Sociology & Cultural Awareness in Pharmacy Practice Handouts PDF

Sociology & Cultural Awareness in Pharmacy Practice Presenter: Kiran Parsons Learning Objectives for Sociology & Pharmacy Practice: As a result of this lecture, you will be able to:  Describe five features of a pharmacist practising with a person-centred (PCC) approach in the context of the contemp...

Sociology & Cultural Awareness in Pharmacy Practice Presenter: Kiran Parsons Learning Objectives for Sociology & Pharmacy Practice: As a result of this lecture, you will be able to:  Describe five features of a pharmacist practising with a person-centred (PCC) approach in the context of the contemporary model for good pharmacy practice.  Describe the key evidence-based benefits from providing a PCC approach in health care.  Recognise illness as a social concept and as a behaviour and discuss the sociological models mentioned to understand these behaviours  Discuss the effect of society on an individual’s health and health behaviour  Define the term concordance and describe how it differs from compliance and adherence  Define cultural competence and understand the need for cultural competency in the practice of pharmacy  Outline the key considerations for pharmacists in providing care with cultural awareness The Contemporary Model for Good Pharmacy Practice Provide medicines together with services, systems and information Provide health information and primary health care services Improve Patient Health Outcomes pharmacy as an effective and integral part of the health care delivery system which coordinates its activities with other health care providers Involves an understanding of the sociobehavioural aspects of illness Providing Person Centred Care (PCC) is highlighted in key pharmacy documents  Competency standards  Professional Practice Standards  Code of Ethics for Pharmacists  Seventh Community Pharmacy Agreement - Pharmacy Guild of Australia (7th CPA in place till 30 June 2025) A Person-Centred Care pharmacist: Benefits of PCC  Better outcomes in chronic health problems  Increased patient satisfaction, QoL & engagement  Reduced patient anxiety  Improved professional satisfaction  Improved business outcomes Key Principles of PCC 1. bio-psycho-social perspective: broadening the focus of the pharmacist-patient interaction to include psychological and social factors as well as physical symptoms 2. patient as a person: exploring the meaning of illness and health to each individual patient 3. sharing power and responsibility: including the patient in decision making and considering them to be an expert in their own health 4. therapeutic alliance: valuing the relationship between pharmacist and patient as a means of promoting health 5. pharmacist as a person. Pharmacists are not interchangeable, the particular qualities, attitudes and values of the pharmacist are important and will suit one patient better than another Why Sociology?  Health & Illness are social phenomena  Affects everyone  Individual reactions are socially patterned  Health care takes place within a specific organisational context:      West: get ill  see Dr, pharmacist, nurse, naturopath Some western countries healthcare is free or subsidised Being healthy or ill affects our relationships with other people in society & how we present ourselves Taking medication affects our identity Pharmacists practice within social relationships and structures The effect of society on health community income & social status policy education lifestyle health care Social & Behavioral Science in Pharmacy  Knowledge of which enhances pharmacy practice  Socio-behavioural theories attempt to describe the patterns and meaning of human behaviour and the wider influences on the individual (the science of society)  Help understand and predict : Why individuals and society behave the way they do in relation to health and illness How individuals and society use medicine and look after their health in general  If you want to solve medicine-related or health-related issues you need to take into account social and behavioural theory Marxism Parsonian Interactionism Feminism Behaviour theory Medicalisation Iatrogenesis Ethnicity Social & Behavioral Science in Pharmacy  Different way of defining illness: layman defined term Traditional: A malfunction of a physical process or structure Socio-behavioural: a bio-physical state influenced by individual and psychosocial issues such as beliefs, thoughts and behaviour  Health & Illness – mean different things to different individuals  Health: dichotomy or spectrum WHO definition: health is a state of complete