Living with appending a scarlet letter: The lifelong suffering of children of alcoholics in South Korea

Children of alcoholics (COAs) are those who have grown up with parental alcoholism. The purpose of this study was to understand the lives of Korean COAs within a Korean cultural context, influenced by Confucianism. Prior literature has extensively reported about the adverse life experiences of COAs related to their alcohol dependent parents. Indeed, most of these studies assume the U.S.- or Western-centric perspective. However, in order to provide culture-specific care, health professionals who provide care for diverse ethnic families have to understand the cultural influences on the families which have an ill family member. Data were collected from 20 Korean adult children through semi-structured interviews. All interviews were audio-recorded and fully transcribed. Thematic analysis was used for the data analysis. The lives of Korean COAs were described with four themes, namely: “Losing family,” “Life with holding a bomb,” “My life ruined,” and “Being bound.” Conclusion: In conclusion, the findings of this study demonstrated how cultural components could shape individual’s life experiences in a family having an alcohol dependent family member. This study would be helpful for health professionals to deeply understand the alcoholic family members within a specific cultural background as well as to build a cultural-specific care-plans for them.     

Impact of an oncology pharmacy residency training program on quality improvement initiatives in an oncology center

The concept of quality care is something every patient expects, regardless of how they enter the health care system. The specialty-trained oncology pharmacy practitioner possesses many skills to offer the patient and other health care practitioners. Oncology pharmacy residency training involves specific types of learning situations and experiences, which will be critical for future roles the specialty resident may assume. Oncology practice is an area requiring a high level of care for patients, and highly skilled pharmacy practitioners are crucial for the care of these patients.     

Psychotherapeutic interventions with substance abusers--the clinical context

Drug/alcohol dependent individuals need to discover and understand how they have adopted extraordinary drug solutions for a range of problems. I believe human relationships can best provide this opportunity through either a professional psychotherapeutic relationship or peer group experiences such as group therapy and self-help groups such as AA or NA. Addicts need to learn that drug solutions preclude more ordinary solutions to life problems, and that therapeutic and peer groups experiences can provide the creative challenges, tools, and impetus to find alternative solutions. Clinical work with severe and disabling human problems teaches the humbling nature of our work as health care professionals. Clearly, work with substance abusers is no exception. As we gain in our scientific, technical and clinical understanding of these problems, we are able to help our patients make enlightened choices about what is useful and effective in their treatment and recovery. However, there is much we do not understand about substance abuse, and there are many affected by the problem who cannot accept what we have to offer. Effective practice in this case, then, must still be guided by practical and empirical measures of what is safe and what works. Health care professionals do not have a corner on this market of what is safe and what works. Practitioners need to honor their traditions where treatment is guided by careful collection of data and continual pursuit of root causes, mechanisms, and etiologies. But, above all, rigid attitudes about the advantages of our own approach and the limitations of other approaches need to be avoided. In this respect we honor "above all" the primary tradition in clinical practice--"to do no harm".     

Cultural Competency in Health Care and Its Implications for Pharmacy

As the United States becomes more diverse, a patient's cultural influences on health outcomes and health care decision-making and delivery need to be considered. Cultural influences affect a patient's decision to take drug therapy and concomitant alternative therapies. Seven components have been identified to improve culturally competent care in a variety of practice sites. The first component to developing culturally competent practices involves the analysis of self and system attitudes and practices toward various cultures. In the second component, health care providers should increase their knowledge about the cultures they serve through different patient assessment techniques, readings, and community activities. The third component involves improving cross-cultural communication by being aware of differences in social norms, assessing health literacy, using interpreters, knowing another language, and using bilingual patient education materials. In the fourth component, pharmaceutical care plans should accommodate cultural preferences such as the use of herbs, spiritual healers, and additional family decision-makers. Therapeutic plans should be negotiated between patient and provider to optimize outcomes. The fifth component discusses health care provider and system involvement in the community through health fairs, ethnic festival participation, and communication with cultural decision-makers to help provide culturally competent care by fostering communication ties. In the sixth component, knowing and following regulations such as the federal Culturally and Linguistically Appropriate Services and the Joint Commission standards for organizational cultural competency can help enhance care for patients from various cultures. In the last component, quality assurance assessments of procedures to improve care for various diverse cultures should be conducted, with findings (in terms of strengths and areas of improvements) shared with other providers and systems. Pharmacists and pharmacy technicians in a variety of systems and practices can improve care to patients with differing cultures by using these seven components to enhance culturally competent care.     

