Cultural Competence Essentials of Cultural Competence in Pharmacy Practice: Chapter 1 Notes Chapter Author: Dr. Kimberly Vess Halbur
Definitions of Culture • “The accumulated store of shared values, ideas (attitudes, beliefs, values, and norms), understandings, symbols, material products, and practices of a group of people” (Institute of Medicine, 2003) • “The integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values and institutions of race, religious, or social groups” (Office of Minority Health, 2000)
More Definitions of Culture • “An integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values and institutions of a racial, ethnic, religious or social group” (Cross, Bazron, Dennis and Isaacs, 1989) • “Totality of socially transmitted behavioral patterns, arts, beliefs, values, customs, life ways, and all other products of human work and thought characteristics of a population of people that guide their worldview and decision making” (Purnell and Paulanka, 2003)
Why does cultural competence matter in pharmacy practice? • One of goals of drug therapy is improved quality of life (Hepler & Strand, 1990). • Why pharmacists must understand their own cultural background (Zweber, 2002). • This course will enable pharmacy students to use cultural competence to improve health outcomes for diverse populations.
Changing Demographics • U.S. census projections for Caucasians and people from African American, Latino, Native American/Alaskan and Asian backgrounds. • Projections for people of European American descent by the year 2040 (http://www.census.gov/ipc/www/usinterimproj/natprojtab01a.pdf ).
Rationale for Cultural Competence • Oath of a Pharmacist • Ethical Codes • Law • Professional Standards
Oath of a Pharmacist Devote professional life to the service of all humankind through the profession of pharmacy. Consider the welfare of humanity and relief of human suffering primary concerns. Maintain the highest principles of moral, ethical, and legal conduct. Developed by the American Pharmaceutical Association Academy of Students of Pharmacy/American Association of Colleges of Pharmacy Council of Deans (APhA-ASP/AACP-COD) Task Force on Professionalism; June 26, 1994
APhA Code of Ethics Principle III requirements: pharmacist “communicates with patients in terms that are understandable” and “respects personal and cultural differences among patients.” Pharmacists are expected to maintain knowledge and abilities as “health information advances” (Principle IV).
Ethical Principles Related to Cultural Competence (con’t) • Principle VII: pharmacists are obligated to patients, the community and society. • Principle VIII requires pharmacists to be fair, equitable and just in the distribution of health resources.
Professional Standards • CLAS—National Standards for Culturally and Linguistically Appropriate Services • JCAHO
What are the CLAS standards? • “A means to correct inequities that currently exist in the provision of health services and to make these services more responsive in the individual needs of all patients/consumers.” • Intended to be inclusive of all cultures . • Intended to help eliminate racial and ethnic health disparities.
What is JCAHO? • Pharmacists and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards. • Evaluates and accredits health care organizations and programs in the United States. • Focus: quality and safety improvement.
Legal Rationale • Title VI of the Civil Rights Act of 1964 • Any federally funded program may not discriminate on the basis of race, color or national origin. • “No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance.” • EQUAL ACCESS and EQUAL HEALTH CARE
Legal Rationale (con’t) • OBRA ’90: Omnibus Budget Reconciliation Act • Mandated that pharmacists provide the option of counseling to all Medicaid patients regarding their prescription medications. • Requires the pharmacist be able to communicate with patients. • Cultural competence is needed to meet this communication requirement!
Case Studies • Your best friend and roommate tells you about buying a new car. He/she says, “I got a great deal. But, geez, did I ever have to Jew them down.” What do you say or do? • You are being interviewed for a position that will require you to work with Native Americans with diabetes. The interviewer says, “We really need someone committed. Those people need all the help they can get.” What do you say?
KWL Chart • What I know about cultural competence • What I want to know about cultural competence • At the end of the semester… • What I’ve learned about cultural competence
Reflection Questions 1. In what ways can pharmacists positively impact health disparities? 2. How are the changing demographics of the U.S. impacting the need for cultural competence in pharmacy practice? 3. List three reasons for pharmacists to work toward cultural competence.