Health care disparities start at the local pharmacy, study shows

Sharon Youmans, Pharm.D., MPH

Despite years of effort in reaching out to their local communities, the role pharmacists play as health care providers still remains unclear to the people who need them the most - elderly Americans with multiple medications for chronic diseases.

As a result, many patients with the most complex prescription needs may be hesitant to ask the questions they need to take their medications safely and consistently, according to a new study from the UCSF School of Pharmacy.

In one of the first studies to interview only elderly African-Americans regarding their perceptions of their community pharmacist, UCSF researchers also report that most would like to relate to their pharmacist the way they do with their personal doctors, but very few actually achieve that. Findings were published last month in the spring issue of the journal “Ethnicity and Disease.”

“There are many articles describing physician-patient relationships, but there is a paucity of information on patients and their pharmacists,” explained Sharon Youmans, PharmD, MPH, a UCSF associate professor of clinical pharmacy who led the study. “When we look at the issues of adherence to prescription regimens and safety in combining medications, that relationship plays a critical role.”

The study involved interviews with 30 women and 12 men, all of whom were African Americans over age 60 and living in San Francisco. A majority of these participants took four to six prescription medications regularly and reported an average of two chronic illnesses.

Researchers found that most participants sought a close relationship with a knowledgeable and respectful community pharmacist and most also reported an interest in engaging in informed decision-making, including discussions regarding medication options, side effects and concerns about rising medication costs. Yet few participants reported feeling comfortable initiating such discussions, due to either not being able to identify the pharmacist or a sense that the pharmacist was too busy to talk with them. None said they perceived this as an issue of discrimination.

Youmans said the study highlights the importance of patient-pharmacist communication and identifies the need for far more training of pharmacists and pharmacy staff in cultural competence and communication.

The study also showed that the individual pharmacists, and the profession as a whole, need to make increased efforts to become integral partners of local, state and national initiatives aimed at decreasing health disparities, she said.

“This is an issue of coming out from behind the counter and making a connection with our patients, no matter who they are,” Youmans said. “If we, as pharmacists, are going to help reduce the health disparities in underserved populations, this study shows the first step we all need to make.”

UCSF is a leading university that advances health worldwide by conducting advanced biomedical research, educating graduate students in the life sciences and health professions, and providing complex patient care.

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