[NYAPRS Enews] NMQF: Report Finds Racial Disparities in Medication Access

[Matt Canuteson]

Report Finds Racial Disparities in Prescription Drug Access, Use,
Regimen Adherence 

The National Minority Quality Forum Thursday, May 14, 2009 

A new report from the National Minority Quality Forum finds that
appropriate medications for a variety of diseases often are
under-prescribed, over-prescribed, or mis-prescribed for African
Americans, Hispanics and Asian Americans. This comprehensive review of
studies on medication use in U.S. minority groups, entitled Origins and
Strategies for Addressing Ethnic and Racial Disparities in
Pharmaceutical Therapy: The Health-Care System, the Provider, and the
Patient, reveals disparities in treatment of minority patients with
cardiovascular illness, asthma, psychiatric illness, pain and other
conditions.

The report, authored by Richard Levy, Ph.D., Robert C. Like M.D., M.S.,
and Harry S. Shabsin, Ph.D., finds disparities in access to medications
through insurance programs, in the prescribing of medications and in
adherence to medication regimens. The report offers recommendations for
health-care planners and advocates, clinicians and health-care
organizations to improve prescribing and use of medications in a diverse
society.

"Since medications are a cornerstone of treatment for many diseases,
addressing unequal or inappropriate medication use should be a focus for
practitioners and organizations committed to the goal of eliminating
health-care disparities. We hope this report raises awareness of the
extent of medication disparities and will stimulate solutions to address
the problem," said Dr. Like, Professor and Director of the Center for
Healthy Families and Cultural Diversity of the UMDNJ-Robert Wood Johnson
Medical School.

The report points out that improving access to and use of medications in
diverse groups requires policies that enable affordable, personalized
therapy. Ethnic/racial background should, like other factors such as age
or gender, be considered in selecting drugs and dosages, in the
composition of drug formularies and preferred drug lists, and in
determining the scope of drug substitution policies. The report
emphasizes that therapy must be tailored to individual needs and
stereotyping and overgeneralization in caring for diverse populations
should be avoided.

Dr. Levy, a health care consultant and former vice president of the
National Pharmaceutical Council, states: "Differences in response to
pharmaceuticals in minority populations indicate the importance of
including diverse groups in comparative-effectiveness assessments.
Failure to do so may reduce, rather than improve, the quality of care
for ethnic and racial minorities". 

Key Findings from the Report

Many studies have revealed ethnic/racial disparities in prescribing
(under-prescribing, over-prescribing or mis-prescribing) for specific
diseases or classes of medication, including medications for asthma,
depression, psychosis, cardiovascular disease, diabetes, pain and
infectious disease. 

*	Medication disparities can stem from a relative lack of health
and drug insurance, aggressive cost containment in pharmacy benefits
plans and reduced services at pharmacies in minority neighborhoods. All
of these situations can limit access to medications or cause patients to
reduce or discontinue therapy. 
*	Most state Medicaid programs utilize pharmaceutical cost
containment polices which include prior authorization, generic
substitution, preferred drug lists, copayments and caps. While
fulfilling their intent to save drug costs, these policies may have the
unintended consequences of limiting access to necessary medications.
This limitation has been associated with increased utilization of
medical services by minority patients. 
*	Suboptimal prescribing may reflect a clinician's lack of
knowledge about the patient's culture or to the clinician's beliefs
about that culture. Clinicians who have that knowledge and who
communicate well can positively affect treatment outcomes. 
*	Relatively low adherence in filling initial prescriptions,
refilling prescriptions and taking medications according to directions
has been reported in minority patients being treated for asthma,
depression, psychosis, cardiovascular diseases, osteoporosis, diabetes
and in receiving vaccinations. Low medication adherence in minority
populations has been correlated with reduced health status
*	Much of the association between race/ethnicity and low adherence
is explained by low household income, lack of insurance, poor education,
low health literacy, language barriers and cultural beliefs. Low
adherence may also reflect poor communication by providers, often due to
lack of cultural competence training and time/resource constraints. 
*	Use of herbal or other folk remedies by persons from various
cultural backgrounds can complicate, interact and sometimes detract from
treatment with western medicines. 
*	Response to medications and optimal dosages may differ due to
genetic or environmental factors, or diet. Ethnic differences have been
consistently reported in the metabolism, effectiveness and frequency of
side effects of many important drugs. Failure to account for these
differences when prescribing or selecting agents for formularies or
preferred drug lists may lead to suboptimal treatment and disparities. 

The report is available online at
http://store.nmqf.org/p-13-nmqf-e-books.aspx
<http://www.trafficresults.com/click-rabbit.php?acctid=E3Bs9EE5XzU=&doci
d=DC1568312052009-1&redirect=1&url=http://store.nmqf.org/p-13-nmqf-e-boo
ks.aspx> . 

 

 

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