Culturally Competent Care Fights Health Disparities

Miguel Oseguera, CPhT, got his start in pharmacy by sweeping floors. Although he worked his way up to becoming a pharmacy technician, the first-generation Mexican American never envisioned owning his own pharmacy, let alone bridging the gap in culturally com- petent health care. But that is what happened in summer 2019, when he opened the doors to Familia Farmacia, which serves the Hispanic community of Modesto, California.

Entrepreneur Invests in His Community

Oseguera saw an opportunity to fill a void when the only independent pharmacy in the South Modesto neighborhood closed after 34 years. The area, in California’s Central Valley nearly 100 miles from San Francisco, has a largely Mexican and Mexican American population.

“Let's face it: No chain pharmacies or other big businesses were going to come to this area,” he said. “Most of the businesses here are independently owned.”

Oseguera’s pharmacy has features that attract Hispanic patients, one being its location in their neighborhood. In addition, the staff provides service in English and Spanish, something Oseguera emphasized is essential in establishing strong patient rapport.

“Speaking the language is enough already,” he said. “But it’s also an important way to develop a sense of trust that helps your patients relate to you.”

Oseguera, a Modesto-area native, said his cultural ties give him another advantage. “I was born here and raised with Mexican values so that I can relate to the people here,” he said.

Not only are most of Oseguera’s patients Mexican or Mexican American, but many hail from the same region as his family, Michoacán. He equates the high concentration of immigrants from Michoacán in the Modesto area with those from Ireland, Italy, or Asian countries moving to specific regions.

The pharmacy’s inventory and layout reveal another draw for Oseguera’s patients: One wall houses a vast collection of prepackaged herbs used in traditional home remedies in the Mexican culture.

Oseguera’s initiatives are logical and appropriate to address health challenges in diverse populations, according to Drug Topics® Editorial Advisory Board member Lakesha Butler, PharmD, BCPS, clinical professor of pharmacy practice at Southern Illinois University Edwardsville.

Members of minority populations “understand the history of medical racism and mistreatment of people of color in this country, enduring it ourselves,” said Butler, who is African American. “This understanding often translates to providing compassionate care and advocating for minoritized communities.”

Innovative Pharmacist Uses Social Media to Reach Minority Populations

Frank North, PharmD, MPA, president-elect of the National Pharmaceutical Association and founder of Frank North and Associates, has dedicated his career to addressing disparities in the African American community. His family history—North’s father was among the first African American students to earn a PhD from the University of Colorado in Boulder—and professional goals illustrate a principle of cultural competency: valuing diversity.

“Many think all people of African descent have the same culture, but African Americans have their own subcultures within their families and throughout different regions of the United States,” North said. “Also, African American culture differs from Africans’ culture from other countries such as Ghana or Europe.”

As a clinical pharmacist for the Rowe Network, a company founded by Tisha Rowe, MD, North uses social media to reach out to African American patients. The company engages patients using a telemedicine network called RoweDocs. North addresses access and adherence issues. He also directs users to other health care providers.

“I try to connect with folks on social media and establish a rapport so I can direct them to health care services provided by people who look like them,” North said. 

Social media is hugely influential in the Black community. According to a 2020 report from Pew Research, 8 of every 10 Black social media users consider it an effective platform for raising awareness of social and political issues.1 Seven of 10 Black social media users view it as a useful tool in influencing decisions. The statistics in Hispanic and Asian communities are similar, and White social media users trail by roughly 10% in each category.¹

RoweDocs also disseminates information regarding health initiatives such as diabetes month, breast cancer awareness, and the American Heart Association’s Go Red for Women. Prospective patients visiting the website may subscribe to the company’s newsletter, watch videos, and read blogs. The website also encourages users to leave comments—a feature North said creates opportunity for additional interaction.

