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Family Caregiving and Community Pharmacists Addressing challenges for immigrant families

Immigration plays an important role in the Canadian society and it will continue to do so for decades to come.

Almost 40 percent of the population in Canada is of a non-British or non-French heritage. According to the 2006 census, 20 percent of all citizens are first-generation Canadians born outside the country.  This plurality and diversity may at times present challenges to the delivery of healthcare services to immigrant communities.On Dr. Gordon Atherley’s talk show, Family Caregivers Unite!, I discussed these challenges as they relate to the Muslim community and the community’s family caregivers. The recording can be downloaded from www.voiceamerica.com/episode/53084/family-caregiving-in-the-muslim-community.

We discussed how a language barrier between the patient and the healthcare provider constitutes one of the main challenges. Cultural barriers also come into play. For instance, Muslim communities don’t consume any pork-derived products, and Hindu communities don’t consume products from animal origin. Some medications come in the form of gelatin capsules, and sometimes the manufacturer doesn’t provide the information whether the gelatin used is from vegetable or animal sources and, if from animal sources, what animals were used to make it. If this concern is not properly addressed, the patient will likely be reluctant to take the medication in question. Women from various immigrant communities want to be examined and treated only by female physicians.

In every community, family caregivers play a critical role in our health and long-term-care system by providing a significant proportion of the care for the chronically ill and aging. Family caregiving saves the healthcare system considerable effort and expense.In a recent study by Dr. Sophie Hill from La Trobe University in Australia, results have shown that up to half of patients do not take their medicines as prescribed. Sometimes it’s difficult for patients to adhere to a medication schedule. Some patients might stop taking their medications if they do not get immediate results. Others could stop taking their medicines to stay within their monthly budgets. In my own practice as a community pharmacist, I have seen this latter case happening often in immigrant communities.Hill and her colleagues concluded that simplified doses, assessment of medicines by pharmacists and programs to help patients manage their medicines all showed some promise with regard to adherence. Among all health care professionals, the community pharmacists are the most accessible to the patients, and the ones who are seen most often by the public. Therefore, they are often the first line healthcare professionals helping family caregivers with medication management for their care recipients.

Pharmacists are the experts on medications. However, their knowledge and skills are often underutilized.  The pharmacists’ main role is to ensure that the medications are used properly and safely by patients, by counseling them on how to maximize benefits of drug therapy and how to minimize adverse effects and drug interactions. Pharmacists also recommend over-the-counter (OTC) medications for minor ailments.  As a general standard of practice, the pharmacist is required to provide counseling to the patient on any new prescription medication, and on any change in dosage of an existing medication. In the case of a family caregiver coming to the pharmacy to pick up the medication on behalf of the patient, this counseling on medication is usually provided to the family caregiver.

Caregivers’ primary concerns are not knowing enough about how drugs interact and not being able to recognize side effects. Another challenge is the proper administration of the medications at the right time intervals, with the proper dosage, and the proper direction for use. In immigrant communities, those challenges are compounded by language, immigration and separation from family in the home country. Understanding medication is therefore essential to the family caregiver.  This is where the community pharmacist can help family caregivers through the provision of both verbal and written information on the patients’ medication usage, particular precautions, and monitoring of alarming symptoms or “red flags”. In addition, follow-up with the caregiver is usually needed. This education is instrumental in avoiding medication errors, such as giving the patient the wrong medication or the wrong dosage or giving the medication at the wrong time. 

In many family caregiving situations, the patient is using a large number of medications. Combined with the fact that decreased memory and varying degrees of dementia are common problems in the elderly, the result is different forms of medication errors. Pharmacists can provide a solution to this problem by dispensing the patient’s medications in blister packs or “dosettes”. Studies have shown that this form of dispensing can minimize many medication errors.  The Ontario Ministry of Health and Long-Term Care (MOHLTC) launched the MedsCheck program in 2007. This program benefits patients who are on three chronic medications or more. MedsCheck consists of a one-on-one 30 minute annual appointment with the pharmacist to review medications and help the patients better understand their medication therapy and ensure that medications are taken as prescribed. The cost for this program is covered by the government.  Patients may require another MedsCheck during the year for reasons including a planned hospital admission or medication managing after hospital discharge. 

An expanded MedsCheck program was launched in 2010. It reaches residents of licensed Long-Term Care Homes and patients who are home-bound and not able to attend their community pharmacy for the service. All of those consultation sessions with the pharmacist could be carried out with the family caregiver, which will help him better understand the patient’s medication regimen. A recent article in the Toronto Star, written by Theresa Boyle, highlighted Virtual Ward, a new healthcare program. Virtual Ward is an initiative launched in Toronto by Dr. Irfan Dhalla, a general internist at St. Michael’s Hospital. The idea consists of the formation of an interdisciplinary team with a 24/7 access through a hotline number. The team includes doctors, nurses, care coordinators, a nurse practitioner and a pharmacist. They discuss treatment plans for patients who have been recently discharged from hospital. 

The day that patients are discharged from hospital, they are “admitted” to the virtual ward. For up to two months, they receive a high level of care, ensuring a safe transition back home. The team members visit them as needed and address problems before they become serious enough to warrant a trip back to the emergency room and possibly another hospital admission. The team coordinates services with a patient’s family doctor, reviews medication regimens and helps arrange appointments for services such as blood tests. This program will be beneficial for family caregivers, particularly in immigrant communities.  If the program is extended, community pharmacists will be members of the team with the key role of helping family caregivers with their family members’ medications.

Dr Ahmed El Zoeiby, B.PH, R.PH, M.SC, PH.D, Community Pharmacist aelzoeiby@hotmail.com


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