physical, mental and social well-being and not merely the absence of diseases and infirmity  Disease: professionally defined, but health experts argue about definition  Illness: defined by the individual and can be influenced defined by society (Parson’s concept: the ‘sick role’) Models of Health & Illness Earliest beliefs Disease due to evil spirits Hippocrates 460370BC Imbalance of 4 body fluids cause disease God’s punishment Decartes (post-Renaissance) Body viewed as a machine Body & mind separate The role of microbes & other disease causing agents The effects of nutrition, hygiene and lifestyle factors Biopsychosocial model Current thinking takes into account: genetic determinants psychosocial factors behavioural determinants environmental & socioeconomic determinants Biomedical model Disturbed physiological processes caused by injury, biochemical changes or infection Separates physical from psychological & sociological influences Dominated healthcare processes Factors influencing health Adapted from Rees, J. A.; Smith, I; Watson, J. Pharmaceutical Practice 5th ed. Edinburgh : Elsevier 2014. Community level  Individual  Political and economic Psychosocial environment climate (e.g. employment (e.g. relationships, level) housing)  Microphysical  Macrophysical environment (e.g. environment (e.g. airchemicals, noise) quality) level  Work environment (e.g. work stress)  Social Justice/equity (e.g. social security system)  Behavioural environment (e.g. smoking, alcohol, exercise)   Social class and education Genetics & biological factors – ethnicity, sex, gender  Local control/cohesiveness (e.g. local planning efforts) Effects of personality in illness  Shown to be associated with illness and poor health  High levels of anxiety, depression, anger/hostility  more disease prone  More positive approach to stress  less disease prone, recover faster if they get ill  Friedman & Rosenman 1974 – Type A personalities (competitive, achievement orientated, self-critical, tightly scheduled, easily angered or stressed) show clear association with coronary heart disease Illness Behaviour Models The process of becoming ill  Kasl & Cobb 1966 defined 3 types of behavior in the progress of disease: 1. Preventative health behaviour: undertaken by an individual who believes himself to be healthy for the purpose of preventing or detecting illness in an asymptomatic state e.g. quitting smoking or taking vitamin C to prevent a cold 2. Illness behaviour: any behaviour undertaken by an individual who feels ill to relieve that experience or to better define the meaning of the illness experience e.g. taking anti-inflammatory medicine for pain 3. Sick-Role behaviour: (Talcott Parsons) adopted when an individual perceives themselves to be sick, takes on a socially determined role e.g. taking time off work following a myocardial infarction Sick-Role Behaviour Socially determined role which includes the following components:  The patient is not blamed for being sick  The patient is exempt from work & other responsibilities  The illness is seen as legitimate as long as the patient accepts that being ill is undesirable  The patient is expected to seek competent help to get well again  The role is legitimised or conferred by someone Does not seem to apply to chronic illness or mental illness or to certain diseases such as alcoholism Sick-Role & Non-Adherence  Non-adherence in terms of the sick role model: e.g.   Patient is diagnosed by their GP as having a bacterial infection  GP prescribes course of antibiotic therapy  The patient obtains the prescription and initially complies with the directions on the label  After a day or two, the patient feels much better and therefore no longer justifies playing the sick-role  Continuation of an antibiotic regimen is inconsistent with this  Patient perceives taking the antibiotics as part of being sick  BUT, ‘I’m not sick anymore so I do not need to take this medication?’