Scoping Reviews
Tuesday, October 15, 2024
08:30 AM–10:00 AM
Abstract
Background: Persons displaced from their homelands by war or other catastrophes suffer high rates of health-determinant challenges: chronic diseases; infections; psychiatric comorbidities; long stays in unsanitary conditions; and experiences with governmental violence (e.g., torture, rape) that commonly lead to mistrust of authorities, including healthcare providers. How these challenges affect pharmaceutical care is unclear. Previous reviews on asylum-seeker/refugee (ASR)-pharmacist interactions covered only barriers/facilitators to access, using research published before recent global events (e.g., Ukrainian invasion). Objectives: Assess current literature on medication-related behaviors/beliefs of ASRs; describe gaps; identify implications for pharmaceutical care.
Methods:
Searches of PubMed and PsycINFO (peer-reviewed articles published 1990-May 2024; no “grey” literature due to possible sensationalism/bias), combined terms “refugees” or synonyms (e.g., “parolees”; “asylum-seekers”) with pharmacy-related terms (e.g., “medication adherence”; “medication beliefs”; “vaccination”). Guidelines on trauma-informed care (TIC) were reviewed for pharmacy-relevant information. Studies of U.S. natural disasters and disease-screening programs/treatments were excluded. A health psychologist knowledgeable about ASRs and TIC reviewed titles, abstracts, and articles; tabulated/summarized findings; and identified themes.
Results: Of 622 titles, 252 were retained after exclusions and duplications. The overarching theme was substantial heterogeneity, both geographically and by legal status, in factors affecting medication-taking behaviors/beliefs: disease prevalence, perceived etiologies (e.g., spiritual, biomedical), specific traumas (e.g., physical/sexual assault, positional torture), and trust in community leadership. Despite availability of TIC guidelines for medical settings, no reports on trauma-informed pharmaceutical care were identified. Nonetheless, key TIC features—secure relationships; seeking permission before eliciting history to avoid re-traumatization; promoting patient empowerment using individual or community collaboration—could be applied in pharmacy settings. ASR-community collaboration in interventions/education is associated with increased vaccine uptake.
Discussion: Heterogeneity makes “one-size-fits-all” pharmaceutical care inappropriate for ASRs. Although peer-reviewed evidence to guide trauma-informed pharmaceutical care is limited, available evidence suggests pharmacists could potentially improve care for ASRs by incorporating TIC into practice and staff oversight.
Other: Unfunded research.
Presenting Author
Kathleen A. Fairman MA, PhDMidwestern University, College of Pharmacy-Glendale
Authors