmacy care

The issue of access to care encompasses a broad range of factors, including access to health insurance, income, coverage by Medicare and other insurers. It also encompasses broader definitions of access. Geography and transportation limit people’s ability to access many types of services, including pharmacies. If a person doesn’t live near a pharmacy or has no access to transportation, their access is limited. Similarly, if the pharmacy in their neighborhood does not stock what they need, their access to the care they need is limited.

More about the role of pharmacists in eliminating racial and ethnic health disparities in the book, “What Pharmacists Need to Know About Racial and Ethnic Health Disparities”.

Ch 4 Mechanisms of health disparities

Infographics are a great way to begin a discussion about mechanisms of health disparities.

Infographic mechanisms of health disparities

Conceptual model: Mechanisms of health disparities

This infographic illustrates multiple potential pathways leading from race and ethnicity to disparities in health outcomes, mechanisms of health disparities. Chapter 4 of “What Pharmacists Need to Know About Racial and Ethnic Health Disparities” explores mechanisms and explanations and provides students with tools for understanding this complex topic.

The visual can provoke thought, raise questions, and educate, all at the same time. The infographic suggests pathways, but doesn’t cover them all. The student can take this infographic, generate hypotheses, and explore relationships.

For example, a student might begin with the association between race and ethnicity and socio-economic status, and then follow the pathways leading through occupation, income, education or neighborhood, which then lead through variables such environmental exposures, ability to understand health information or health insurance coverage, and then to health outcomes.

Another set of pathways might begin with the association between race and ethnicity and culture and religion (another broad area, in itself). One can follow the pathways through behaviors such as diet, reproductive practices, attitudes towards medication, education and occupation, and lead to differences in risk factors and health outcomes.

Chapter 4 also explores direct effects of race or ethnicity on health – and discusses the landmark study “The effect of race and sex on physicians’ recommendations for cardiac catheterization” that was published in the New England Journal of Medicine in 1999.

“What Pharmacists Need to Know About Racial and Ethnic Health Disparities” – a text tailored for pharmacy students.

Available on amazon.com

Book Review

“What Pharmacists Need to Know About Racial and Ethnic Health Disparities”

Book review pharmacy health disparities

Great to see this thoughtful book review of “What Pharmacists Need to Know About Racial and Ethnic Health Disparities” in the American Journal of Pharmaceutical Education.

Dr. Christine Catney, of the University of Iowa College of Pharmacy reviewed the text, recommending the book.

 

She wrote,

Pharmacy educators who are developing materials and approaches for teaching health disparities and cultural competence topics will appreciate the author’s suggestions for assignments and learning activities. Examples of these ideas include examining census forms, preparing reports to illustrate and explain specific health disparities in detail, and generating examples from students’ pharmacy practice experiences. Several of these ideas, as well as examples provided within the text, could be transformed into small group activities for a flipped classroom approach.

Teaching about pharmacy health disparities

She also pointed out the need to cover other disparities that are affected by factors such as income, gender, age (under 18 years and 65 years and over), geographic location, sexual orientation, disability, and special or chronic care needs, and I couldn’t agree more.

There are so many issues in considering pharmacy health disparities, and the important thing is to begin the discussion. The classroom is the right place to generate lively discussion about pharmacy health disparities and the pharmacist’s role in addressing disparities. Learning about health disparities during professional training is a first step towards cultural competence and equips students to engage in these issues throughout their lives and careers.

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