Socio-economic and Cultural Issues and Implications in Pharmacology

Socio-economic and Cultural Issues and Implications in Pharmacology

Learning Outcomes

  • Identify the factors influencing medication use by patients and communities.

  • Discuss the affordability, availability, and accessibility of medication in Aotearoa New Zealand.

Questions in Pharmacology

  • What is adherence?: Adherence in pharmacology refers to the extent to which a patient’s behavior—taking medication, following a diet, and/or executing lifestyle changes—corresponds with agreed recommendations from a healthcare provider.

  • What is compliance?: Compliance is a term often used interchangeably with adherence but may imply a passive role by the patient instead of an active agreement.

  • Factors Affecting Adherence: Factors may include financial constraints, physical disabilities, social issues like transportation, intellectual understanding of the medication's importance, psychological beliefs, personal inconveniences, and cultural beliefs regarding health.

  • Influence of Nurses: Nurses can influence adherence by educating patients, addressing barriers, and providing support tailored to individual circumstances.

Non-adherence

  • Definition: Non-adherence refers to the extent to which a patient's medication use behavior fails to coincide with the healthcare provider’s planned regimen.

  • Intentions: Non-adherence can be intentional or non-intentional.

  • Estimated Rate: The rate of non-compliance is estimated at 40%.

  • Types of Non-adherence:

    • Not obtaining prescribed drugs from the pharmacy.

    • Not taking drugs as prescribed.

    • Using drugs unsafely.

    • Not getting repeat prescriptions.

Factors Influencing Adherence to Drug Therapy

  • Financial: Cost and socio-economic group can limit access to medications.

  • Physical: Disabilities and unacceptable side effects (e.g., nausea) can deter medication use.

  • Social: Issues such as lack of transportation and inconvenient pharmacy hours can impact adherence.

  • Intellectual: Difficulty in understanding the importance of medication, inability to read or interpret instructions, cognitive disabilities, and forgetfulness can hinder proper medication use.

  • Psychological: Personal health beliefs and beliefs about medications contribute to adherence issues.

  • Personal: Inconvenience, embarrassment about conditions, or stigma around certain medications can lead to non-adherence.

  • Cultural: Health and illness beliefs, traditional practices, and integration of alternative treatments can influence medication adherence. Notably, "intelligent non-compliance" refers to informed choices that may appear as non-adherence to providers.

  • Others: Influence from drug advertising and reliance on self-diagnosis through the internet (e.g., Dr. Google).

Patient Education

  • Essential aspects include:

    • Instructions on how to retrieve, store, and administer medication.

    • Awareness of potential side effects and adverse reactions (e.g., diarrhea with antibiotics).

    • Sharing understanding through whanau (family) and caregivers.

    • Guidance on how to obtain repeat prescriptions and maintaining medication adherence.

    • Emphasizing the importance of follow-ups.

Promoting Compliance

  • Strategies beyond patient education may include:

    • Personalized follow-ups and reminders.

    • Simplifying drug regimens to reduce complexity.

    • Ensuring accessibility to information resources.

    • Encouraging involvement of family members in understanding treatment plans.

Funding

  • Government funding directly impacts the accessibility and affordability of medicines in New Zealand.

Role of Pharmac

  • Established in 1993, Pharmac is accountable to the Minister of Health and is part of New Zealand's Medicines System.

  • Responsibilities include:

    • Ensuring affordable access to medicines.

    • Promoting optimal use of medicines through public information campaigns.

    • Assisting District Health Boards (DHB) in managing pharmaceutical expenditures.

    • Determining which medicines are funded by the government and the subsidy applicable to each,

    • Medicines may be fully funded, part funded, or not funded at all, and the government publishes a list of funded medicines in the Pharmaceutical Schedule.

Access to Medicine

  • Access to medications is supported through the Primary Health Care Strategy, aiming to improve health outcomes and minimize inequalities.

  • Key elements include:

    • Reduced prescription costs for those enrolled in a Primary Health Organisation (PHO).

    • Lowered fees for consultations with primary healthcare practitioners.

