Pharmacists can be DEAI change agents

“Health care is built on science, but its execution through, among and between human beings with needs preferences, fears insecurities, purpose aspirations a wish for something greater.”1Wolf J.A. Niederhauser V. Marshburn D. LaVela S.L. Reexamining “Defining Patient Experience”: the experience in healthcare.Patient Exp J. 2021; 8 (Article 4)Google Scholar If we are to achieve true diversity, equity, accessibility, inclusion (DEAI), must consider humans who interact during health encounters. Pharmacist–patient interactions affected by environments which pharmacists practice larger societal structures they exist. There be an increased emphasis understanding how these aspects each other influence patient outcomes. The of this article examine DEAI research pharmacy, identify gaps research, provide avenues further work DEAI. Before examining area, clarification definitions needed. numerous For purposes report, diversity defined as “A mix differences any particular setting include not necessarily limited race, religion, ethnicity, gender, sexual orientation, nationality, age or generation, job function.” Inclusion “An environment where people feel valued respected their uniqueness sense belonging.” Equity “The process fairness, equality, that includes reallocation resources implementation polices eliminate historical, systemic disadvantage.” Accessibility “As giving equitable access everyone along continuum ability makes space characteristics person brings.”2Winters M.F. Inclusive Conversations. Berrett-Koehler Publishers, Oakland, CA2020Google Searching number databases over past 10 years (PubMed, OVID, Web Science, Google Academic Search Premier) using terms “pharmacy,” “pharmacy practice,” “pharmacist,” “"diversity,” “equity,” “inclusion,” “accessibility,” yielded large citations. Articles were excluded if did directly address pharmacy. majority literature related pharmacy education. review contemporary Bush et al.3Bush A.A. McLaughlin J.E. White C. A education.Am J Pharm Educ. 2017; 81 (5961)Crossref Scopus (8) categorized into 3 main themes: describing need for, strategies used to, increase numbers diverse individuals within schools colleges pharmacy; fostering nurturing previously ignored social groups; incorporating curricula research. authors concluded while increasing necessary, it sufficient change institutional climates. lack tools guide educators climates nurture within. Research lacking affects development inclusive policies/procedures improves climate those working studying environments. teaching materials. suggests physiological genomic paradigms taught medicine based antiquated, outdated concepts often do represent populations physicians will care.4Swartz T.H. Palermo A.S. Masur S.K. Aberg science value diversity: closing our diversity.J Infect Dis. 2019; 220: S33-S41Crossref PubMed (43) same could said curricula. Pharmacy programs investigate begin adjust basic, clinical, administrative meet needs. Another avenue has been incorporate curriculum student practitioners training cultural competency (understanding beliefs behaviors various groups behaviors).5O’Connell M.B. Rodriguez de Bittner M. al.American College Clinical PharmacyCultural implications part 3A: education, curriculums, future directions.Pharmacotherapy. 2013; 33: e347-e367Crossref (29) Although beneficial improving patients providers, needed link provision competence How does improve patients’ medication use? affect quality costs care? Are there effective methods teach perpetuate stereotypes (having trainees automatically attribute certain attributes all share background)? troublesome concept representing race biological rather than upstream causes downstream health-related disparities disproportionately racialized groups.6Amutah Greenidge K. Mante A. al.Misrepresenting - role medical propagating physician bias.N Engl Med. 384: 872-878Crossref (35) Scholar,7Arya Butler L. Leal S. al.Systemic racism: pharmacists’ responsibility.J Am Assoc (2003). 2020; 60: e43-e46Abstract Full Text PDF (5) Much disparities. Wenger al.8Wenger L.M. Rosenthal Sharpe J.P. al.Confronting inequities: scoping pharmacist disparities.Res Social Adm Pharm. 2016; 12: 175-217Crossref (11) indicated relative peer-reviewed articles area focused services either diagnosis mental illness abuse/misuse drugs. Less considered from groups. narrow approach single group limits make processes patterns. encouraged researchers use relevant theory regarding ensure scholarship only comments what happening provides insights why happening.8Wenger also recognized knowledge communities serve own implicit bias. Implicit bias shown professional behavior.9Hall W.J. Chapman M.V. Lee K.M. al.Implicit racial/ethnic professionals Its outcomes: systematic review.Am Public Health. 2015; 105: e60-e76Crossref (666) Avant al.10Avant N.D. Penm Hincapie A.L. Huynh V.W. Gillespie G.L. “Not exclude you, but…”: characterization microaggressions recommendations academic pharmacy.Curr Teach Learn. 1171-1179Crossref (1) good discussion pharmacists, practicing may become aware mitigate effect interactions. This report would remiss without acknowledging disparate impact coronavirus disease 2019 pandemic Black Brown communities.11Ford C.L. Commentary: addressing inequities era COVID-19: urgent critical theory.Fam Community 43: 184-186Crossref Given occurrence heightened awareness racial policing, housing, care, more explicitly understand structural racism health. Structural constellation macro-level systems, forces, institutions, ideologies, interactive generate reinforce ethnic groups.12Powell building upon John Calmore.N C L Rev. 2008; 86: 791-816Google Scholar,13Pincus F.L. Discrimination comes many forms: individual, institutional, structural.Am Behav Sci. 1996; 40: 186-194Crossref (84) It can manifest through discrimination—institutional practices policies implicitly differentially impact, harm, nondominant groups.14Angermeyer M.C. Matschinger H. Link B.G. Schomerus G. attitudes individual discrimination: two sides coin?.Soc Sci 2014; 103: 60-66Crossref (33) Researchers start community-led research15Greenhalgh T. Jackson Shaw Janamian Achieving co-creation community-based services: case study.Milbank Q. 94: 392-429Crossref (300) members equal partners endeavors inform action Scientists committed endeavor long term, funding agencies employers modify ways view reward Health provided systems. contribute outcomes conducting level document expose issues at system-level interface two. Caroline Gaither, PhD, FAPhA, Professor, Department Pharmaceutical Care Systems, Pharmacy, University Minnesota, Minneapolis, MN (E-mail: [email protected] )