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Creating Equitable Pharmacy Practices

Being a pharmacist and a person with disability, I appreciate and understand the complexities that exist in healthcare settings. For me, poorly planned physical environments are the number one barrier to access. As a healthcare professional, a major barrier is not being aware of the needs of my patients and clients – or not asking the right questions.

Pharmacy is not immune to the common barriers identified by the World Health Organisation that people with disability encounter when they attempt to access health care including attitudinal, physical, communication and financial barriers. This post touches on other aspects of pharmacy practice we need to examine, which impact these barriers.

Improving disability services in pharmacy will require implementing changes to multiple areas including regulations, policies, and practices that foster inclusivity and accessibility. Below are my thoughts on some potential changes that could ensure equitable access in pharmacy practice.

“Nothing about us, without us”

People with disability report experiences of prejudice, stigma, and discrimination by health service providers, and it is no different with pharmacy.[1] Limited knowledge and understanding of the rights of people with disability and their health needs causes disparities in service. Multiple factors may contribute to a lack of understanding, first and foremost being pharmacists and healthcare professionals not listening to and learning from people with disability. This may be due to inadequate training and professional development about disability. It is vital to listen to the voices of lived experience, to challenge previous practices and create environments where people feel comfortable to discuss their needs.

Disabled individuals are often not involved in the design of, or decision-making about, the provision of health services. It is vital to creating a platform where we hear from and gain insights, feedback, and guidance on improving disability visibility and inclusivity within pharmacy practice.

Training and Education

Incorporating disability awareness and sensitivity training into the curriculum for pharmacy professionals would be a great place to start. Even though it has been a few years since I completed my degree, from memory, there was not much in terms of inclusive practices within the pharmacy curriculum. This should include information on various types of disabilities, communication strategies, and ways to accommodate individuals with disabilities. By incorporating this training, we would ensure awareness and empathy towards people with disabilities are instilled in early career pharmacists.

A report released by International Pharmaceutical Federation (FIP) in 2023 recognised development of the pharmacy workforce as crucial for achieving universal health coverage.[2] The findings also indicated gaps and opportunities to support workplace-based education and training. Whilst disability awareness training is now a common component of the on-boarding process, often it is an e-learning module. It would be far more effective to combine this learning with lived experience, to help solidify and understand the discrimination faced by people with disabilities.

I believe awareness has improved today, however, there needs to be more of a shift in the way we look at disability from the medical model (people with disabilities are something that needs fixing) to the social model of disability. The medical model of disability describes what a person cannot do or be. The social model sees ‘disability’ as the result of the interaction between people living with impairments and an environment riddled with physical, attitudinal, communication and social barriers. Furthermore, the medical model assumes people with disabilities have limited autonomy. This can often lead to instances of misdiagnosis and overshadowing, where healthcare professionals incorrectly attributes symptoms as a behaviour linked to their learning disability and fails to investigate any possible underlying health cause. If more of us, particularly healthcare professionals use the social model, it may be the key to transformative thinking that minimises disability discrimination.

It is also imperative to integrate cultural competency and disability awareness training for pharmacy staff, including pharmacy assistants, dispense technician and pharmacists. This can enhance understanding, reduce stigma, and improve interactions with individuals with disabilities from diverse backgrounds.

Accessibility Standards

We must establish and enforce accessibility standards for pharmacies, ensuring that physical spaces, information, and services are accessible to individuals with different types of disabilities. This includes wheelchair ramps, accessible counters, information in alternative formats and languages.

For me, being a both a patient and a pharmacist, I am often astounded by the lack of seats for people waiting to collect prescriptions. Utilising universal design concepts will tackle environmental barriers which severely impact disabled individuals. Australia has an aging population, which means such measures will also assist in accessibility for the elderly. Whilst an issue such as this can be solved quite easily in theory (add seats!), I understand the lack of space in some pharmacies make this difficult – however, not impossible.

Reasonable Accommodations

Implementing clear policies regarding reasonable accommodations for both pharmacy staff and customers with disabilities will create equitable environments in pharmacies. This may involve providing assistive technologies, modifying workstations, or adjusting procedures to accommodate different needs.

As a young pharmacy intern, I recall interviewing and trialling at several pharmacies prior to starting my internship year. I regret to say that a few of the pharmacies were inaccessible as there were steps leading into the dispensary, often without a handrail. And what made it even more distressing was the lack of accommodations offered by the pharmacy owner or manager, to ensure I was given the equitable opportunities for employment. At the time, I was neither confident nor comfortable to request reasonable adjustments and so I faded into the background and looked for work elsewhere. It is my hope that this has improved since my intern year.

These days, I know what I need, and I am not afraid to request adjustments. Being a bilateral above knee amputee means constant lower back pain. Standing for 10+ hours a day can be taxing. I am pleased to report that I have been offered a seat and more breaks so to accommodate my needs.

Data Collection and Reporting

I have noted there is a real lack of data available on access to, or regarding the quality of, the care for people with disability in the community pharmacy setting. Without this data, it is difficult to determine drivers of health inequities, and to develop evidence‐informed policies to improve care and track progress towards reducing health inequities.

Lack of data as an impediment to raising awareness about the needs and experiences of people with disability in the health care system, to understanding the issues and barriers, and to making improvements to services. Implementing mechanisms for collecting and reporting data on disability demographics within pharmacy practice can help identify areas for improvement and measure progress over time.

Communication Accessibility

Ensure that pharmacies have systems in place to facilitate effective communication with individuals who have various communication needs. This may involve offering sign language interpreters, written information in plain language, or accessible electronic communication.

We must also consider inclusive prescription labelling practices such as providing information in multiple formats (e.g., large print, braille) and ensuring that prescription information is easily understandable for individuals with various cognitive abilities. Another challenge – ensuring patients are aware of the availability of these practices.

Accessible IT

Today, a lot of what we do is on our phones and tablets, including pharmacy related tasks. We must ensure that pharmacy information systems and online platforms are designed with accessibility in mind. This includes websites and mobile apps that are compatible with screen readers and other assistive technologies.

Recognising, addressing and appreciating intersecting identities is essential to addressing barriers in the healthcare system. It is my hope that implementing the above changes will lead to pharmacy practice becoming more inclusive, ensuring that individuals with disabilities have equal access to healthcare services, work environments and are visible and heard in the healthcare system.

[1] VanPuymbrouck L, Friedman C, Feldner H. Explicit and implicit disability attitudes of healthcare providers. Rehabil Psychol. 2020 May;65(2):101-112. doi: 10.1037/rep0000317. Epub 2020 Feb 27. PMID: 32105109; PMCID: PMC9534792.

[2] Fauziyyah, Afina & Koudmani, Diala & Meilianti, Sherly & Aqqad, Farah & Masyitah, Nisa. (2023). Community pharmacy insights: Supporting the need for self-care (A FIP Multinational Needs Assessment Programme Report).

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