Society is made up of people from various backgrounds and circumstances. Diversity opens our minds to alternative lifestyles and ways of living which enriches our society. However, health services and healthcare professionals often do not fully tailor or cater for the unique requirements of individuals. Consequently, some people can become disadvantaged and their voices seldom heard.
The ‘medically underserved’ are typically eligible to receive a health service but for varying reasons do not, despite them being potentially most in need. These individuals have been shown to have distinctive healthcare needs, yet they may be less inclined to participate in health screening services and have been shown to have poorer health outcomes.
The following groups may be more susceptible to poorer health and therefore more in need of support:
- Black, Asian and Minority Ethnic groups
- Patients with disability (visual, learning and/or hearing impairment)
- Patients who are housebound
- Patients who are homeless or have no fixed address
- LGBTQ communities
- Patients with mental health illnesses and/or physical disabilities
- Geriatric patients with multiple comorbidities and polypharmacy
- Refugees or seeking asylum and the traveller communities.
However, it is worth bearing in mind that although it can be helpful to talk about groups of people who have common concerns, distinctive needs and face shared barriers to health care, it is important to be mindful that not everyone who may belong to an ‘underserved’ community are the same and some may not have poorer health when compared to the rest of the population, nor require additional support to manage medicines.
Healthcare professionals exhibit the same levels of implicit bias as the wider population, which in turn influences the clinician-patient interaction
Equality laws exist to protect the rights of minority groups. For example, the Equality Act 2010 legally protects people from discrimination. As pharmacists, we have a legal duty to encourage equal access to health services in the community to all patients without restricting these services to just those who may be more accepting of the invitation.
A recent study looked into the implicit bias displayed by healthcare professionals towards patients. Its findings indicated that healthcare professionals exhibit the same levels of implicit bias as the wider population, which in turn influences the clinician-patient interaction.
Further work needs to be undertaken to reconfigure services so that the most vulnerable are supported with their health and medicines. One way to achieve this would be to raise awareness of these influences to avoid subconscious biases and disparities in delivering healthcare to all patients.
What work is being done to support these patients?
An independent study evaluating the scale, causes and costs of wasted medicines estimated that in England alone, the yearly cost of NHS prescription medicines wastage is £300 million, including £90 million worth of medicines unused at patients’ homes and £110 million returned to community pharmacies.
Medicines Use Reviews form part of the English Government’s medicines management strategy to help improve medication adherence and reduce wastage. A team of researchers at the University of Nottingham, led by Dr Asam Latif, have developed a short Medicines Use Review (MUR) e-learning programme, aimed at community pharmacy staff. The aim is to improve pharmacists’ awareness, attitudes and behaviours towards the medically underserved.
The free e-learning programme has been co-produced by professionals and patients with the view of incorporating a shared decision making model. The team will investigate whether this educational intervention can change the attitudes and behaviours of pharmacy staff.
The primary outcomes include evaluating the impact of the e-learning programme in improving the provision of MURs to underserved communities. It further aims to capture the pharmacy staff’s experience, perceived impact on practice and any potential barriers and facilitators to successful implementation of the e-learning. Underserved patients’ experiences of medicines and level of support received from healthcare professionals will also be explored.
Three ways pharmacists can better support underserved communities:
- Proactively identify medically-underserved patients and tailor services to them
- Review staff members’ approach to make it more open and engaging in order to build trust and rapport
- Be aware of unconscious bias – subtle attitudes or stereotypes that we all have. Research shows unconscious bias can influences our decisions and actions without us even realising it.
By improving pharmacists’ awareness of underserved communities we might be able to better help patients and improve their health outcomes.
Latif A et al. Supporting underserved patients with their medicines: a study protocol for a patient/professional coproduced education intervention for community pharmacy staff to improve the provision and delivery of Medicine Use Reviews (MURs). BMJ Open 2016; 6:e013500.
Evandrou M et al. Ethnic inequalities in limiting health and self-reported health in later life revisited. Journal of Epidemiology and Community Health 2016; 70 (7):653-62.
Healthwatch Lincolnshire. Seldom Heard Voices. Boston England. 2015.
Reducing inequalities in healthcare provision for older adults. Nursing Standard 2011; 25 (41):49.
FitzGerald C, Hurst S. Implicit bias in healthcare professionals: as systematic review. BMC Medical Ethics 2017; 18: 19.
Trueman, P. Lowson, K. Blighe, et al. Evaluation of the scale, causes and costs of waste medicines. Report of DH funded national project. York and London: York Health Economics Consortium and The School of Pharmacy, University of London. 2010.