Means-tested or Income-tested

  • Definition: Refers to determining eligibility for subsidies or programs based on income levels.

  • Support for eligible individuals includes:

    • Pharmaceutical Subsidy Card.

    • High User Health Card.

    • Community Services Card.

    • The Disability Allowance.

    • Accident Compensation Corporation (ACC) support for personal injuries.

Pharmaceutical Subsidy Card (PSC)

  • Allows cardholders and their family to fill prescriptions at reduced or no charge, also referred to as the Safety Net Card.

  • It does not require income testing.

  • Issued after payment for 20 subsidised prescription items since February 1 of that year.

  • Limitations include the requirement to visit the same pharmacist to maintain a record of prescriptions.

High User Health Card (HUHC)

  • Provides additional assistance for recurring health issues and prescription costs for individuals without a Community Services Card.

  • Introduced for individuals with ongoing health needs and does not involve income testing.

  • Since July 1, 2007, the subsidy only applies for casual visits outside regular doctor consultations.

  • Reduces prescription costs from $15 to $5.

Community Services Card (CSC)

  • Also known as the Health Card, this program reduces the costs for families on low to moderate incomes for health services and prescriptions.

  • It reduces the cost of physician visits and prescriptions from $15 to $5.

  • Benefits include:

    • Lowered fees for after-hours doctor visits.

    • Reduced costs for glasses for children under eight.

    • Assistance with travel and accommodation for necessary treatment at distant hospitals.

Disability Allowance

  • A weekly payment for individuals encountering ongoing costs due to disability, which may include doctor visits and medications.

Accident Compensation Corporation (ACC)

  • Covers part or all costs of medications for injuries deemed to be covered under ACC.

  • This may include co-payments, partial charges, and full costs of medicines not listed in the Pharmaceutical Schedule after appropriate approvals.

Special Authority Medicines

  • Some medications require a Special Authority to be funded, contingent upon meeting predetermined criteria established by Pharmac.

  • Example: Lipid-lowering medications requiring doctor application for subsidy, usually applied to expensive medications to minimize costs to the patient.

Repeat Prescriptions

  • Prescription fees apply primarily upon first dispensing.

  • Patients may receive repeat prescriptions and can request all medications at the first dispensation if there are difficulties associated with return visits, such as transportation issues.

Socio-economic and Cultural Issues and Implications

  • Socio-economic status influences medication affordability, availability, and accessibility.

    • Age: Young individuals may avoid medications for perceived social stigma (e.g., asthma); older adults may experience polypharmacy.

    • Gender: Women may lack authority over healthcare decisions and financial agency to procure medications.

    • Education Level: Long-term medication reliance creates potential dependence on drugs rather than independence.

Cultural Issues and Implications

  • Individual perceptions of quality of life are often influenced by cultural beliefs, which may shape treatment selection procedures.

    • Traditional figures (family members, leaders, or healers) often consulted before conventional treatment.

    • Cultural interpretations of illness may lead patients towards spiritual or traditional remedies instead of prescribed medications.

    • Stigma associated with mental health conditions may result in individuals avoiding seeking treatment.

    • Language barriers, education, and cultural restrictions can impact acceptance of prescribed therapies.

  • It is essential for healthcare providers to recognize cultural influences in healthcare choices to provide tailored treatments.

Nursing Considerations

  • Nurses serve as advocates for patients, guiding discussions about potential challenges filling prescriptions.

  • Respect for patient culture and beliefs is critical in the nursing role, and open communication and understanding of these factors help facilitate better care and adherence.

  • Accommodations may include incorporating traditional practices into medicines when safety permits.

  • Strategies to improve adherence include prescribing single or less frequent doses (e.g., once-daily regimens) that can reduce complexities and increase compliance.

    • Example: Using Depo Provera instead of a daily oral contraceptive.

  • Addressing language barriers through services and supporting patients in navigating healthcare systems is a key nursing responsibility.

Summary Questions

  • Define adherence and compliance in pharmacology.

  • Identify factors affecting individual adherence to prescription regimens.

  • Discuss methods nurses can utilize in influencing adherence and compliance.