Medical Errors: The Hidden Victim

Abstract

This article examines the impact of medical errors upon health care practitioners. Medical errors are viewed from the perspective of extreme job related and personal stress. A transactional model of stress comprised of both situational and appraisal variables are utilized to explain the unique coping problems of health care professionals when dealing with serious medical errors. The culture of medicine, unique ethical requirements, and societal expectations are examined as an integral part of the context of coping with errors. The debilitating emotional impact of catastrophic medical errors is a function of a culture of perfectibility, blame and the myth of an error free practice of health care. The belief in the utilitarian value of blame and punishment inhibits the open discussion and processing of errors, which could lead to better data for process and system change. Change in the socialization of health care providers and the culture of medicine as well as a supportive environment for practitioners who err are needed in order to address the systems aspect of medical errors and to offer assistance to practitioners who inevitably will commit error as part of working in a complex, highly technological health care system.     

An Opportunity to Integrate Cultural Sensitivity Training Into the Doctor of Pharmacy Curriculum

Instructors of pharmacy skills-based laboratory courses are positioned to prepare students to be practice-ready practitioners through use of hands-on instructional activities essential for pharmacists. This commentary explores an approach to developing cultural sensitivity in pharmacy students, a skill which is reflected in Accreditation Council for Pharmacy Education (ACPE) Standard 3.5 and viewed by the authors as a critical skill for all healthcare practitioners. This commentary challenges the Academy to develop best practices for promoting cultural sensitivity in student-learners with the goal of producing students aware of how their own experiences may influence health inequities. The authors propose, using the model of self-efficacy theory as a framework, that skills-based pharmacy education is an ideal platform for cultural sensitivity skill development and engagement because of its ability to go beyond knowledge attainment and influence student abilities, behaviors, and attitudes. The authors’ recommendations include that members of the Academy self-assess personal and institutional cultural sensitivity, ensure integration of cultural sensitivity in curriculum, use self-efficacy theory as a guide to integrate best practices for providing culturally sensitive care in laboratory activities, and develop best practices.     

Serving multi-ethnic populations: measuring the cultural sensitivity of pharmacy interns in New York City

The cultural sensitivity of pharmacy interns in New York City towards issues associated with serving multi-ethnic populations was examined and measured. Cultural sensitivity included areas such as ability to speak/understand the local language, an understanding of the health needs and problems of different cultural groups and the desire to help patients of different ethnic backgrounds. In general, the 108 pharmacy interns who answered the survey instrument appeared to recognise the importance for practising pharmacists to be sensitive to the needs of ethnic populations. The interns felt that medication compliance, pharmacist-patient relationship, patient satisfaction, patient trust and ability to understand over-the-counter directions would be greater if the pharmacist could speak the language and understand the culture of the customer population. Pharmacy interns of ethnic background and those with multilingual capabilities were found to exhibit greater cultural sensitivity. The results should be useful to educators in preparing future pharmacists for the profession.     

Cultural competence and unique concerns in patients with ethnic skin

The projections of increases in the number of skin of color patients over the next several decades, necessitates expertise in cultural competence for health care providers. Acquiring competency begins with practitioners reflecting on their self identity and personal beliefs. Additionally, understanding African-American cultural habits and practices and their impact on disease is critically important. We review, in this article, the fundamentals of becoming cultural competent. Patients are best served when their physician embraces their culture, their view of the health care system as well as habits and practices.     

Surveillance study on the needs for self-medication of local residents and community pharmacists in Fukuyama

In recent years, self-medication is promoted to control the health care cost of aged people in Japan. On the other hand, there are many pharmacists who are perplexed in diversification of work with promotion of self-medication because of shortage of information, including the knowledge of an over-the-counter drug, health food, etc. It is therefore needed to design an efficient education program for pharmacists, especially in aging society such as Fukuyama. In this study, we investigated the needs for self-medication of local residents and community pharmacists in order to clarify the high-priority education themes for promotion of self-medication in Fukuyama. The pharmacist's needs were extracted by the KJ method and prioritized by the two-dimensional developed leaf method, and the local resident's needs were extracted by questionnaire survey from 420 general populations who live in Fukuyama. As a result, we found that the community pharmacists were especially in need of acquisition of the knowledge about "health food" and "food", and the local residents were especially in need of consultation with community pharmacists about "medicine", "side effect of medicine", "health food" and "food". Moreover, we also found that sixty percent of local residents did not have knowledge about interaction of "medicine" and "health food" while the half of them was taking in "health food". From the above result, knowledge improvement of "health food", "food" and "interaction of medicine and health food" in addition to "medicine" and "side effect of medicine" is the high-priority education themes for local residents and community pharmacists to promote self-medication in Fukuyama.     

