Racial and Ethnic Disparities in Community-Based Pharmacies

Racial and Ethnic Disparities in Community-Based Pharmacies: Comparison

Please note this is a comparison between Version 2 by Jason Zhu and Version 1 by Stefanie Ferreri.

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 Hispanic	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 Hispanic	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 ** Hispanic	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 Immunizations
Jameson JP and Baty JP, 2010	Non-white	Disease control by a pharmacist	Medication Optimization
Kirwin JL, Cunningham RJ, et al., 2010	White ** Black Hispanic Asian Unknown	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 Hispanic Haitian 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 Hispanic	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 ** Asian Hispanic Other	Pharmacists provided medication management.	Medication Optimization
Snella KA; Canales AE; et al., 2006	African American Hispanic	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 Hispanic/Latino	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 Caucasian	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.

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