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Appiah-Num Safo AA, Okoro ON, Attakorah J. Perceptions of Healthcare Providers about Pharmacists’ Clinical Roles in Patient Care in Ghana. Innov Pharm 2022. [DOI: 10.24926/iip.v13i4.5018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Clinical pharmacy practice is distinguishable from the dispensing model by its focus on direct patient care. To function effectively in this role, pharmacists need to have clinical competencies, hence the establishment of the Doctor of Pharmacy (PharmD) program. In Ghana, the PharmD program is in its early stages; graduating its first set of pharmacists in 2018. There is therefore need to understand how these recent PharmD graduates are engaging in clinical roles and the perceptions of other health professionals they need to work collaboratively with.
Methods: Four different focus group discussions (FGDs) were conducted with physicians, nurses and pharmacists in separate sessions. Questions explored perceptions of the clinical roles of pharmacists. The FGDs were audio-recorded and transcribed verbatim. A thematic analysis of the transcripts was conducted.
Results: Perceptions around the roles of clinical pharmacists were in two categories – (1.) Roles associated with the provision of direct patient care [(i.) assurance of appropriateness, and (ii.) optimization of pharmacotherapy; and (2.) Roles involving participation in inter-professional collaborative care with other healthcare professionals through their (i.) contribution of pharmacotherapy expertise, and (ii.) input in interprofessional education and practice.
Conclusion: Findings from the study highlight perceived contributions of pharmacists, and potential for more relevance to clinical care, while also drawing attention to the emergence of clinical roles of pharmacists in healthcare systems in a global context. There is continuing need for advocacy for the pharmacy profession and policy changes in healthcare delivery models to maximize potential benefits of clinical pharmacists to health outcomes.
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Okoro ON, DeVuyst-Miller SA, MacDonald DA, Montag-Schafer KG, Pereira CR, Schweiss SK, Yapel AM. Integrating social determinants into pharmacotherapy courses: A case-based learning approach. Curr Pharm Teach Learn 2022; 14:1438-1447. [PMID: 36154989 DOI: 10.1016/j.cptl.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/05/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The recognition of social determinants as major drivers of health outcomes has important implications for health care providers, including pharmacists. It is therefore imperative that providers have the requisite knowledge, skills, and attitudes to adequately address the contributions of social determinants of health (SDOH) alongside the impact of medical care on health and treatment outcomes. Case-based learning is a common practice in pharmacy education. Patient cases used in pharmacotherapy courses typically highlight clinical parameters and quantitative indices, often to the exclusion of sociocultural contexts. In actual practice, pharmacists (and other health care providers) must consider both clinical information and the context of SDOH in order to deliver responsive and effective patient care. EDUCATIONAL ACTIVITY AND SETTING The aim of the project was to build patient cases that reflect both aspects. The intent is to use these cases in the core pharmacy curriculum to teach students how to concurrently consider both clinical and social elements in patient care. Eleven pharmacists and educators participated in three work groups to develop 10 cases for pharmacotherapy courses in cardiovascular disease, diabetes management, and mental health. Two of the cases were facilitated with fourth year students on advanced pharmacy practice experiences. SUMMARY Feedback from case developers and students highlights features of the cases that lend them to utility in the pharmacy curriculum. The integration of SDOH in patient cases provides opportunity for students to build the relevant competencies that will enable them to provide holistic patient care.
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Affiliation(s)
- Olihe N Okoro
- University of Minnesota, College of Pharmacy, 235 Life Science, 1110 Kirby, Drive, Duluth, MN 55812-3003, United States.