. Pharmacist role to reinforce the importance of adherence with appropriate verbal and written counselling. The HCP – Patient Relationship Paternalism: Do as I say Health Care Professionals Dominant and autonomous Role of expert Predominantly one way communication Legitimates patient’s illness & determines course of treatment Patient Passive and dependent on HCPs Expected to cooperate Level of control is low Allows privileges of sickrole Spoiler alert: it doesn’t work The move from paternalism Recent Australian studies have shown that: Up to 50% of patients taking antihypertensive agents do not adhere to their medication regimen Around 20% of people who were commenced on an ACEI, ARB and or a calcium channel blocking agent failed to collect a second prescription At 24 months following initiation of therapy, 50% of people had stopped taking their medication An average estimated rate of 25–50% of patients for whom medications are prescribed, fail to receive full benefit due to inadequate adherence About half of all patients with chronic diseases have been known to stop having prescriptions dispensed within one year Why concordance? Review by Haynes et al. 2001  Interventions that used a combination of approaches: Providing more convenient care Giving patients more information Providing reminders Offering medicine counselling  DID NOT lead to large improvements in adherence rates  Need a different approach  In line with patient-centred care Concordance vs Compliance & Adherence Compliance  The extent to which a person’s behaviour in terms of taking medications, following diets or executing lifestyle changes, coincides with medical or health advice Concordance  Concordant: to be in agreement, consistent  Concordance is a process  Result is the patient and HCP participate as partners to reach an agreement on when, how and why to use medicines  Requires:  The HCP’s expertise  The experiences, beliefs and wishes of the patient Adherence  The extent to which a person’s behaviour in terms of taking medications, following diets or executing lifestyle changes, coincides with agreed recommendations from a health care provider - adapted from Marinker et al. 1997 Concordance  What can Pharmacists do in practice? Reinforce prescriber’s instruction & provide other important information Explore patient’s ideas, concerns & expectations Develop a rapport with patient Provide additional information Decide with patient - prioritise key info - provide in manageable chunks - patient’s view of the medicine - previous experience with medicine - patient’s concerns about medicine - accept legitimacy of patient’s views - basically all the attributes of good communication skills - does patient want any other info? - discuss pros and cons of medicine - avoid jargon - checks understanding - discuss other options - negotiates mutually acceptable plan - let patient know what to do or where to go if problems or questions Adapted from box 18.1 – A concordance model for pharmacy, pg. 165; Pharmaceutical Practice 5th ed. Rees et al. Concordance  What can Pharmacists say to encourage concordance? Explore patient’s ideas, concerns & expectations Provide additional information Decide with patient - “how do you feel about starting this medication?” - “do you feel you will be able to take this medicine as Dr has suggested?” - “how have you been getting on with your medicines?” - “do you have any concerns about starting this medication?” - “Is there anything in particular that worries you?” - “can I give you some more information about that?” - “would you like to know more?” - “are there any questions I can answer for you?” - “would you like to go away and read this and think a bit more about it?” - “it’s understandable that you are worried about those side effects, it can happen with this medicine. How would you feel about trying it for a week/month and see how you are get on?” - “how do the benefits versus the risks of this medicine weigh up for you?” Adapted from box 18.2 – A concordance model for pharmacy, pg. 165; Pharmaceutical Practice 5th ed. Rees et al. Health Literacy Introduced in PP1 – Lynne Emmerton  Health literacy is a person’s ability to find, understand and use health information  Low health literacy particularly an issue with over 65 year olds, people from diverse cultural & language backgrounds Health Literacy Health Literacy  For pharmacists  Assume a person has limited health literacy unless demonstrated otherwise  Then ‘step up’ the complexity of information to an appropriate level  Process strategies:  Content strategies:  Plain language Speak clearly Repeat key points Prioritise information Limit information Use illustrations Engagement strategies: Encourage questions: “What questions do you have for me?” Use teach-back (challenging to do well) Encourage demonstration Cultural Awareness Code of Ethics Cultural Awareness Culture means "patterns of human behaviour including thoughts, actions, customs, values, and beliefs that can bind a racial, ethnic, religious, or social group within society."  