Cultural Competence
Essentials of Cultural Competence in Pharmacy
Practice: Chapter 1 Notes
Chapter Author: Dr. Kimberly Vess Halbur
Definitions of Culture
• “The accumulated store of shared values, ideas
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(attitudes, beliefs, values, and norms),
understandings, symbols, material products, and
practices of a group of people” (Institute of
Medicine, 2003)
“The integrated patterns of human behavior that
include the language, thoughts,
communications, actions, customs, beliefs,
values and institutions of race, religious, or
social groups” (Office of Minority Health, 2000)
More Definitions of Culture
• “An integrated pattern of human behavior that
includes thoughts, communications, actions,
customs, beliefs, values and institutions of a
racial, ethnic, religious or social group”
(Cross, Bazron, Dennis and Isaacs, 1989)
• “Totality of socially transmitted behavioral
patterns, arts, beliefs, values, customs, life
ways, and all other products of human work and
thought characteristics of a population of people
that guide their worldview and decision making”
(Purnell and Paulanka, 2003)
Why does cultural competence
matter in pharmacy practice?
• One of goals of drug therapy is improved
quality of life (Hepler & Strand, 1990).
• Why pharmacists must understand their
own cultural background (Zweber, 2002).
• This course will enable pharmacy students
to use cultural competence to improve
health outcomes for diverse populations.
Changing Demographics
• U.S. census projections for
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Caucasians and people from African
American, Latino, Native
American/Alaskan and Asian
backgrounds.
Projections for people of European
American descent by the year 2040
(http://www.census.gov/ipc/www/usinterimproj/natprojtab01a.pdf ).
Rationale for Cultural Competence
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Oath of a Pharmacist
Ethical Codes
Law
Professional Standards
Oath of a Pharmacist
• Devote professional life to the service of all
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humankind through the profession of pharmacy.
Consider the welfare of humanity and relief of
human suffering primary concerns.
Maintain the highest principles of moral, ethical,
and legal conduct.
• Developed by the American Pharmaceutical Association Academy of
Students of Pharmacy/American Association of Colleges of Pharmacy
Council of Deans (APhA-ASP/AACP-COD) Task Force on Professionalism;
June 26, 1994
APhA Code of Ethics
• Principle III requirements: pharmacist
“communicates with patients in terms that
are understandable” and “respects
personal and cultural differences among
patients.”
• Pharmacists are expected to maintain
knowledge and abilities as “health
information advances” (Principle IV).
Ethical Principles Related to Cultural
Competence (con’t)
• Principle VII: pharmacists are obligated to
patients, the community and society.
• Principle VIII requires pharmacists to be
fair, equitable and just in the distribution of
health resources.
Professional Standards
• CLAS—National Standards for Culturally
and Linguistically Appropriate Services
• JCAHO
What are the CLAS standards?
• “A means to correct inequities that
currently exist in the provision of health
services and to make these services more
responsive in the individual needs of all
patients/consumers.”
• Intended to be inclusive of all cultures .
• Intended to help eliminate racial and
ethnic health disparities.
What is JCAHO?
• Pharmacists and Joint Commission on
Accreditation of Healthcare Organizations
(JCAHO) standards.
• Evaluates and accredits health care
organizations and programs in the United
States.
• Focus: quality and safety improvement.
Legal Rationale
• Title VI of the Civil Rights Act of 1964
 Any federally funded program may not discriminate
on the basis of race, color or national origin.
 “No person in the United States shall, on the ground
of race, color, or national origin, be excluded from
participation in, be denied the benefits of, or be
subjected to discrimination under any program or
activity receiving federal financial assistance.”
 EQUAL ACCESS and EQUAL HEALTH CARE
Legal Rationale (con’t)
• OBRA ’90: Omnibus Budget Reconciliation
Act
 Mandated that pharmacists provide the option
of counseling to all Medicaid patients
regarding their prescription medications.
 Requires the pharmacist be able to
communicate with patients.
 Cultural competence is needed to meet this
communication requirement!
Case Studies
• Your best friend and roommate tells you about
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buying a new car. He/she says, “I got a great
deal. But, geez, did I ever have to Jew them
down.” What do you say or do?
You are being interviewed for a position that will
require you to work with Native Americans with
diabetes. The interviewer says, “We really need
someone committed. Those people need all the
help they can get.” What do you say?
KWL Chart
• What I know about cultural competence
• What I want to know about cultural
competence
• At the end of the semester…
 What I’ve learned about cultural competence
Reflection Questions
1. In what ways can pharmacists positively
impact health disparities?
2. How are the changing demographics of
the U.S. impacting the need for cultural
competence in pharmacy practice?
3. List three reasons for pharmacists to work
toward cultural competence.