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Healing the Hues: Unveiling Solutions in Minority Healthcare & Disparities

AUDREY B. JOHNSON, RPH,CPH, MSM

Disclosure:

I do not have a vested interest in or affiliation with any corporate organization offering financial support or grant monies for this continuing education activity, or any affiliation with an organization whose philosophy could potentially bias my presentation.

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Minority Health Disparities:

John Hopkins Medical Center – Baltimore, MD

Healing the Hues: Unveiling Solutions in Minority Healthcare & Disparities

Pharmacist Objectives:

1. List diseases of prevalence in respective Minority populations.

2. Describe three populations included in statistical evaluations of healthcare disparities.

3. Describe tools and methods utilized to evaluate the cultural competency of a practice.

Pharmacy Technician Objectives:

1. Describe three key barriers identified in healthcare for minority populations.

2. Develop methods of cultural competency

3. Indicate practice approaches to assist patients of disparities.

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Discussion Topics:

Minority Population: ◦ African Americans, Hispanic , and Asian Americans

◦ Secondary Groups

◦ Multiple Race/Bi-Racial/more than 2 Races

Disparities: ◦ Economic, Underserved, Under Educated, Disabilities

Culture: Social, Beliefs, Behavior, Influence

Diversity: Race, Gender, Sexual Orientation, Age

Projected Race Profile for U.S. Population

Two or More Races population is projected to be the fastest growing

2+ Race Population expected to triple in size by 2050 (@226% growth)

Asian population is projected to be the second fastest-growing

group, with an increase of 128 percent projected for the Asian

Census.gov; Current Population Reports 2015

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Statistical Data and Evaluation of Healthcare Disparity in Minority Populations:

Disease prevalence

Patient Care Disparities

Professional Disparities

Access-Accessibility

Disease prevalence in Minority Populations:

African American

The death rate for African Americans was generally higher than whites for heart diseases,

stroke, cancer, asthma, influenza and pneumonia, diabetes, HIV/AIDS, and homicide

Hispanic Population

Puerto Ricans have a low birth weight rate that twice that of non-Hispanic whites.

Puerto Ricans also suffer disproportionately from asthma, HIVAIDS and infant mortality

Asian Population

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The Cost Impact for United States:

OMH reported in 2017 the cost for Health

disparities and subsequent deaths among

race and ethnic minorities was reported by

NIH as $1.24 trillion

• Between 2014 and 2060, the U.S. population is projected

to increase from 319 million to 417 million,

reaching 400 million in 2051.

• By 2044, more than half of all Americans are projected to belong

to a minority group (non-Hispanic White alone)

• By 2060, nearly one in five of the nation’s total population is projected to be foreign born.

U.S. Population projection 2014 to 2060

Census.gov/March 2015; Current Population Reports Colby, L. and Ortman, J.

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Disparities in Healthcare

SOCIAL, ECONOMIC AND ENVIRONMENTAL DISADVANTAGES

Sub-category Groups most likely to experience Disparity in Care, Treatment, or Access:

People with disabilities

People with limited English proficiency

People with low health literacy

Racial /ethnic minorities

Sexual and gender minorities

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Statistical review on Disparities:

◦Infant Mortality ◦HIV Rates ◦Patients with Disabilities

Disparity in Health Care for Patients with Disabilities

5min video

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Infant Mortality rate by Maternal race

2x higher for Black non-Hispanic than Hispanic, Asian, and White non-Hispanic

HIV Rates: CDC- HIV Surveillance Report 2010-2015

Black/African American 49 % Multiple races 25 % Hispanic/Latino 23 % White 6.3% Asian 5.9 %

CDC-MMWR / April 18, 2014 / Vol. 63 / No. 1

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Barriers in Minority Health

Barrier and absence of support:

2min video

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Barriers of Influence: PRIMARY BARRIERS:

(PATIENT INFLUENCED)

