Chapter Author: Dr. Kimberly Vess Halbur 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). Cultural competence is a crucial part of the knowledge and abilities needed to address health disparities. 8

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. Being culturally competent enough to address health care disparities and work with patients from diverse backgrounds allows pharmacists to carry out these responsibilities. Principle VIII requires pharmacists to be fair, equitable and just in the distribution of health resources. This allows pharmacists to work effectively with patients from various cultures while monitoring patient care and advocating for health disparities. This allows pharmacists to work effectively with patients from various cultures while monitoring patient care and advocating for health disparities

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.