Cultural Competence
Mickie Cathers
About one in four adults live with a disability, according to CDC. Disabilities—whether of the body or mind, lifelong or temporary—are a universal experience that affects nearly everyone at some point in their lives.
Disability imposes restrictions on participation and limitations on activities, including access to health care.
“As pharmacists, we have an incredible impact for helping patients with these challenges,” said Steve Erickson, PharmD, associate professor of clinical pharmacy at the University of Michigan, during a session at the 2023 APhA Annual Meeting & Exposition in Phoenix. Pharmacists are in a unique position to deliver and improve equal access for patients with disabilities and support those patients as they navigate the health care landscape.
Having a disability that is associated with chronic conditions and polypharmacy is also a common problem. Patients with disabilities often have a complex medication regimen similar to those of the nursing home population, with a high prevalence of drug interactions. “People with developmental disability have significantly higher hospitalization due to adverse medication events in comparison to the general population,” said Erickson. Patients with heart failure or atherosclerotic CVD and intellectual disability are significantly less likely to receive guideline-based treatments such as ACE inhibitors—especially those with Down Syndrome—and beta-blockers.
Accessible health care
There are two models of disability: medical and social. The medical model views disability as a problem that exists in a person’s body and requires medical treatment. This leads the person with a disability to feel excluded, undervalued, pressured to fit in, and patronized. The social model of disability distinguishes between impairment and disability, identifying the latter as a disadvantage that stems from a lack of fit between a body and its social environment. Disability results from the interaction between individuals with a condition and personal and environmental factors, including negative attitudes, inaccessible transportation and public buildings, and limited social support. This is further compounded by other social determinants of health such as race/ethnicity, age, language, sex or gender, poverty, and education level.
“It’s the environment that makes the impairment disabling,” said Erickson. “Think of your practice site. Is there access to the pharmacy with handicap parking, and clear pathways and signage? How loud or bright are the sounds and lighting in the pharmacy area/waiting room/exam room environment? What is the length of time to access services, what is the wait time to have a prescription filled, is there enough time during consultations?”
Cultural competence
To be healthy, everyone—those with and without disabilities—needs the tools and knowledge to promote wellness along with access to appropriate, integrated, culturally sensitive, and respectful health care.
“Become aware of your bias and society’s view of this population,” said Erickson. Steps for becoming culturally competent include valuing diversity and acceptance of differences; embracing self-awareness and consciousness of the impact of culture, beliefs, and attitudes when interacting with patients; and building knowledge of a patient’s culture.
“Know the people you serve,” Erickson said. “Know their needs. Reach out and learn from them. Be sensitive and accommodating to the needs of individuals and that person’s cultural perception of disability. Asking the right questions and listening to patients describe their experiences is a first, good step.” ■
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