Mohammed Omar Sarwar’s pharmacy has only delivered a few contraception service consultations so far – but they have all been to young Caucasian women.
‘We haven't seen any diversity within that service,’ Mr Sarwar tells The Pharmacist, despite the fact that ‘the need for contraception is across the board’.
Based in what he describes as an ‘ethnically diverse area’ in the North East of England, the pharmacy often tailors its advice to patients according to their religious and cultural needs and individual circumstances.
But Mr Sarwar believes more needs to be done to ensure that patients from different backgrounds can engage with services from community pharmacies.
‘I think every service that comes out nowadays really should have a cultural competency evaluation on it,’ he said, suggesting that the service level agreement or the service scope could explore how the service is culturally competent.
‘I think that should be integrated into every service that we do.’
Cultural competence refers to the culture-specific skills needed to interact effectively with people from different cultural backgrounds.
And it could be essential to tackling health inequalities, which often affect patients in multiple ways, notes Mr Sarwar.
In a talk at the Pharmacy Show earlier this month, Mr Sarwar highlighted how differences in health and wellbeing between different groups of people can be ‘determined by circumstances beyond an individual's control’ – including factors like sex, age, sexual orientation, race, ethnicity, disability, as well as socioeconomic characteristics such as living in a socially deprived areas with poor housing or hygiene, high unemployment rates, or poor education.
‘What we're seeing in community pharmacy nowadays, especially in the pharmacy that I work in, is a variety of these characteristics. It's not just people coming in with one of these things. There's a variety of inequalities that are presented to me in one go in the pharmacy that I personally work at,’ Mr Sarwar adds.
For instance, in his pharmacy, Mr Sarwar sees refugees and asylum seekers who do not speak English well, are affected by post-traumatic stress disorder (PTSD) and want to access clinical health services.
There is also an ageing population within the area, where he sees patients with Parkinson’s disease and some experiencing Parkinson’s psychosis, which can result from medications.
He highlights the need for pharmacy teams to understand how a patient’s background might contribute to their clinical needs – particularly when the walk-in accessibility of community pharmacies made them the first port of call for many patients.
For instance, in an effort to meet patients’ religious needs around fasting and medication administration, Mr Sarwar’s team runs Ramadan medication reviews.
Using information from the Muslim Council of Britain, which brings together guidance from religious leaders and healthcare professionals, Mr Sarwar’s team can advise patients on any adjustments that they can make, or – particularly in the case of diabetic patients – consider whether to fast at all.
‘It’s not a commissioned service, its’s not something that we get paid for or anything like that, it is just something that… I guess is the right thing to do if we can help someone out there,’ Mr Sarwar told The Pharmacist.
A report released by the Muslim Council of Britain earlier this year found that British Muslim communities experience a ‘particular prevalence’ of ‘deep-seated’ health inequalities.
The study, done in conjunction with Marie Curie, the University of Leeds and University College London, highlights how the Covid-19 pandemic made pre-existing heath inequalities worse, disproportionately impacting the health of people from most minoritised groups, particularly around end-of-life care.
Briony Hudson, associate director internal research development at Marie Curie, commented on the report: ‘Services must explore and understand the needs of diverse local communities, including British Muslims, to adapt services and make them more accessible.
‘Organisations providing health and social care services must ensure that individuals, and those who are important to them, are placed at the centre of decision-making.’
Understanding patients’ mental health and wellbeing is also important to cultural competence, Mr Sarwar tells The Pharmacist.
‘It doesn't matter where you're from in the world, everybody has the ability to be impacted by mental health issues,’ he says.
‘But of course, sometimes if communication is a barrier, it doesn't always come across that there's a problem. We have a lot of patients who have PTSD who fled war torn countries, for example. Sometimes, they may not want to communicate that though.’
And he suggests that pharmacy teams could learn to ‘read between the lines’ to understand ‘when someone might feel a little bit uneasy, or when to advise someone for a more private conversation’.
Mr Sarwar says that diversity within his team – for which he often recruits locally – helps them to be more aware of the needs of the population they serve, including the ability to speak several languages that might help them communicate with patients. Where this is not possible, the team uses translation services.
For pharmacy teams that do not share the cultural experiences of their patients, ‘there's a lot of good training [and] resources online nowadays’, Mr Sarwar told The Pharmacist, highlighting learning modules from the Centre for Pharmacy Postgraduate Education (CPPE).
Any effort to interact and have a conversation with patients would help pharmacy teams to learn more, he adds.
‘It's not like anybody is perfect at this. It's an ongoing journey of learning, different situations that happen [and] allow you to highlight different ways that we can better ourselves,’ he tells The Pharmacist.
A small-scale qualitative study published in the Health Expectations journal this summer interviewed 14 participants working across community pharmacy roles, including eight qualified pharmacists, one foundation trainee pharmacist, three pharmacy technicians/dispensers and two counter assistants, about their perspectives on cultural competence and training.
It highlights how patients might hold cultural beliefs that influenced their decisions around medicines, as well as the work of pharmacy teams. For instance, one pharmacist recalled spending time sourcing an alternative, liquid form of medication for a patient who would not take a capsule containing pork gelatine.
‘It was acknowledged by many participants that although it may take additional time to source suitable medications for patients, it was important for delivering high-quality care, and there was an underpinning belief that these additional considerations would lead to a more individualised approach to patient care,’ write the study authors.
They add that patients from certain backgrounds may face difficulties accessing different services, such as concerns around being seen accessing methadone treatment, or engaging with a pharmacy member of staff of a different gender.
The study highlights approaches used by some pharmacies such as posters translating medicines information.
And it reports unanimity from all 14 participants from a variety of pharmacy roles that ‘some form of [cultural competence] education should be built into pharmacy staff training’, which many felt was currently lacking.
Mr Sarwar agrees. ‘Education, to me is really the key,’ he told delegates at the Pharmacy Show earlier this month.
In addition to pharmacists educating themselves, he suggested that pharmacy owners could also play a role in educating their staff, their local communities and their patients – taking advantage of opportunistic conversations to speak to them about their health.
‘We should be having these conversations with as many people as we can, regardless of who they are, or where they're from everybody who walks through the door,’ he said.
He also suggested that greater diversity at senior levels of healthcare could also play a role in tackling health inequalities.
‘I still feel as though there is a lack of representation within healthcare, within pharmacy. I feel as though we need to be more influential as decision makers higher up the tree and address some of these inequalities and some of these problems that we're having,’ Mr Sarwar added.
And all pharmacy teams must be prepared to give ‘everybody who walks through the door equal treatments and the same chance to get the same level of care and advice’, he said.