Transcript Chapter 13 - American Pharmacists Association

Patients with Disabilities
Essentials of Cultural Competence in Pharmacy
Practice: Chapter 13 Notes
Chapter Author: Dr. Jeanne Frenzel
Learning Objectives
1. Identify the major disabilities affecting the U.S. patient
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population.
Articulate strategies for treating patients with a variety of
disabilities.
Understand the risk factors and health disparities that may
exist for people with disabilities.
Understand deafness as a cultural model.
Articulate barriers to health care that are relevant for people
with disabilities.
Identify common disabilities that will present in pharmacy
practice.
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
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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.
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.
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.
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).
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
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 lowincome families have activity limitations.
 1 in 5 people older than 15 with a functional limitation has
income below poverty level.
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
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.
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.
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
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?