Organisational culture: an important concept for pharmacy practice research

Throughout the developed world, community pharmacy is under considerable pressure to play a greater part in delivering effective primary health care. The requirement to adopt new roles continues to challenge community pharmacy and drive change. The factors that determine the ability of community pharmacy to effectively deliver services for health gain are complex and include; policy, professional, financial and structural elements. There is also evidence to suggest that organisational culture may influence the effectiveness of an organisation. In order to address this there is a need to understand the dimensions of organisational culture that lead to successful implementation of the change necessary for community pharmacy to become a more effective primary health care organisation. In this commentary, we introduce the concept of organisational culture, outline two frameworks for studying culture, and argue the benefits of pursuing an organisational culture research agenda for the evolution of pharmacy practice and research.     

A Service-Learning Elective in Native American Culture, Health and Professional Practice

Objectives

To evaluate the success of an elective course in Native American culture, health, and service-learning in fostering interest in experiences and careers with the USPHS Indian Health Service (IHS), and in shaping reflective practitioners.

Design

Students conducted readings, kept reflective journals, and engaged in discussions with Native American and non-Native American speakers. Students orally presented a Native American health issue and spent their fall break in Chinle, Ariz, providing social and healthcare services to the Diné under the supervision of IHS pharmacists. Opportunities for additional IHS experiences were discussed, as was discerning the Creator''s call to a professional life of service.

Assessment

Thirteen of 15 students who had completed the service-learning course by January 2007 responded to a brief survey indicating that not only were the course objectives met, but the experiences had a lasting impact on professional mindset and career plans.

Conclusion

The course had a lasting impact on students'' understanding of Native American social and health care issues, and on how they will practice their profession and live their lives.     

Disparities in Latino substance use,service use,and treatment: Implications for culturally and evidence-based interventions under health care reform

Background

The goal of this systematic literature review was to enhance understanding of substance use, service use, and treatment among Latino subgroups to improve access to care and treatment outcomes in an era of health care reform.

Methods

The authors used 13 electronic databases and manually searched the literature from January 1, 1978, to May 30, 2013. One hundred (69%) of 145 primary research articles met the inclusion criteria. Two blinded, independent reviewers scored each article. Consensus discussions and a content expert reconciled discrepancies.

Results

Current rates of alcohol and substance abuse among Latinos are comparable to or surpass other U.S. ethnic groups. Disparities in access and quality of care are evident between Latinos and other ethnic groups. As a heterogeneous group, Latinos vary by geographic region in terms of substance of choice and their cultural identity takes precedence over general ethnic identity as a likely determinant of substance abuse behaviors. There is growing research interest in systems influencing treatment access and adherence among racial/ethnic and gender minority groups. However, studies on Latinos’ service use and immediate treatment outcomes have been both limited in number and inconsistent in findings.

Conclusions

This review identified human capital, quality of care, and access to culturally responsive care as key strategies to eliminate disparities in health and treatment quality. Implications are discussed, including the need for effectiveness studies on Latinos served by systems of care that, under health care reform, are seeking to maximize resources, improve outcomes, and reduce variation in quality of care.     

A qualitative synthesis of pharmacist,other health professional and lay perspectives on the role of community pharmacy in facilitating care for people with long-term conditions

Background

There is increasing interest in an enhanced role for community pharmacy (CP) in facilitating care for people with long-term conditions (LTCs). It is important to understand the perspectives of stakeholders in order to identify key issues that may impact on future development of the role and related services.

