Hispanics Face Significant Disparities
In Pharmaceutical Treatment
Study shows Hispanics
have less access to state-of-the-art medications; Genetic
and environmental factors demonstrate need for prescribing tailored
to the individual
WASHINGTON, DC (March 8, 2004) — Hispanics are less likely
to receive or use medications for asthma, cardiovascular disease,
HIV/AIDS, mental illness, and pain, according to a new study. These
disparities in pharmaceutical treatment are substantial and often
persist even after adjustment for differences in income, age, insurance
coverage, and coexisting medical conditions.
The study, Genes,
Culture, and Medicines: Bridging Gaps in Treatment for Hispanic
Americans, was co-authored by Dr. Carolina Reyes, Adolph
P. Falcón, Texas State Senator Leticia Van de Putte, and
Dr. Richard A. Levy. It encourages physicians to tailor prescribing
for Hispanics based on age, coexisting conditions, responsiveness
to medications, and cultural perceptions of disease and treatment.
According to Senator Van De Putte, study co-author and practicing
pharmacist, “This study brings together for the first time emerging
research demonstrating that genetic and environmental factors have
a significant impact on the effectiveness of medicines for Hispanic
patients. Eventually advances in genetics will allow us to tailor
pharmaceutical therapy to individual needs.”
The study shows that differences among racial and ethnic groups
in how medicines are metabolized have been observed, and may be
due to variation in genes regulating drug metabolism, environmental
factors, or their interaction. These differences can result in higher
or lower levels of drugs in the bloodstream.
Based on preliminary evidence, the study pointed to several classes
of medicines that particularly warrant extra attention:
• Some Hispanic groups may require lower doses of antidepressants
and some antipsychotic medications and may be more prone to increased
side effects at normal doses of these medicines. In one study, the
average therapeutic dose for Hispanics was half the dose commonly
given to Caucasians or African Americans.
• Mexican Americans metabolize drugs regulated by the
CYP2D6 gene faster than whites, impacting 30 percent of therapeutically
important medications, including many cardiovascular drugs.
The study found that language barriers and differences in cultural
values can have an impact on the quality of care delivered and can
negatively influence medication compliance, self-management of chronic
disease, and overall health outcomes for many Hispanic patients.
“Patients and physicians need to be on the lookout for unexpected
responses to medications,” said Dr. Carolina Reyes, Assistant Clinical
Professor at the UCLA School of Medicine and the study's lead author.
“Physicians must help their patients identify what to look for in
determining whether a prescribed medicine might be too weak or too
strong of a dose and health providers must be aware of environmental
factors such as a patient's diet and environmental pollutants in
the community. Good communication and awareness between patients
and their doctors will ensure the best access and care for Hispanic
populations.”
The authors make several recommendations:
• Improve access to pharmaceutical therapy.
Health care financing and reimbursement practices should
be broad and flexible enough to enable rational choices of drugs,
dosages, and formulations for Hispanic patients based on their genetic,
medical, and cultural needs. Choice of the best pharmaceutical therapy
should be between patient and provider.
• Prescribe based on individual needs. Hispanic
populations require prescribing that considers the many biological,
environmental, and cultural factors that can influence drug effectiveness
and patient adherence to treatment regimens.
• Treat coexisting conditions. Pharmaceutical
treatment must take into account coexisting conditions common in
this population, including depression paired with asthma, diabetes
or cardiovascular disease, and diabetes paired with depression.
• Meet quality standards of cultural proficiency
and communication. Communication barriers and cultural
differences between health care providers and Hispanic patients
can reduce treatment adherence and compromise overall disease management.
Implementation of existing federal and professional standards for
cultural and linguistic proficiency is a priority.
About the National Alliance for Hispanic Health
The mission of the Alliance is to improve the health and well-being
of Hispanics. The Alliance is the nation's oldest and largest network
of Hispanic health and human services providers. Alliance members
deliver quality services to over 12 million persons annually. As
the nation's action forum for Hispanic health and well-being, the
programs of the Alliance strive to:
• Inform and mobilize consumers;
• Support providers in the delivery of quality care;
• Promote appropriate use of technology;
• Improve the science base for accurate decision making; and
• Promote philanthropy.
The Alliance provides key leadership and advocacy to ensure accountability
in these priority areas with the result of improving health for
all throughout the Americas. The constituents of the Alliance are
its members, Hispanic consumers, and the greater society that benefits
from the health and well-being of all its people.
About the National Pharmaceutical Council
Since 1953, NPC has sponsored and conducted scientific, evidence-based
analyses of the appropriate use of pharmaceuticals and the clinical
and economic value of pharmaceutical innovations. NPC provides educational
resources to a variety of health care stakeholders, including patients,
clinicians, payers, and policy-makers. More than 20 research-based
pharmaceutical companies are members of NPC.
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Please direct all media inquires to Pat
Adams, phone (703) 620-6390.
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