Pharmacy-Related Health Disparities Experienced by Non–English-Speaking Patients: Impact of Pharmaceutical Care
Sarah M. Westberg, PharmD, BCPS; Todd D. Sorensen, PharmD
J Am Pharm Assoc (2003) 2005;45:48-54. doi:10.1331/1544345052843066


Objectives  To identify the availability of foreign language services in pharmacies near a medical clinic serving a large immigrant population and determine whether the type of observed drug therapy problems differed between English- and non–English-speaking patients at this clinic.

Setting  A community health care center in a diverse neighborhood of Minneapolis, Minnesota.

Participants  40 pharmacies near the clinic and in the surrounding Minneapolis–St. Paul area known to provide services to patients in languages in addition to English and 91 clinic patients, including 38 for whom English was not their primary language, seen for full pharmaceutical care assessments.

Interventions  Comprehensive drug therapy assessments were conducted for English- and non–English-speaking patients (with assistance from interpreters) in a primary care setting secondary to physician referral. Patient-specific data and the results of the pharmacist's assessment were recorded in a patient management database.

Main Outcome Measures  Language services provided by area pharmacies, frequency of drug therapy problems in English- and non–English-speaking patients, and the status of patient's medication conditions before and after provision of pharmaceutical care.

Results  Of the six primary languages other than English (Vietnamese, Hmong, Laotian, Somali, Spanish, and Cambodian) spoken by clinic patients, written or verbal information was available for five languages in one or more area pharmacies. The clinic pharmacist completed comprehensive assessments for 91 patients via 230 patient encounters, identifying 186 drug therapy problems. Problems related to adherence were significantly more prevalent in non–English-speaking patients compared with English-speaking patients (31% versus 12%). In all 91 patients, the percentage achieving desired drug therapy outcomes improved by 24% after a pharmacist joined the team of clinic providers.

Conclusion  Despite the availability of clinic-based interpreters and foreign language services in pharmacies, adherence-related problems are significantly more common in non–English-speaking patients. Pharmacists committed to providing pharmaceutical care must consider the impact of language barriers when working to optimize drug therapy outcomes.

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Chiquette E, Amato MG, Bussey HI. Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs.  Arch Intern Med.  1998;158:1641–7.[PubMed][CrossRef]
Smith DH, Fassett WE, Christensen DB. Washington State CARE project: downstream cost changes associated with the provision of cognitive services by pharmacists.  J Am Pharm Assoc.  1999; 39:650–7.
Beney J., Bero LA, Bond C. Expanding the roles of outpatient pharmacists: effects on health services utilization, costs, and patient outcomes.  Cochrane Database Syst Rev.  2000(3):CD000336. Review.
Cranor CW., Bunting BA, Christensen DB. The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program.  J Am Pharm Assoc.  2003;43: 173–84.
Isetts BJ, Brown LM, Schondelmeyer SW, Lenarz LA. Quality assessment of a collaborative approach for decreasing drug-related morbidity and achieving therapeutic goals.  Arch Intern Med.  2003;163:1813–20.[PubMed]
Camarota SA. Immigrants in the United States—2000. A snapshot of America's foreign-born population. Washington, D.C.:  Center for Immigration Studies;  2001. Last accessed at www.cis.org/articles/2001/back101.html, December 21,  2004.
 U. S. Census Bureau Web site. USA quickfacts. Last accessed at http://quickfacts.census.gov/qfd/states/00000.html, December 21,  2004.
Siganga WW, Huynh TC. Barriers to the use of pharmacy services: the case of ethnic populations.  J Am Pharm Assoc.  1997;NS37:335–40.
Chin MH, Cook S, Jin L, et. al. Barriers to providing diabetes care in community health centers.  Diabetes Care.  2001;24:268–74.[PubMed]
Ngo-Metzger Q, Massagli MP, Clarridge BR, et al. Linguistic and cultural barriers to care: perspectives of Chinese and Vietnamese immigrants.  J Gen Intern Med.  2003;18:44–52[PubMed]
Werner MA, Knobeloch LM, Erbach T, Anderson HA. Use of imported folk remedies and medications in the Wisconsin Hmong community.  West Med J.  2001;100:32–4.
Charupatanapong N, Cheung HC, Huynh JH, Nguyen KV. Self-medication practices of the low income Asian elderly.  J Pharmacoepidemiol.  1997;6:5–22.
Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice. New York:  McGraw-Hill;  1998.
Tucker CM, Herman KC, Pedersen TR, et al. Cultural sensitivity in physician–patient relationships: perspectives of an ethnically diverse sample of low-income primary care patients.  Med Care.  2003;41:859–70.[PubMed]
Scott DM, Hakanson NM, Montagne M, Schwanke R. The development and evaluation of an interdisciplinary health training program: a pharmacy perspective.  Am J Pharm Ed.  1983;47:42–8.
Beck RJ, Ellis LB, Scott DM, et al. Microcomputer as patient educator.  Am J Hosp Pharm.  1982;39:2105–8.[PubMed]
Scott DM, Nordin JD. The pharmacist's role in projects for children and youth.  Am J Hosp Pharm.  1980;37:1339–42.[PubMed]
Frakes M, Cipolle RJ, Strand LM,  Morley. Assurance [database]. Minneapolis, Minn.:  Institute of Pharmaceutical Care, University of Minnesota;  2004.
 Workgroup for the Elimination of Health Disparities. Eliminating health disparities in the United States. Bethesda, Md.:  Health Resources and Services Administration;  2000.
Brach C, Fraser I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model.  Med Care Res Rev.  2000;57(suppl 1):181–217.[PubMed]
Muzyk AJ, Muzyk TL, Barnett CW. Counseling Spanish-speaking patients: Atlanta pharmacists' cultural sensitivity, use of language-assistance services, and attitudes.  J Am Pharm Assoc.  2004;44:366–74.
Bowman N. Pharmacy translation handbook. Sioux Falls, S.Dak.:  Pharmacy Translations, LLC;  2003. Accessed at www.pharmacytranslations.com, November 15,  2004.
Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: the clinician's guide,2nd ed. New York:  McGraw-Hill;  2004.
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