The Nursing Council of New Zealand guidelines for cultural safety state that the term “culture” encompasses, but is not restricted to: o Age or generation o Sex o Gender o Sexual orientation o Occupation and socioeconomic status o Ethnic origin or migrant experience o Religious or spiritual belief o Disability Cultural Awareness  Cultural awareness begins with knowledge  Different cultural groups may have:  different beliefs about their medical conditions and medications  differences in how they seek care and from whom that care is sought  differences influenced by time of arrival in Australia, length of settlement, socio-economic background, level of education, rural or urban residence, identification with cultural and religious background, and different life experiences  Cultural safety in healthcare means ‘to provide care in a manner that is respectful of a person’s culture and beliefs, and that is free from discrimination’ Cultural Awareness  Pharmacist should continue to develop cultural competence (life-long learning)  Benefits of increasing cultural safety in the pharmacy setting:   patient more likely to discuss health beliefs  patients feel comfortable and are more likely to return  stronger patient and community relationships and overall better health care If patients do not feel culturally safe : × they may be less likely to access health care × this can lead to poor outcomes and sub-optimal health care × × they may refuse treatment they may be non-adherent × they may be less likely to follow up if services Cultural Awareness Key considerations for pharmacists  Be aware of your own cultural beliefs relating to health care.  Be aware of judging other people's behaviour and beliefs about health care according to the standards of your own culture.  Be aware of making assumptions about cultural influences and applying generalisations to individuals. Cultural Awareness Key considerations for pharmacists  Understand that the behaviour and beliefs of people within each culture can vary considerably.  Understand that not all people identify with their cultural or religious background.  Increase your knowledge about different cultural health practices and issues through cultural background information sessions and/or resources and cultural awareness training.  Understand the importance of appropriate communication. Cultural Awareness Providing a culturally safe environment in the pharmacy Health information posters and leaflets portraying different ethnic groups and languages  Local Aboriginal Health Workers  Discuss at staff meetings  Private counselling space  Employing staff from other cultures  Use of interpreter services   Staff training Staff from different cultural backgrounds can teach other staff members about their culture  Advice is jargon free, plain language, with the assistance of diagrams, written resources and visual aids  Cultural training courses (accredited or  approved by PSA, RACGP, the Pharmacy Guild or NACCHO) Skellett, Lucy. Cultural awareness and cultural safety. Australian Pharmacist References: Pharmaceutical Society of Australia. Code of Ethics for Pharmacists (2017). Luetsch, K. (2019). From enforcement to advocacy – Developing a Foucauldian perspective of pharmacists' reflections on interactions with complex patients. Research in Social and Administrative Pharmacy, 15(5), 528-535. https://doi.org/https://doi.org/10.1016/j.sapharm.2018.06.020 Skellett, Lucy. Cultural awareness and cultural safety. Australian Pharmacist, Vol. 31, No. 5, May 2012: 382-384 Bell, JS et al. Concordance is not synonymous with compliance or adherence. Br J Clin Pharmacol. Vol. 64 No. 5, Nov 2007: 710–711 Roller, Louis and Gowan, Jenny. Disease State Management: Illness Behaviour, the Sick Role, Adherence and the Pharmacist. AJP: The Australian Journal of Pharmacy, Vol. 91, No. 1087, Dec 2010: 60-64 Wolters M, Rolf vH, Blom L, Bouvy ML. Exploring the concept of patient centred communication for the pharmacy practice. International Journal of Clinical Pharmacy 2017 12;39(6):1145-1156. Sánchez AM. Teaching patient-centered care to pharmacy students. International Journal of Clinical Pharmacy 2011 02;33(1):55-7. Larivaara P, Kiuttu J, Taanila A. The patient-centred interview: the key to biopsychosocial diagnosis and treatment. Scand J Prim Health Care 2001 03;19(1):8-13. Gibson K, Cartwright C, Read J. Patient-Centered Perspectives on Antidepressant Use. International Journal of Mental Health 2014, 43:1, 81-99. Pharmaceutical Society of Australia. Pharmacists in 2023: For patients, for our profession, for Australia’s health system. Canberra: PSA 2019 Rigby D. Medication in Review: The Patient-centred Imperative. The Australian Journal of Pharmacy. Aug 2011, Vol. 92, No. 1095, : 38-39 Daniels, A. Placing the patient at the Centre. Australian Pharmacist. September 2015; 34:9, 10.