| | | | - Danielle A MacDonald
- Essentia Health and Duluth Family Medicine Clinic, Duluth, MN, United States; University of Minnesota, College of Pharmacy, Duluth, MN, United States; University of Minnesota, Department of Family Medicine and Community Health, Duluth, MN, United States
| | | | - Chrystian R Pereira
- University of Minnesota, College of Pharmacy, Minneapolis, MN, United States
| | - Sarah K Schweiss
- University of Minnesota, College of Pharmacy, Duluth, MN, United States
| | - Ann M Yapel
- Essentia Health and Duluth Family Medicine Clinic, Duluth, MN, United States; University of Minnesota, College of Pharmacy, Duluth, MN, United States; University of Minnesota, Department of Family Medicine and Community Health, Duluth, MN, United States
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Singhal C, Aremu TO, Garg P, Shah K, Okoro ON. Awareness of the Malaria Vaccine in India. Cureus 2022; 14:e29210. [PMID: 36262953 PMCID: PMC9574518 DOI: 10.7759/cureus.29210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/05/2022] Open
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Okoro ON, Hillman LA, Cernasev A. Intersectional invisibility experiences of low-income African-American women in healthcare encounters. Ethn Health 2022; 27:1290-1309. [PMID: 33734922 DOI: 10.1080/13557858.2021.1899138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The disparities that Black/African-American women experience in health care are persistent and staggering. Findings from health outcomes research continue to demonstrate poorer outcomes for African-American women compared to women of other race/ethnicity in several conditions. These racial/ethnic and gender health disparities observed are complex, heavily nuanced and multi-factorial. To understand these, there is a need to apply an 'intersectionality' lens. Intersectionality refers to the experience of persons with multiple intersecting statuses. The objective of this exploratory study was to gain insight into the healthcare experiences of low-income African-American women. METHODS In-depth one-on-one interviews were conducted with 22 women and 2 focus group discussions with community leaders and advocates. Investigators conducted a thematic analysis of the transcripts. RESULTS The thematic analysis revealed four major themes, which tell the story of the intersectional invisibility experienced by low-income AA women in the healthcare system. These included (1) the perception of 'not feeling heard'; (2) patient as 'expert of her own body'; (3) disregard of patient preferences; and (4) the need for self-advocacy. CONCLUSIONS Black/African-American women, and particularly those with socioeconomic disadvantage, experience intersectional invisibility resulting from provider implicit bias, stereotypical assumptions, and systemic structures that enable discriminatory practices in healthcare delivery. Healthcare provider education that more explicitly addresses these biases and stereotypes should be complemented with system-level interventions that aim to dismantle the structural racism inherent in healthcare policies and practices.
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Affiliation(s)
- O N Okoro
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, USA
| | - L A Hillman
- Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - A Cernasev
- College of Pharmacy, University of Tennessee Health Science Center, Nashville, TN, USA
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Okoro ON, Arya V, Gaither CA, Tarfa A. Examining the Inclusion of Race and Ethnicity in Patient Cases. Am J Pharm Educ 2021; 85:8583. [PMID: 34301554 PMCID: PMC8655150 DOI: 10.5688/ajpe8583] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/18/2021] [Indexed: 05/22/2023]
Abstract
Health disparities continue to exist in the United States, with the most significant differences in care occurring between racial groups. Racial health disparities are largely a result of the strong association between race and structural inequities, (differentials in the distribution of power, resources, opportunities). The use of case-based learning is common practice in pharmacy education, and the race of the patient who is the subject of the case is often included out of convention. In some cases, race is included to inform treatment based on guidelines developed from epidemiological and clinical studies that link race to disease by conferring biological significance to race categories. This continuing use of race and ethnicity to guide treatment contributes to racial health disparities and may further perpetuate existing provider implicit bias. This paper discusses the pedagogical approach of using patient cases and the convention, propriety, and implications of including race in patient cases, and guides pharmacy educators in how to use information on race.
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Affiliation(s)
- Olihe N Okoro
- University of Minnesota, College of Pharmacy, Duluth, Minnesota
| | - Vibhuti Arya
- St. John's University, College of Pharmacy and Health Sciences, Queens, New York
| | | | - Adati Tarfa
- University of Wisconsin-Madison, School of Pharmacy, Madison, Wisconsin
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Okoro ON, Cernasev A, Hillman LA, Kamau NM. Access to Health Care for Low-Income African American Women: Lived Experiences and Expectations. J Health Care Poor Underserved 2021; 31:939-957. [PMID: 33410817 DOI: 10.1353/hpu.2020.0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Women of color and people of low socioeconomic status continue to have poorer health outcomes than their counterparts. This study explored patientsatisfaction and perceptions of low-income African American women regarding access to care. METHODS The study took a mixed-methods approach. Ninety-five women were surveyed using the Short-form Patient Satisfaction Questionnaire (PSQ-18). Two sub-scales assessed satisfaction with access to care. Qualitative data were collected using one-on-one interviews (n=22) and two focus groups of community leaders. A thematic analysis was then conducted. RESULTS On a 5-point scale, patient-satisfaction with access was moderate (accessibility and convenience -2.99; financial aspects -3.35). Emerging themes included obtaining insurance, dynamics of insurance eligibility, adequacy and scope of insurance coverage, scheduling appointments, and transportation. CONCLUSION Providing insurance coverage for people with low incomes is not sufficient to close the racial/ethnic disparities gap in access to care. Understanding the challenges from patients' perspectives can help to make health care resources and services more accessible.
