Pharmacy students prepare for diverse populations

KINGSVILLE, Texas — Pharmacists face an ever-changing population, especially in Texas, where the minority is becoming the majority. To combat the health disparities of the border and South Texas, students at the Texas A&M Health Science Center (TAMHSC) Irma Lerma Rangel College of Pharmacy in Kingsville are prepared to counsel, care for and serve Hispanic patients in multiple ways.

“The percentage of Hispanic residents in South Texas is even greater and continuing to grow,” said Anna Brozick, Pharm.D., assistant professor and director of the Introductory Pharmacy Practice Experience (IPPE) program. “Thus, it is critical for our future pharmacists to develop Spanish language skills to communicate with their patients. The focus during the first three years for all pharmacy students is basic medical Spanish and terminology that equips them with words and phrases to address over-the-counter and prescription medication needs.”

Two of the fastest-growing metropolitan areas in the country are Laredo and McAllen, and the U.S.-Mexico border area has more than 13 million people. As the first professional school in South Texas, it is the mission of TAMHSC-Rangel College of Pharmacy to serve this area, and more than half of the college’s graduates remain in South Texas to practice.

To prepare students for practice in South Texas, students receive six hours of basic medical Spanish language practice, development and assessment in their first year. They practice writing prescription labels in Spanish and explore case studies to demonstrate health care system barriers to Spanish-only patients.

“The ability to speak Spanish as a health care professional is an absolute necessity in South Texas,” said Melissa Fredericks, second-year doctoral pharmacy student. “I also believe that, with time, Spanish-speaking will become more and more of a necessity all over the United States.”

Once students understand the language and the culture, patients respect and trust them with their health care needs. They sometimes share more with the pharmacist in a counseling session than with the doctor.

“Besides language skills, pharmacists need to take into account the patient’s values, beliefs, ways of life and practices in order to establish trust with their patients,” said Mary Chavez, Pharm.D., professor and chair of pharmacy practice.

The pharmacist may not understand why the patient does not follow directions or is not compliant with their medication. For example, a patient may take a smaller dose than prescribed because he or she believes the prescription medication is much stronger than a traditional Hispanic herbal remedy.

The Spanish terminology students learn allows them to communicate medication directions in Spanish, such as “Take one tablet by mouth every day” or “Give one teaspoonful every six hours as needed for pain or fever.” Also, all students learn basic identification phrases such as, “What is your birth date?” or “What allergies do you have?”

“When language is a barrier, our pharmacy students have an opportunity to be the only person capable of communicating with a patient,” said Joan Everett-Houser, Pharm.D., associate professor of pharmacy practice, who teaches Spanish language classes as an elective to nearly half of each graduating class.

Adrian Sandoval Jr., Class of 2012, Pharm.D., RPh, who is in his first year of community pharmacy residency at Scott & White Healthcare, took Spanish as an elective and watched his case load triple after he revealed that he could counsel in Spanish. He did not mind the increase, though.

“One of my tasks was to counsel patients on their blood thinner medication before discharge, and on Thursdays, I would be sent to all other units to counsel patients as well,” he said. “The patients were very thankful, and it was very gratifying.”

In the Spanish class, students prepare a notebook of vocabulary and translations as a personalized resource to aid them in medical terminology needed for patient care.

“It is important for students to go beyond the language and truly understand the health seeking behavior of their patients and who is the primary decision maker in the family on health-related issues,” said Lourdes Cuéllar, M.S., RPh, FASHP, director of pharmacy and clinical support services at TIRR Memorial Hermann in the Texas Medical Center in Houston. “Students must learn how to ask questions about folk medicine that patients may be taking as first line treatment or along with traditional Western medicine. More importantly the students should validate that their patient truly understands why they are taking the medication by assessing the patient’s health literacy.”

The class explores many terms and names for diseases, body parts and foods that might be used by patients while emphasizing those terms most commonly used in South Texas. This serves as a means of preparing students for real-life patient encounters and counseling sessions.

Fredericks said it’s an invaluable class that should be a required part of the curriculum.

“I have noticed that Spanish-speaking patients are always grateful when a health care professional uses Spanish to communicate with them, especially in cases when the patient cannot understand any English,” said Fredericks, who translates for patients daily as an intern at Wal-Mart.

Pharmacy students are taught to recognize beliefs, values, language preferences and health practices in multiple cultural perspectives, as well as seek an understanding and respect for another person’s culture. As they discuss differences in cultural attitudes toward medicine, illness, gender of health care professionals and nonverbal communication, pharmacy students are better equipped to care for their future patients. By adding this Spanish language component, students are prepared for a greater impact on patient care as it relates to pharmacy.