Cultural practices

Religious – Belief Systems

Access

Economic

Participation*

Behavior

Family Support/Guidance

SECONDARY BARRIERS:

(PROFESSION INFLUENCED)

Trust -Comfort

Literacy - Comprehension

Access

Cultural Competency*

Diversity in Practice setting*

Linguistic barrier*

Policy-Programs

Barriers correlate: PRIMARY BARRIERS:

(PATIENT INFLUENCED)

Cultural practices

Religious – Belief Systems

Access

Economic

Participation*

Behavior

Family Support/Guidance

SECONDARY BARRIERS:

(PROFESSION INFLUENCED) Trust -Comfort

Literacy - Comprehension

Access

Cultural Competency*

Diversity in Practice setting*

Linguistic barrier*

Policy-Programs

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Health Literacy Report: 2017 National Assessment of Adult Literacy (NAAL). These findings include:

Only 12 percent of U.S. adults had proficient health literacy

Over a third of U.S. adults—77 million people—would have difficulty with common health tasks, such as following directions on a prescription drug label or adhering to a childhood immunization schedule using a standard chart.

Limited health literacy affects adults in all racial and ethnic groups.

Adults with basic or below basic health literacy ranges from 28 percent of white adults to 65 percent of Hispanic adults.

College graduates can have limited health literacy.

Compared to privately insured adults, both publicly insured and uninsured adults had lower health literacy skills.

All adults, regardless of their health literacy skills, were more likely to get health information from radio/television, friends/family, and health professionals than from print media.

AHQR Disparities Report: Agency for Healthcare Quality & Research Disparities in quality of care are common:

Blacks and AI/ANs received worse care than Whites for about 40%

Asians received worse care than Whites for about 20%

Hispanics received worse care than non-Hispanic Whites for about 60%

Poor people received worse care than high income people for about 80%

www.ahrq.gov; 2010 Disparities in Health Care Quality Among Racial and Ethnic Minority Groups

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Framework of Influencing Barriers

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Snapshot of Clinical Trial Data:

Cancer is the 2nd Leading Cause of Death in All Races – Clinical Trail for approved Oncology Drugs for 2017 reflects the following:

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Barriers identified: Clinical Trial Participation

2016 FDA Launched a first phase campaign to encourage Minorities to participants in Clinical Trials Increase Awareness Encourage discussions Encourage participation

Unveiling Solutions:

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NIMHD speaks to efforts in solutions:

NIMH Scientific Advancement Plan : published Dec. 2017 3min video

The increasing diversity of the United States population has significant implications for the structure of the health care workforce. People of color now constitute a majority in 48 of the largest cities in the U.S., and five states have “minority majorities.”

2014 National Conference of State Legislatures

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Findings on patient preferences in Care

Diversity leads to increased racial and ethnic minority patient choice

and satisfaction:

Racial and ethnic minority patients who have a choice are more likely to select health care professionals

of their own racial or ethnic background

Racial and ethnic minority patients are generally more satisfied with their care, and are more likely to report receiving higher-quality care, when treated by a

health professional of their own racial or ethnic background

Increasing diversity will also lead to improving the ability of

the health care workforce to effectively address the health care needs of all Americans

Advisory Committee on Minority Health (ACMH) –recommendations of action

• Expand partnerships and funding sources to make the health care workforce more representative and reflective of diverse communities.

• Strengthen the quality of the K -16 educational system and access to professional schools.

• Increase the diversity of leadership in the health care service and education

• Examine and modify accreditation and licensure procedures to ensure cultural competency, diversity, adequate training opportunities, and quality of health care providers

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NCSL – Workforce Diversity Report of 2014 Workforce

Relative to the U.S. population, African Americans and Hispanics are still

significantly underrepresented within the ranks of Physicians, Nurses

and Dentists

Fewer than 5 percent of physicians or dentists are African American or

Hispanic

Only 5.4 percent of nurses are African American; by comparison, 83.2

percent are white Source: Center on Education and the Workforce. Office of Management and Budget

Healthy People 2020: Action Model

Action Model to achieve

Overarching Goals:

Interventions: Policies Programs Information

Outcomes:

• Specific risk factors, diseases, and conditions

• Behavioral Outcome

• Injuries

• Well-being and health related Quality of Life

• Health equity

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Healthy People 2020 Overarching Goals of Healthy People 2020

The recommended overarching goals for Healthy People 2020 continue the tradition of earlier Healthy People initiatives of advocating for improvements in the health of every person in our country.

