Language barriers increasing risk of drug mishaps in Australia

Culturally and linguistically diverse Australians at higher risk of medicine-related harm, report finds In short: Australians from culturally and linguistically diverse backgrounds face a higher risk of medicine-related harm, according to a recent report from the Pharmaceutical Society of Australia. Experts say cultural differences, poor health literacy and language barriers can lead to misunderstandings about how to use medications safely and effectively. What's next? The report outlines five strategies to improve outcomes, including more home medicine reviews, better data collection and wider use of interpreters. Pharmacist-turned-translator Evelyn Pe has heard some horrific stories about medication misuse from people with culturally and linguistically diverse backgrounds. Ms Pe, who worked as a pharmacist in Myanmar before she came to Australia as a refugee, said medications only worked properly if taken as directed and misuse could cause serious harm or death. One healthy young woman in Australia Ms Pe knew started taking her late mum's cancer drugs as she was told cancer was hereditary. "She asked me how she can buy the medications?'" Ms Pe said. "All her hair is falling out, it's a very dangerous situation." While this was an extreme case, Ms Pe said there were a few situations she saw repeated time after time, such as people not understanding they needed to take a full five-day course of antibiotics. "When they are starting to feel better on day two, they are saving [the medication] for next time or sharing it with others,"she said. Many people did not understand the importance of taking drugs at a certain time of day or revealing if they were fasting for cultural reasons, which could interfere with the medication, or felt uncomfortable talking about their use of traditional medications, Ms Pe said. These are not isolated cases. According to a new report from the Pharmaceutical Society of Australia (PSA) Australians from culturally and linguistically diverse (CALD) backgrounds face a higher risk of medicine-related harm. Ms Pe, who did not contribute to the report, said a combination of cultural differences, poor health literacy and language barriers often resulted in people not understanding how to take their medications safely and effectively. PSA is now calling for a range of different measures including more interpreters and an increased number of at-home medicine reviews, to keep vulnerable Australians safe. Limited English, multiple medications In 2022, 4.6 million Australians who received medicines through the Pharmaceutical Benefits Scheme (PBS) were born overseas, with 500,000 of them reporting limited English proficiency. And of the PBS recipients with limited English proficiency, 45 per cent of people received six or more different medicines. Mark Naunton, PSA national president and professor of pharmacy at the University of Canberra, said these figures showed people from CALD backgrounds were clearly able to access medication in Australia, but issues could arise if they were not given clear information. "When people who have English as a second or third or even fourth language, and probably fifth to some, there can be easy misunderstandings on how medicines can be used appropriately,"he said. "We have plenty of case reports where people have become unwell and then gone to hospital as a result of [medicine-related harm], all completely preventable. "The sad reality is we need better systems. We need systems utilised to make sure that the people are safe." It is not clear exactly how many people from CALD backgrounds have been hospitalised with medicine-related harm,but figures from 2019 show 250,000 hospital admissions a year were due to medicine-related problems, with an extra 400,000 emergency department presentations likely to be medication-related. According to the PSA, half of this harm is preventable. However, Geraldine Moses, a specialist clinical and drug information pharmacist who did not contribute to the report, said while it was "wonderful" to see a focus on the struggles CALD populations had with medication, it was crucial to exercise caution. "It is important to not overreact to the claim that these people are on multiple medicines," she said. "Polypharmacy — taking five or more medicines per day — is common amongst all Australians, and it doesn't have to be a bad thing. "It can be what we call "rational polypharmacy" where all the medicines are appropriate, effective, and safe." Dr Moses said most health professionals working "at the coal face" already knew CALD populations were more at risk of medicine-related harm and agreed more needed to be done to keep people safe. "We also know that health literacy is a challenge among many Australians,"she said. "Add to that the complexity of coming from CALD backgrounds, understanding medicines can become a nightmare. "So this report is very helpful to give us guidance on the extent of the problems and where the issues lie." Five key recommendations The PSA's report highlights five recommendations which Professor Naunton said would improve communication and lead to better patient outcomes: - A wider use of interpreter services - More home medicine reviews for CALD communities - Better data collection - Expanding access to culturally-appropriate information about medications - Cultural awareness training for pharmacists. Dr Moses said she would "definitely support" these suggestions and specifically highlighted the importance of more medication reviews either at home or with a GP and translator services. "We all need to recognise that problems can arise when family members act as translators, especially young children," she said. "The translators we support should be properly trained and approved translators." Dr Moses said messages could be lost in translation if the health issue was embarrassing or needed a level of maturity, such as genito-urinary problems. The PSA wants to see the establishment of a new national policy and funding stream to support the routine use of professional interpreters and culturally appropriate communication tools. In a statement, the federal Department of Health, Disability and Ageing said it already funded interpreter services, including the free telephone interpreting service for pharmacies and medical practitioners, which supported "clear communication about medicines" and reduced the "risk of incorrect or unsafe use". But Ms Pe said very few people from CALD populations knew this service existed, let alone that it was something they could routinely ask for when filling their scripts. Slow down, ask more questions In a statement, a spokesman for the federal health department said it recognised people from CALD backgrounds often faced "additional challenges in using medicines safely". He said the government had delivered more than $60 million in funding through the quality use of diagnostics, therapeutics and pathology program. Many of these funded projects, such as providing free, specialist-supported medicine education for migrant, refugee and asylum seeker communities and developing easy-to-understand medicines information in multiple languages for people taking osteoporosis medicines, align with recommendations in the PSA's report. But Professor Naunton said there needed to be more services specifically targeted for CALD populations, in addition to those programs that had already been funded. "Typically people who are disadvantaged do need extra supports to bring them up to a level playing field,"he said. Doing more now to ensure better long-term outcomes was something Dr Moses said was appropriate as modern medications had become "very complex and difficult for everyone to understand". "But these problems are hugely amplified for people who come from CALD backgrounds, so they need our help to use their medicines safely and most effectively," she said. For pharmacists working directly with CALD populations, Ms Pe's message is simple: slow down, talk to the client and ask more questions, even if that meanscalling a translator. "They need to take time and explain what to do, how much they need to, make sure the clients really understand,"she said.