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Title: Essentials of Cultural Competence in Pharmacy Practice: Chapter 13 Notes


1
Patients with Disabilities
  • Essentials of Cultural Competence in Pharmacy
    Practice Chapter 13 Notes
  • Chapter Author Dr. Jeanne Frenzel

2
Learning Objectives
  1. Identify the major disabilities affecting the
    U.S. patient population.
  2. Articulate strategies for treating patients with
    a variety of disabilities.
  3. Understand the risk factors and health
    disparities that may exist for people with
    disabilities.
  4. Understand deafness as a cultural model.
  5. Articulate barriers to health care that are
    relevant for people with disabilities.
  6. Identify common disabilities that will present in
    pharmacy practice.

3
Overview
  • 1 in 5 people living in the U.S. has a disability
  • 1 in 7 has an activity limitation (37.7 million).
    Of these 11.5 million cannot attend school or
    work or care for themselves.
  • In people older than 15, 34.2 million people have
    a functional limitation and often multiple
    limitations (e.g., unable to walk short
    distances, hear a normal conversation, read
    newsprint, or make themselves understood).
  • 1 in 25 people rely on personal assistance with
    activities of daily living (ADL) such as bathing,
    dressing, eating, and walking.
  • An estimated 2.5 million people have
    developmental disabilities, resulting in activity
    limitation.
  • Groups of people with disabilities often build a
    common identity, a culture of disability, that is
    based on similar experiences, values, and beliefs.

4
Deaf Culture
  • About 10 of the U.S. population report hearing
    loss, a subset of which are deaf.
  • About 2 million people are deaf in the U.S.
  • Primary communication is ASL (American sign
    language)
  • Socioeconomic, education, and literacy levels are
    lower among deaf individuals.
  • Deaf high school graduates have a literacy level
    of 4th-5th grade, due to English being their
    second language.
  • Deafness is measured on a spectrum and described
    by three models medical, cultural and social.

5
Blindness
  • The condition of lacking visual perception, with
    varying degrees of severity.
  • Total blindness complete lack of form and light
    perception.
  • Legally blind a person whose vision measures
    20/200 with correction. A person who has 20/200
    vision is able to see an object 20 feet away,
    whereas a person with normal sight (20/20) can
    see that same object from 200 feet away.
  • Low vision People who do not meet the standard
    of legally blind, but still have significant
    visual impairment.

6
Blindness (continued)
  • Approximately 10 million people in the U.S. are
    blind. More than 50 of those are over 65. About
    1.3 million people are legally blind.
  • Age related macular degeneration is the 1 cause
    of blindness in the U.S., followed by glaucoma
    (2), and Retinal damage due to diabetes (3).

7
Verbal Communication Impairments
  • Patients may be nonverbal or have verbal
    communication impairments.
  • To address these patients, pharmacists must seek
    alternative methods of communication
  • Assistive devices
  • Electronic communication devices
  • Continue to partner with the patient in
    healthcare decisions

8
Impact of Disabilities
  • Families and caregivers largely impact the care
    of a person with disabilities.
  • Pharmacists should be aware of the beliefs of the
    patient and the family.
  • Disability typically results in the loss of
    income. Approximately 6.5 million people who
    belong to low-income families have activity
    limitations.
  • 1 in 5 people older than 15 with a functional
    limitation has income below poverty level.

9
Risk Factors and Nutrition
  • People with mental illness
  • Comorbid health issues (cardiovascular and
    respiratory diseases, diabetes, and obesity)
  • Medication use, unemployment and poverty may
    contribute to weight gain
  • Poor nutritional status
  • Falling prey to people promoting curative products

10
Pregnancy and Sexuality
  • People with developmental disabilities have poor
    knowledge of pregnancy, childbirth,
    contraception, and STDs
  • Individuals with moderate developmental
    disabilities are less sexually active than the
    general population but are more likely to be
    targets of sexual abuse.

11
Spirituality
  • Studies have shown that spirituality is common
    among those dealing with chronic disability and
    chronic illnesses such as hypertension, diabetes,
    and chronic renal failure.
  • Spirituality, when used as a source of strength,
    has positively impacted recovery from illness and
    coping skills for those with disabilities.
  • Reductions in stress and symptom severity, as
    well as decreases in hospitalization, have been
    linked to activities such as prayer, worship, and
    meditation.

12
Health Care Barriers
  • People with disabilities have many barriers to
    adequate health care services. Four issues
    responsible for these barriers are
  • Attitude
  • Program
  • Physical limitations
  • Communication

13
Reflection Questions
  1. How will you assist patients with disabilities in
    obtaining and understanding their medications?
  2. As a pharmacist, what types of disabilities do
    you feel you should be most prepared to handle?
  3. How would you need to change your pharmacy if
    another pharmacist working with you had a
    disability? What types of disabilities would you
    be the most and least prepared to manage?
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