Health determinants are the range of personal, social, economic, and environmental factors that determine the health status of individuals or populations.

Social determinants include family, community, income, education, sex, race/ethnicity, geographic location, and access to health care, among others.

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Case Study:

46 yr Hispanic male arrives to Excel Pharmacy to have a prescription filled

Patient is asked by the Pharmacy Technician to provide information (DOB, Allergies, Address)

He is Non-English speaking and does not understand

No one on the Pharmacy team speaks Spanish

The two Pharmacy Technicians are snickering and seemly to the patient making fun of him

He gets upset and begins to raise his voice, in apparent pain he holds his chest

What is the next action in this scene?

What are the options for your Pharmacy to address?

Under utilized services: Health Navigators

Case Managers

Counseling Services

Supportive Care tools

Rispite Care

Hospice

Foundations-Grants

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Framework for DEI Model

Diversity

Equals

Numbers

Inclusion

Equals

Behaviors

Equity

Equals

Outcomes

Why Culturally and Linguistically Services matter: (CLAS)

Presented by NPA (National Partnership in Action to End Health Disparities)

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Cultural Competency for Health Care: Understanding cultures, languages, home lives and values of patients

Providers adapt how they communicate with patients about their

health or needed health care

Cultural competence involves avoiding stereotyping and over- generalizing

Providers to tailor medical instructions and guidance to the individual patient

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Pharmacy Practice Solutions:

MTM Services- Medication Therapy Management

Collaborative Practice Agreements

Specialty Certifications – Nutrition, Senior Care, Diabetes, Asthma

Community Outreach- Provide Talks in Community, Faith Based

Connect with Special Groups- Disability, Veterans, Counsel on Aging

Learn a Second Language

Workplace Diversity & Cultural Competency Training

Tools and Methods: Pharmacists must continue to learn about different cultures

Effective communication – Eye contact, Listen, Non-verbal ques

Printed Literature in Multiple Languages

Prescription Label – print in patients primary language

Forms- (difficult for the data entry person to transcript)

Support Translation Service for access- ACHA Required for Medicare service/network

Staff training – eModules, scenarios, Role-play

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Assessment Quiz:

1. List 2 diseases of prevalence in respective Minority populations. a. Black non-Hispanic b. Hispanic c. Asian

2. Describe three populations included in Disparities data 3. Describe three key barriers identified in Minority Health Care

4. Name a method or tool for cultural competency in Pharmacy

5. Indicate 2 practice approaches to assist patients of disparities:

Unveiling Solutions: Health Equity awareness

Health Education Training Disease Self-Management

Compliance-Adherence

Clinical Trails Enrichment

Cultural Competency training for Healthcare Professionals

Diversity Training

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Resources: AACP- American Association for Colleges of Pharmacy

CDC – Center for Disease Control

HHS- Health and Human Services

NHI – National Health Institute

OMH – Office of Minority Health

NPA – National Partnership for Action (to End Health Disparities)

Think Cultural Health /HHS.gov

FDA - 2017 Drug Trial Snapshots the Summary Report; fda.gov

NHRQ- National Healthcare Research &Quality

MMWR – Morbidity Mortality Weekly Report / April 18, 2014 / Vol. 63 / No. 1

IHI- Institute for Healthcare Improvement / Achieving Health Equity; White Paper 042016

Solutions Discussion- Q&A

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Thank you HEALING THE HUES-

UNVEILING SOLUTIONS