Racial and Ethnic Disparities in Community-Based Pharmacies: Comparison
Please note this is a comparison between Version 1 by Stefanie Ferreri and Version 2 by Jason Zhu.

As pharmacy practice shifts its focus toward population health care needs that serve public health, there is a need to understand community-based pharmacies’ contributions to the reduction in health disparities.

  • pharmaceutical care
  • healthcare disparities
  • community pharmacy

1. Introduction

Racial and ethnic healthcare disparities are prevalent throughout the United States [1]. While this issue has received considerable attention from researchers, health practitioners, academics, and policymakers, disparities between White people and Black, Indigenous, and People of Color (BIPOC) persists—particularly in access to health care, disease incidence and prevalence, and mortality [2][3][4][5][6][7][2,3,4,5,6,7]. Over the past several decades, there have been various calls to change how race and racism are examined in healthcare [8]. In 2003, in Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, the Institute of Medicine (IOM) identified potential sources of racial and ethnic disparities in healthcare and provided recommendations for healthcare professionals, health systems, and policy makers [9][10][9,10]. However, racial and ethnic disparities in the United States continue. According to the 2018 National Healthcare Quality and Disparities Report, Black, American Indian or Alaska Native, and Native Hawaiian or Pacific Islander patients continue to receive poorer care than White patients on 40% of the quality measures included, with little to no improvement over the previous decades.
For health systems, the IOM recommendations include developing and implementing interventions that promote the use of evidence-based guidelines, structuring payment systems that ensure equitable access, cultivating communication and trust between providers and patients, employing language interpretation services, and engaging in multidisciplinary treatment and preventative care teams [11]. While many health systems have incorporated these recommendations, the novel coronavirus (COVID-19) pandemic exposed and compounded serious flaws in the American health care system [12].
One healthcare setting largely overlooked by researchers in the deployment of equitable services is the community pharmacy. Pharmacy practice models have highlighted community pharmacies’ unique position in connecting individuals to care [12][13][14][12,13,14]. Yet, little research has been performed in this setting to understand its delivery of equitable care. As one of the most accessible healthcare systems, community-based pharmacies can employ many of the IOM’s recommendations to target and reduce racial and ethnic healthcare disparities. As pharmacy practice shifts its focus toward population health care needs that serve public health, there is a need to understand community-based pharmacies contributions to the reduction in health disparities [15][16][15,16].

2. Publication Years and Study Design Characteristics

In total, 4 of the 42 publications were published within five years following the IOM guidelines. Furthermore, 15 articles were published between 2008–2012, which was more than five but less than 10 years since the release of the IOM recommendations, with the remaining articles being published greater than 10 years since the release of the 2003 IOM recommendations. Among the 42 articles, 11 articles used an experimental design, 20 employed an observational design, and 11 used an implementation science design.

3. Study Subjects

Here mostly focused on African American (n = 21) and Hispanic (n = 23) groups. Interventions were developed for American Indians and Alaskan Natives in 4 of the articles and for Asian individuals in 2 of the articles. The majority of the studies (n = 39) focused on the general population. Two studies’ research participants were pediatric patients, and one studies’ research participants were older adults. Majority of the studies targeted patients with diabetes (n = 17) and hypertension (n = 13). The remaining studies targeted general health literacy and counseling barriers (n = 8), vaccinations (n = 4), obesity and other weight related parameters (n = 4), asthma (n = 3), HIV (n = 2), smoking cessation (n = 2), dyslipidemia (n = 2), cancer prevention (n = 1), ophthalmic care (n = 1), and psychiatric illness (n = 1).

4. Pharmaceutical Care Services and Community-Based Setting

In the articles reviewed, pharmaceutical care services included medication and/or disease-state management (n = 17), patient counseling and education (n = 7), communication services, including language assistance (n = 8) and health literacy (n = 2), point of care testing (n = 5), and telemedicine (n = 1). Most of the pharmaceutical care services were rendered in the traditional community pharmacy (n = 13) and community-based clinic (n = 13) setting. The remaining services were rendered in community outreach sites (n = 9), safety-net or federally qualified health systems (n = 4), patient homes or nursing homes (n = 2), and community-based health systems (n = 1). Additional information regarding the articles reviewed can be found in Table 1.
Table 1.
Characteristics of community-based pharmaceutical services that target racial/ethnic health care disparities.
Author, Year Target Population * Targeted Intervention Pharmaceutical Service Type
Anderegg MD, Gums TH, et al., 2016 African American

MTM visits Medication Optimization
Blake SC, McMorris K, et al., 2010 African American

Caucasian **
Health communication training for pharmacists Language/Literacy
Caballero J, Souffrant G, et al., 2008 Hispanic Pharmacists provide psychiatric services Medication Optimization
Carrillo M, Sias J, et al., 2018 Hispanic, Spanish speakers Expanded and enhanced diabetes health education by an interprofessional team Patient Education or Counseling
Carter BL, Coffey CS, et al., 2015 African American

MTM visits Medication Optimization
Collins B, Bronson H, et al., 2018 Non-Hispanic Black

Non-Hispanic White **

Hispanic of any race
HIV testing program Point of Care Testing
Congdon, H.B., Dowling, et al., 2013 Hispanic MTM visits Medication Optimization
Elliott JP, Harrison C, et al., 2015 Black, Non-Hispanic