Improving Health Literacy Helps Pharmacist Reach Non-English Speakers

Donney John, PharmD, uses his role as executive director of NOVA ScriptsCentral, a nonprofit pharmacy in Falls Church, Virginia, to improve health literacy in non-English-speaking communities. Like other charitable pharmacies across the nation, NOVA ScriptsCentral’s mission is to help underserved populations. John’s organization is predominantly grant-funded and focuses on providing uninsured patients prescriptions at little to no cost.

NOVA ScriptsCentral site users can choose to have the web copy translated from English into Spanish, Portuguese, Chinese, French, Hindi, or Vietnamese. The pharmacy’s efforts to connect with these patient populations do not stop there.

This year marks the launch of the NOVA ScriptsCentral’s Diabetes Access Pilot Initiative 2021. NOVA ScriptsCentral will offer free insulin to uninsured patients who receive care at any of the 16 clinics with whom the pharmacy partners in northern Virginia.

“Virginia passed a law where the maximum co-pay for insulin is $50,” John told Drug Topics®. “This does nothing for people who have no insurance because they always pay cash.”

In addition to generating revenue from donors, NOVA ScriptsCentral is registered as a pharmacy allowed to accept old medications patients bring in and dispense them to others in need. John referenced a charitable pharmacy in California that dispenses medications it has repackaged from physician samples. However, he said, such a practice is illegal in many states. Other states observe a Good Samaritan law that allows them to engage in such activities to improve medication access for patients in need.

John traces his mission to his childhood, growing up among diverse cultures in New York City. Eventually, he would practice as a pharmacist working with underserved communities at a federally qualified health center in Boston. These experiences helped him recognize cultural nuances among minority communities.

“If people of color don’t have access to the right medical care or understand their health, they’ll never improve their health,” he said. “To change their behavior, you must first understand the people and where they’re coming from.”

Looking Ahead

Despite the efforts of Oseguera, North, and John, and other like-minded pharmacy professionals, Butler said pharmacy practice has yet to master authentic cultural competence.

“Unfortunately, cultural competency in pharmacy has only scratched the surface in addressing the pertinent factors contributing to health disparities,” she said. “There has been a significant gap in addressing racism in pharmacy and health care, resulting in health inequities that persist.”

For example, the coronavirus disease 2019 (COVID-19) pandemic challenged many aspects of the health care system while magnifying disparities regarding access to care, supplies, and mortality in minority communities.

“You see a level of disbelief about the coronavirus and the hesitancy around getting the vaccine that’s more prominent in communities of color—especially in African American communities,” North said. “Minority groups tend to respond better to health care providers who look like them, have their best interest at heart, and are able to break down barriers.”

Unfortunately, the odds that a minority patient can navigate the health care system by only interacting with minority professionals belonging to their communities is statistically impossible. Consequently, all health care providers and clinicians must improve their skills in serving patients outside their own communities.

Butler emphasized the importance of building trust when bridging cultural gaps, regardless of whether the health care professional shares the same background.

“Patient-provider trust is critical when serving communities of color,” she said. “Trust can be built by addressing unconscious biases, using inclusive language that does not cause further marginalization, and taking the time to build relationships with communities of color, to name a few.”

In the meantime, pharmacies that serve minority communities remain steadfast in their efforts. “If we don’t help our people, who will help our people?” Oseguera asked.

For more information on cultural competency and the pharmacies mentioned in this story, please see the following resources:

1. https://nccc.georgetown.edu/
2. http://www.hpoe.org/Reports-HPOE/becoming_culturally_competent_health_care_organization.PDF
3. Remedichain.org
4. https://rowedocs.com/
5. https://novascriptscentral.org
6. https://familiafarmacia.business.site/

Reference

1. Auxier B. Social media continue to be important in political outlets for Black Americans. Pew Research Center. December 11, 2020. Accessed January 7, 2021. https://www.pewresearch.org/fact-tank/2020/12/11/social-media-continue-to-be-important-political-outlets-for-black-americans/.