Development of a Cultural Intelligence Framework in Pharmacy Education

Objective. Pharmacists must be equipped with the knowledge, skills, and attitudes necessary to provide culturally intelligent and patient-centered care; however, most are not trained to do so. In order to prepare culturally intelligent pharmacists, standards and curricula for cultural intelligence must be defined and implemented within pharmacy education. The objective of this study was to create a cultural intelligence framework (CIF) for pharmacy education and determine its alignment with Doctor of Pharmacy (PharmD) training.Methods. An extensive literature analysis on current methods of cultural intelligence education was used to construct a CIF, which integrates leading models of cultural intelligence in health care education with Bloom’s Taxonomy. Five student focus groups were conducted to explore and map their cultural experiences to the CIF. All focus groups were recorded, transcribed, deidentified and deductively coded using the CIF.Results. The four CIF domains (awareness, knowledge, practice, desire) were observed in all five focus groups; however, not every participant expressed each domain when sharing their experiences. Most students expressed cultural awareness, knowledge, and desire, however, only a few students discussed cultural practice. Participant comments regarding their experiences differed by race and year in the curriculum.Conclusion. This study was a first step toward understanding cultural intelligence education and experiences in pharmacy. The CIF represents an evidence-based approach to cultural intelligence training that can help prepare pharmacy learners to be socially responsible health care practitioners.     

Access to cancer medication in public hospitals in a middle-income country: The view of stakeholder

BackgroundAccess to cancer medicines is a core component of comprehensive cancer care; as such, it is included in Mexico's public health insurance: Seguro Popular de Salud (SPS). Learning about stakeholders' experiences on processes and barriers influencing access to essential cancer medicines within healthcare facilities allows identifying needed policies to improve access to cancer care.ObjectiveThe aim of this study was to obtain the insights of health professionals in public hospitals in Mexico on how SPS influences access to cancer medicines regarding medicine selection, financing, and procurement and supply systems. The purpose is to identify policy areas that need strengthening to improve access to cancer medicines.MethodsSemi-structured interviews were conducted with 67 health professionals from 21 public hospitals accredited by SPS across Mexico. A framework analysis was used with categories of analysis derived from the World Health Organization's Access framework.ResultsMost stakeholders reported that the availability of listed cancer medicines was sufficient. However, cancer specialists reported that medicines coverage by SPS was restrictive covering only basic cancer care. Public hospitals followed SPS treatment protocols in selecting and prescribing cancer medicines but used different procurement procedures. When essential cancer medicines were unavailable (not listed or stocked-out), hospitals reported several strategies such as prescribing alternative therapies, resorting to direct purchases, and assisting patients in obtaining medicines elsewhere. Other reported barriers to access to treatment were: distance to health facilities, poor insurance coverage, and financial restrictions.ConclusionsHealth professionals have encountered benefits and challenges from the implementation of SPS influencing access to cancer medicines and care in Mexico, pointing to areas in which action is necessary. Finding the right balance between expanding the range and cost of cancer treatments covered by insurance and making basic cancer care available to all is a challenge faced by Mexico and other middle-income countries.     

Opportunities and responsibilities for pharmacists to improve their effectiveness in addressing medication adherence through culturally sensitive collaborations with community health workers

ObjectivesDespite progress in addressing health disparities among vulnerable populations, minority populations are at risk for chronic health conditions associated with multiple determinants of health, which affects their health status and access to care. We offer a potential solution, which creates an unconventional medical team between a pharmacist and a community health worker (CHW). We explore weaknesses and challenges in our medication use system in the context of adherence as a drug therapy problem, the role of culture in shaping medication use, and finally offer a unique paradigm for a collaborative interprofessional team consisting of CHWs and pharmacists.SummaryMedication adherence is far from optimal, especially in minority ethnic populations. Members of an ethnic group may acquire beliefs about illness consistent with their culture’s shared customs. These findings intimate that ethnocultural minority groups may have their own remedies for illness that shape their decision to use medications as prescribed. An interprofessional team in which CHWs and pharmacists collaborate offers an opportunity to improve the effectiveness of pharmacists to address adherence-related problems, especially among minority populations in which culturally determined beliefs can shape medication use decisions.This approach holds promise because CHWs are usually embedded within the community in which their patients live, having experienced the same life experiences. These shared experiences may lead CHWs to uncover medication use practices that pharmacists are not able to discover on their own because the relationship with their patients is often not authentic, which, for many minority patients, can only be established through shared experiences.ConclusionThis paper argues that creating teams of CHWs and pharmacists will help address challenges in achieving health equity and health disparities among vulnerable populations in the medication use system.     