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Okoro ON, Nelson CS, Witherspoon SP, Witherspoon SF, Simmons GE. Culturally Responsive Health Promotion to Address Health Disparities in African American Men: A Program Impact Evaluation. Am J Mens Health 2020; 14:1557988320951321. [PMID: 32840146 PMCID: PMC7450466 DOI: 10.1177/1557988320951321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 07/03/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022] Open
Abstract
African American (AA) men continue to experience worse health outcomes compared to men of other races/ethnicities. Community-based interventions are known to be effective in health promotion and disease prevention. The program objectives were to (a) increase knowledge and risk awareness of targeted conditions, (b) change health-care-seeking attitudes toward regular primary care among AA men, and (c) improve their lifestyle-related health behaviors by leveraging the influence of women in their lives. The community-engaged educational intervention targeted both men and women and included eight 90-min sessions per cohort. Topics included prostate cancer, cardiovascular disease, diabetes, mental health, health-care access, and healthy lifestyle. Sessions were both didactic and interactive. A pre-/post-intervention questionnaire assessed knowledge. Interviews were conducted with male participants and a focus group discussion (FGD) with women to assess program impact. Interview and FGD transcripts were analyzed for themes and recommendations. Major themes were-increased knowledge/awareness of risk associated with chronic conditions, change in health-care-seeking attitudes, increased self-efficacy to engage the health-care system, and lifestyle changes. Other impacts reported were building community/social support, a safe and enabling learning environment, and enhanced community health status overall. Recommendations included having extended, more in-depth sessions, targeting the younger generation, smaller cohort sizes, and more community-based health programming. Community-engaged health promotion using a cohort model as well as including women can be effective in increasing knowledge, enhancing self-efficacy, and providing the much-needed social support. These can influence health-related behaviors and thus contribute to improving health outcomes for AA men.
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Affiliation(s)
- Olihe N. Okoro
- Department of Pharmacy Practice
and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota,
Duluth, MN, USA
| | - Chantele S. Nelson
- The Simmons Laboratory, School of
Medicine, University of Minnesota, Duluth, MN, USA
| | | | | | - Glenn E. Simmons
- Department of Biomedical Sciences,
School of Medicine, University of Minnesota, Duluth, MN, USA
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Okoro ON, Hillman LA, Cernasev A. " We get double slammed!": Healthcare experiences of perceived discrimination among low-income African-American women. Womens Health (Lond) 2020; 16:1745506520953348. [PMID: 32856564 PMCID: PMC7457641 DOI: 10.1177/1745506520953348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 05/27/2020] [Accepted: 07/20/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND On account of their racial/ethnic minority status, class, and gender, African-American women of low socioeconomic status are among the least privileged, underserved, and most marginalized groups in the United States. Generally, African Americans continue to experience poorer health outcomes, in which disparities have been attributed to socioeconomic inequities and structural racism. This objective of this study was to explore the lived experiences of low-income African-American women in interacting with the healthcare system and healthcare providers. METHODS Twenty-two in-depth one-on-one interviews were conducted with low-income African-American women. The audio-recorded interviews were transcribed verbatim. An inductive content analysis was performed, using an analytical software, Dedoose® to enabled hierarchical coding. Codes were grouped into categories which were further analyzed for similarities that led to the emergence of themes. RESULTS A key finding was the experience of discriminatory treatment. The three themes that emerged relevant to this category were (1) perceived discrimination based on race/ethnicity, (2) perceived discrimination based on socioeconomic status, and (3) stereotypical assumptions such as drug-seeking and having sexually transmitted diseases. CONCLUSION AND RECOMMENDATIONS Low-income African-American women experience less than satisfactory patient care, where participants attribute to their experience of being stereotyped and their perception of discrimination in the healthcare system and from providers. Patients' experiences within the healthcare system have implications for their healthcare-seeking behaviors and treatment outcomes. Healthcare personnel and providers need to be more aware of the potential for implicit bias toward this population. Healthcare workforce training on culturally responsive patient care approaches and more community engagement will help providers better understand the context of patients from this population and more effectively meet their healthcare needs.
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Affiliation(s)
- Olihe N Okoro
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, USA
| | - Lisa A Hillman
- Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Alina Cernasev
- College of Pharmacy, The University of Tennessee Health Science Center, Nashville, TN, USA
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Okoro ON, Bastianelli KM, Wen YF, Bilden EF, Konowalchuk BK, Schneiderhan ME. Awareness of state legislation on naloxone accessibility associated with willingness to prescribe naloxone. Subst Abus 2017; 39:14-20. [PMID: 28727957 DOI: 10.1080/08897077.2017.1356787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Increasing rates of opioid-related deaths, state naloxone legislation changes, and negativity prompted investigation of predictive factors associated with willingness to prescribe naloxone to populations at risk of overdose, including knowledge of risk factors, assessment of persons at risk, awareness of legislative changes, perceptions of professional responsibility, and confidence around naloxone prescribing and distribution. METHODS Cross-sectional, Web-based, anonymous, voluntary survey to prescribers of 2 regional health care systems serving urban and rural North Dakota, northern Minnesota, and northwestern Wisconsin. Human subject research was approved by university and health care systems' institutional review boards. RESULTS Overall, 203 of 1586 prescribers responded; however, not all prescribers completed each survey item. A majority (89.4%, n = 127/142) of respondents had never prescribed naloxone for overdose prevention. Willingness to prescribe naloxone for 4 patient care scenarios involving substantial opioid overdose risk ranged from 43.4% to 70.5%. Knowledge mean score was 15.5 (SD = 2.9) out of 22 with median 15 (range: 5-22). Naloxone legislation awareness score was 8.8 (SD = 3.8) out of 15 with median 8 (range: 3-15). There was a statistically significant but modest correlation between willingness to prescribe naloxone and the other variables, including awareness of state naloxone-related legislation (r = 0.43, P < .0001), level of self-confidence about dosing, prescribing, and writing protocols for naloxone (r = 0.37, P < .0001), general knowledge (r = 0.24, P = .0032), and perception of professional responsibility (r = 0.19, P = .03). Multivariate regression analysis indicated willingness to prescribe naloxone was associated with statistically significant predictors, including awareness of the naloxone laws (P = .0016) and self-confidence about dosing, prescribing, and writing protocols (P = .0011). CONCLUSIONS Prescribers who are more aware of state laws regarding naloxone and confident in their knowledge of dosing, administration, and writing protocols may be more willing to prescribe naloxone.