White, Non-Hispanic
Pharmacist and student pharmacist directed pediatric health screenings Point of Care Testing
Enfinger F, Campbell K, et al., 2009 African Americans

Caucasians **

Pharmacy team consultations during regular physician visits Medication Optimization
Gazmararian J, Jacobson KL, et al., 2010 African American

White **
Health communication training for pharmacists Language/Literacy
Geiger R, Steinert J, et al., 2018 American Indian/Alaska Natives Pharmacist conducted chart reviews of HCV patients Medication Optimization
Gerber BS, Cano AI, et al., 2010 Latino (Hispanic) Use of bilingual health promoter Language/Literacy
Isaacs D, Riley AC, et al., 2017 African American Interdisciplinary health fairs and community health outreach events Point of Care Testing Patient Education or Counseling

Jameson JP and Baty JP, 2010 Non-white Disease control by a pharmacist Medication Optimization
Kirwin JL, Cunningham RJ, et al., 2010 White **




Pharmacist delivered, primary care, physician-focused intervention Medication Optimization
Lam AY and Chung Y, 2008 Multiethnic Asian Pharmacist-conducted on-site influenza vaccination service Immunizations
Lee J, McKennett M, et al., 2019 Hispanic or Latino Interdisciplinary community health fair Immunizations
Martin SL, Williams E, et al., 2015 American Indians/Alaskan Natives Interprofessional diabetes clinic Medication Optimization
Matthews PH, Darbisi C, et al., 2009. Latino Touch-screen information kiosks with online access as a tool for providing culturally and linguistically relevant diabetic information Language/Literacy
Meyerson BE, Carter G, et al., 2016 African American Voucher outreach program for HIV home testing at three pharmacies Point of Care Testing
Moreno G, Tarn DM, et al., 2009. Latino Access to non-English language pharmacy service Language/Literacy
Muzyk, AJ., Muzyk, TL, et al., 2004. Hispanic

African American

Asian or Pacific Islander
Language-assistance services Language/Literacy
Navarrete, JP, Padilla, ME, et al., 2014 Hispanic Pharmacist-operated HPV vaccine program Immunizations
Ndefo, UA, Davis, PN, et al., 2019 African American Home visits by pharmacists Medication Optimization
Odegard PS, Lam A, et al., 2004 Asian, whose native language was not English Oral and written asthma education Language/Literacy
Owsley C, McGwin G Jr, et al., 2015 African American



Cuban American
Telemedicine screening Telemedicine
Oyetayo OO, James C, et al., 2011 Hispanic Diabetes counseling, education, and monitoring every 3 months by pharmacists Patient Education or Counseling
Rick R, Hoye RE, et al., 2017 American Indian Motivational interviewing and diabetes self-management education Patient Education or Counseling
Sansgiry, SS., Chanda S, et al., 2007. Hispanic Non-English language pharmacy service Language/Literacy
Sharif I, Lo S, 2006 Spanish-speakers Non-English language pharmacy service Language/Literacy
Sharp LK; Tilton JJ, et al., 2018 African American

CHW support in addition to clinical pharmacist support Medication Optimization
Shireman TI, Svarstad BL, 2016. Black Novel tools for improving adherence Medication Optimization
Shiyanbola OO; Kaiser BL, et al., 2021 Black/African American Pharmacist-led educational program on diabetes Patient Education or Counseling
Sisson EM; Dixon DL; et al., 2016 African American

White **



Pharmacists provided medication management. Medication Optimization
Snella KA; Canales AE; et al., 2006 African American

Pharmacist-led diabetes, HTN, and dyslipidemia screening Point of Care Testing
Soller RW, Chan, P, et al., 2012 Spanish-speaking MTM provided by pharmacists Language/Literacy

Medication Optimization
Svarstad, BL, Kotchen, JM, et al., 2013 Black Novel tools for improving adherence Medication Optimization
Tao LS; Hart P; et al., 2003 African American

Pharmacist led education Patient Education or Counseling
Valencia, V, Padilla, ME, 2015. Hispanic Education sessions led by community pharmacists Patient Education or Counseling
Victor RG; Blyler CA, 2018 Non-Hispanic Black Barbers promoted follow-up with pharmacists Medication Optimization
Victor RG; Lynch K, et al., 2018 Black Barbers promoted follow-up with pharmacists Medication Optimization
Wheat L; Roane TE, et al., Black

Native American

Collaboration between pharmacists and CHWs in identifying and addressing barriers to medication adherence and improving health outcomes for patients diagnosed with hypertension with or without diabetes Medication Optimization

5. IOM Recommendations and Gap Analysis

The IOM recommendations (IOMR) most frequently addressed by the included studies were: IOMR 5–11, implement multidisciplinary treatment and preventive teams (n = 30); IOMR 5–12, implement patient education programs to increase patients’ knowledge of how to best access care and participate in treatment decisions (n = 13); IOMR 5–9, support the use of interpretation services where community need exists (n = 12); IOMR 5–10, support the use of community health workers (n = 10); IOMR 5–6, promote the consistency and equity of care through the use of evidence-based guidelines (n = 9); IOMR 5–7, structure payment systems to ensure an adequate supply of services to minority patients, and limit provider incentives that may promote disparities (n = 8), addressed by less than a third of the included studies; IOMR 5–8, Enhance patient-provided communication and trust by providing financial incentives for practices that reduce barriers and encourage evidence-based practice, only addressed by one study.