Introduction to Cultural Competency in Health Care Pharmacy Practice II.

Introduction to Cultural Competency in Health Care

Pharmacy Practice II

Definitions

Culture: set of learned and shared beliefs and values that shape interactions and interpretation of experience; each of us can belong to many different cultures.

Ethnicity: self-defined groups identity that is based on religion, nationality, and cultural patterns

Race: a social and political construct having no scientific basis

US Census Data

People Quick Facts 2000 OR% US%

White, not Hispanic/Latino 83.5 69.1

Black/African Americans 1.6 12.3American Indian/Alaskan Native 1.3 0.9Asian 3.0 3.6Native Hawaiian/Pacific Islander 0.2 0.1Hispanic/Latino 8.0 12.5

US Census Data: County Examples

Multnomah County:Black/African American 5.7%

Language other than English at home 16.6%

Hood River County:Hispanic/Latino 25%

Language other than English at home 24.7%

Health Disparities

Racial or ethnic differences in the quality of healthcareDifferences result in worse clinical outcomesDifferences persist after adjusting for known factors:

Socioeconomic factorsPatient preferencesAppropriateness of intervention

Examples of Health Disparities

Cardiovascular

Cancer

Pain

Asthma

Diabetes

Prenatal Care

Potential Sources of Disparities

Patient variables: preferences, refusal, appropriateness of care

Healthcare systems

Care process: bias, stereotyping, uncertainty

Cross-cultural education

Examining your own cultural background

Review the questions provided

Consider your own bias, stereotyping, uncertainty

Cultural influences

Health Perception

Treatment Preferences

CommunicationVerbal

Nonverbal

Federal Mandate: Title VI

The US Department of Health and Human Services’ Office for Civil Rights (OCR)

mandates that medical professions receiving federal funds must ensure limited English speaking persons can “meaningfully access” services.

National Standards for Culturally & Linguistically Appropriate Services in Health Care (CLAS)

14 standardsCulturally competent care (Stds 1-3)

Language access services (Stds 4-7)

Organizational supports for cultural competence (Stds 8-14)

Varying levels of stringency (mandates, guidelines, recommendations)

National Standards for Culturally & Linguistically Appropriate Services in Health Care (CLAS)

Culturally competent careCare that is compatible with cultural health beliefs, practices, preferred language

Diverse staff and leadership

Education and training in CLAS

CLAS Standards, continued

Language Access ServicesOffer and provide language assistance services at no cost, in a timely manner

Verbal and written notice of right to receive language assistance services

Family and friends should not be used except when requested by the patient

Materials and signs in languages commonly encountered

CLAS MandatesLanguage Access Services

Based on Title VI of the Civil Rights Act of 1964 with respect to services for limited English Proficiency (LEP) individuals

Std 4: Offer and provide language assistance services at no cost and in a timely manner

Std 5: Both verbal and written notice of their right to receive language assistance services

CLAS MandatesLanguage access services

Std 6: Family and friends should not be used to provide interpretation services except when requested by the patient

Std 7: Easily available materials and signage in languages commonly encountered or represented in the service area

CLAS Standards, continued

Organizational supports for cultural competence

Strategic plansSelf-assessmentsData collectionCommunity profilePartner with communityConflict resolutionPublic information

Definitions of DiseaseNavajo

Lack of harmony in and with the universeWHO

Anything less than a complete state of physical, social, and mental well-being

FDAAny deviation from impairment or interruption of the normal structure or function of any part, organ, or system (or combination thereof) of the body that is manifested by a characteristic set of one or more signs or symptoms, including laboratory or clinical measurements that are characteristic of a disease.

Adapted from UC regents – School of pharmacy and center for the Health professions

Cultural influences

Health PerceptionTreatment PreferencesCommunication

Verbal InterpretersLanguage lineOregon Pacific AHECPay attention to your language

Nonverbal

Taking Action: Improving Cross-cultural interactions

Examine your own cultural background.

Learn about the cultures in the community you serve. Show interest.

Be aware. Don’t generalize.

Ask open-ended questions to determine health beliefs and level of understanding.

LEARN MODEL

Listen

Explain

Acknowledge

Recommend treatment

Negotiate agreement

Taking Action: Improving Cross-cultural interactions

Use a trained interpreter.“Language Line”

Be aware of and enlist culturally-based resources.

Learn the language or phrases of the predominant non-English speaking population you serve.

References and Resources

Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. National Academy of Sciences. 2003

National Standards for Culturally and Linguistically Appropriate Services in Health Care Executive Summary. U.S. Department of Health and Human Services, OPHS, Office of Minority Health. Washington, D.C. March 2001

References and ResourcesFadiman, Anne. The Spirit Catches You and You Fall Down. New York: Strauss and Giroux. 1997National Center for Complimentary and Alternative Medicine http://nccam.nih.govU.S. Department of Health and Human Services, Office of Minority Health. http://www.ohmhrc.govUS census data. http://quickfacts.census.gov Ethnic Medicine Information from Harborview Medical Center http://www.ethnomed.org University of California San Francisco Primary Care Resource Links: Cross Cultural http://medicine.ucsf.edu/resources/guidelines/culture.htmlAPhA. Handbook of Nonprescription Drugs 14th edition 2002