A culturally competent education program to increase understanding about medicines among ethnic minorities

Background It has been previously suggested that the risk of medicine-related problems—i.e., negative clinical outcomes, adverse drug reactions or adverse drug events resulting from the use (or lack of use) of medicines, and human error including that caused by healthcare personnel—is higher among specific ethnic minority groups compared to the majority population. Objective The focus of this study was on reducing medicine-related problems among Arabic-speaking ethnic minorities living in Denmark. The aim was twofold: (1) to explore the perceptions, barriers and needs of Arabic-speaking ethnic minorities regarding medicine use, and (2) to use an education program to enhance the knowledge and competencies of the ethnic minorities about the appropriate use of medicines. Settings Healthcare in Denmark is a tax-financed public service that provides free access to hospitals and general practitioners. In contrast to the USA or the UK, serving ethnically diverse populations is still a relatively new phenomenon for the Danish healthcare system. Ethnic minorities with a non-Western background comprised a total of 6.9 % of the Danish population. Methods Data were collected through qualitative research. Four focus group interviews were conducted before and four after the education program. Thirty Arabic-speaking participants were recruited from language and job centers in Copenhagen. Participants received teaching sessions in Arabic on appropriate medicine use. The education program was evaluated by two methods: a written quiz for knowledge evaluation and focus group interviews for process evaluation. It took place during the first semenester of 2012. Results The majority of the participants were dissatisfied with the knowledge about medicines inherited from their parents. They also expressed their frustrations due to communication problems with Danish doctors. According to the impressions and quiz results of participants, the program was relevant, rich in information and effective. The program helped bridge the gap between participants and doctors. The commonality of the culture, language and gender shared by the researcher pharmacist and participants enhanced the success of the program. Conclusion The education program may potentially reduce medicine-related problems by providing participants with knowledge and competencies about appropriate medicine use. We recommend implementing education programs for ethnic minorities using the cultural competence approach to the appropriate use of medicines. Ideally, programs should be implemented in places that are frequented by ethnic minorities, and taught by health professionals with the same ethnic background as participants.     

Concordance: what is the relevance for pharmacists?

Non‐adherence (or non‐compliance) to prescribed medicines has long been regarded as problematic. The concept of concordance, rather than seeking ways to persuade people to take their medicines, instead focuses on the need to adopt a different model of the patient‐prescriber relationship. Much of the discussion about concordance thus far has related to the relationship between doctors and patients. In this article, the role of the pharmacist and ways in which pharmacists could usefully engage with the concordance model, both as part of the primary health care team and as independent practitioners, are considered. Concordance was developed as an ideal to which to aspire and needs to make the transition into practice. It is however important to note that if the move towards concordance is to happen and be successful it will require the support, enthusiasm and commitment of patients and health care professionals generally.     

What race and ethnicity measure in pharmacologic research

Advances in genomic technology have put the utility of collecting racial and ethnic data into question. Some researchers are optimistic about the potential of moving toward "personalized medicine" by using a person's genome to administer medications. Genetics will not erase the importance of race and ethnicity because race and ethnicity do not measure genetic composition. Unlike genes, race and ethnicity are social constructs; 2 persons with identical genetic makeup may self-identify as being of different race or ethnic origin. Race and ethnic categories have been subject to change over time; a person's self-identification may vary according to the context, wording, and format of the question asked. Despite the fluid nature of the concept, self-identified race and ethnicity can capture something that genes cannot, namely, aspects of culture, behavior, diet, environment, and features of social status that commonly used measures of socioeconomic status, such as income, education, and occupation, cannot measure.     

What can we learn from parents about enhancing participation in pharmacovigilance?

Aims

To investigate parents'' views and experiences of direct reporting of a suspected ADR in their child.

Methods

We audio-recorded semi-structured qualitative interviews with parents of children with suspected ADRs. Our sample included parents with (n = 17) and without (n = 27) previous experience of submitting a Yellow Card.

Results

Parents in both groups described poor awareness of the Yellow Card Scheme. Parents who had participated in the Yellow Card Scheme were generally happy to report their child''s ADR via the Scheme and valued the opportunity to report concerns independently of health practitioners. They expressed motivations for reporting that have not previously been described linked to the parental role, including how registering a concern about a medicine helped to resolve uncomfortable feelings about their child''s ADR. Parents who had not previously submitted a Yellow Card expressed uncertainty about the legitimacy of their involvement in reporting and doubts about the value of the information that they could provide.

Conclusion

Promoting wider participation in pharmacovigilance schemes will depend on raising public awareness. Additionally, our findings point to the need to empower lay people to submitting reports and to reassure them about the value of their reports.