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Affiliation(s)
- Olihe N Okoro
- a Department of Pharmacy Practice and Pharmaceutical Sciences , College of Pharmacy, University of Minnesota , Duluth , Minnesota , USA
| | - Karen M Bastianelli
- a Department of Pharmacy Practice and Pharmaceutical Sciences , College of Pharmacy, University of Minnesota , Duluth , Minnesota , USA
| | - Ya-Feng Wen
- a Department of Pharmacy Practice and Pharmaceutical Sciences , College of Pharmacy, University of Minnesota , Duluth , Minnesota , USA
| | - Elisabeth F Bilden
- b Essentia Health , Duluth , Minnesota , USA.,c Minnesota Poison Control System , Minneapolis , Minnesota , USA
| | | | - Mark E Schneiderhan
- a Department of Pharmacy Practice and Pharmaceutical Sciences , College of Pharmacy, University of Minnesota , Duluth , Minnesota , USA
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Abstract
Background Data from the Minnesota Department of Health (MDH) HIV/AIDS Surveillance Report 2015 show that African-born (AB) women continue to be disproportionately affected by HIV. In 2015, these women accounted for more than half (54%) of all new cases of HIV reported among females in Minnesota and 34% of all known female cases in the state. This study was a needs assessment for HIV pre-exposure prophylaxis (PrEP) in vulnerable subgroups within the AB population and adequacy of HIV care for AB persons. The primary objective of this study was to gain an insight into the strategies that will limit the spread of HIV infection and enhance HIV care among AB immigrants. Methods Community advocates, community-based organizations (CBOs), clinicians, and other HIV-related service providers were invited to participate in a focus group, structured interview or complete an assessment tool using the same questionnaire about HIV and PrEP among AB persons. A thematic analysis was then conducted on the open-ended questions addressing perceived barriers. Results Findings suggest the following gender-specific sociocultural factors that drive HIV transmission and constitute barriers to HIV treatment for AB women: domestic/intimate partner violence, gender-biased stigma, discriminatory cultural beliefs and normative values/expectations, unprotected sex with husbands who have sex with other men, gender discordance in health care (preference for female provider), and sexual/reproductive health illiteracy. Recommendation Based on recommendations, a community-based sexual and reproductive health education is being initiated with a curriculum that will be 1) broad (inclusive but not limited to HIV), 2) culturally sensitive/responsive, and 3) at appropriate literacy level for all women, including those who have little or no formal education.
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Affiliation(s)
- Olihe N Okoro
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth
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Okoro ON, Odedina FT, Reams RR, Smith WT. Clinical cultural competency and knowledge of health disparities among pharmacy students. Am J Pharm Educ 2012; 76:40. [PMID: 22544957 PMCID: PMC3327238 DOI: 10.5688/ajpe76340] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 10/29/2011] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To evaluate the level of competency and knowledge about health disparities among third-year doctor of pharmacy (PharmD) students at 2 Florida public colleges of pharmacy and to explore the demographic correlates of these variables. METHODS A cross-sectional survey study design was used to collect data from participants. RESULTS The students had low health-disparities knowledge and moderate skills in dealing with sociocultural issues and cross-cultural encounters. Speaking a language(s) other than English and having exposure to cultural-competency instruction were the demographic variables found to be most significantly associated with clinical cultural competency and/or knowledge of health disparities. CONCLUSIONS Clinical cultural competency and health-disparities instruction may not be adequately incorporated into the pharmacy school curricula in the institutions studied. Relevant education and training are necessary to enhance cultural competency among pharmacy students.
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Affiliation(s)
- Olihe N Okoro
- College of Pharmacy, University of Florida, Gainesville, USA.
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