- January 24, 2013
- By: Colin Poitras
- http://today.uconn.edu
http://youtu.be/mtnliHX4M2Q
Scarred by years of torture and abuse under the brutal Khmer Rouge
regime, Cambodian refugees in the United States have been found to have
significantly higher physical and mental health problems compared to the
general population.
Helping them address their health issues and receive sustained,
adequate health care hasn’t been easy. Many of the refugees view Western
medicine as complementary to traditional Cambodian healing practices –
which may include Buddhist healers, herbalists, and acupuncture – and
only visit a primary care physician infrequently. Language barriers,
social isolation, lack of access to transportation, and limited
financial resources create further impediments to receiving quality
care.
In response to the problem, two UConn professors are working to
improve the health outcomes of Cambodian refugees through community
outreach, medication therapy management, innovative telemedicine and
technology services, research, and policy changes.
Thomas Buckley, assistant clinical professor, UConn School of Pharmacy.
Thomas Buckley, an assistant clinical professor in the School of
Pharmacy and an expert on health disparities and access to care, has
been working with a Connecticut nonprofit advocacy group for the past
seven years to make sure older Cambodian-Americans in Connecticut,
Massachusetts, and California are taking the medications they need. In
addition to serving as a clinical consultant for Khmer Health Advocates
(KHA) of West Hartford – the only Cambodian-American health care
organization in the U.S. – he is preceptor of a clinical rotation for
UConn pharmacy students involving Cambodian refugees.
Megan
Berthold, assistant professor of social work, meets with Theanvy Kuoch,
executive director, right, Sengly Kong, co-investigator, left, and
Gabriel Babalola, financial manager, at Khmer Health Advocates in West
Hartford on Dec. 18, 2012. (Peter Morenus/UConn Photo)
On another front, S. Megan Berthold, assistant professor of social
work and an expert on the physical and mental health consequences of
trauma in refugee groups, has spent the past 12 years working with a
team of researchers to identify Cambodian refugee physical and mental
health problems through an NIMH-funded initiative undertaken in
collaboration with the RAND Corp. The project is led by Grant Marshall
of RAND Corp.
Berthold also recently started working with the KHA, where she
oversees a UConn-funded community-based participatory research study for
Cambodian-Americans that uses computer tablet technology and native
language software to assess the health needs of Cambodian-American
communities in six cities around the U.S.
Bridging the cultural gap
As part of the clinical rotation program Buckley manages at the KHA,
UConn pharmacy doctoral students work side-by-side with Cambodian
community outreach workers to assess the health needs of Cambodian
refugees and help them manage their medications. The students
participate in face-to-face visits with Cambodian-Americans in
Connecticut and Massachusetts, and help counsel individuals in
California through advanced video teleconferencing. Long Beach, Calif.
has the nation’s highest population of Cambodian-Americans, with more
than 70,000 residents.
“Cambodian-American health outcomes are especially bad because of the
treatment they received under the Khmer Rouge,” says Buckley. “Their
rates for diabetes, hypertension, depression, and other symptoms
associated with post-traumatic stress disorder are much higher than
other groups. Although the genocide of the Khmer Rouge happened 30 years
ago, the after-effect is still manifesting itself now.”
An iPad with a Khmer language questionnaire. (Peter Morenus/UConn Photo)
The UConn pharmacy students use a specially-developed questionnaire
to assess a person’s medication and health problems. The information is
then shared with a licensed pharmacist, who may recommend dosage
changes, alternate treatments, or other action. The students in the
program get first-hand experience with medication therapy management,
cultural competency training, and community pharmacy practices.
“We are exploring innovative ways pharmacists can work with a
community health worker and bridge the cultural gap in order to provide
better health services,” says Buckley.
“The biggest problem we see is the complexity of the therapies,” he
says. “A lot of people are getting their drugs from many different
sources. They don’t have one primary care physician controlling
everything. Because they have poor access to healthcare, they are
getting their drugs from a spouse, a sister, an uncle, a close friend …
we found people were taking multiple drugs that were doing the same
thing.”
Some of the nearly 100 Cambodian-Americans surveyed through the
program had stopped taking certain medications after experiencing
adverse side effects. Others took too much medicine, resulting in
additional health concerns.
As a result of the pharmacist-community worker intervention,
successful therapy outcome goals increased from 69 percent to 93 percent
among program participants over a 12-month period, inappropriate
medication use declined by 35 percent, and medication adherence improved
23 percent. A review of the program’s return on investment projected
that for every $1 associated with the cost of the program, $6 in health
care savings was returned.
Buckley’s work led to his receiving the Connecticut Pharmacists
Association’s 2012 Excellence in Innovation award for outstanding
advancement of pharmacy practice. He received the UConn Provost’s Award
for Excellence in Public Engagement in 2011.
Documenting physical and mental health problems
Berthold, meanwhile, recently entered the second phase of a major
research initiative involving the health and well-being of
Cambodian-Americans. She is part of a team of researchers at the RAND
Corp. that is documenting the prevalence of physical and mental health
problems among older Cambodian-Americans and examining whether there are
any links between trauma, post-traumatic stress reactions, and chronic
health problems.
Berthold says the longitudinal study with RAND has amassed a large
amount of data. “The U.S. Veterans’ Administration is very interested in
chronic health issues and the possible link between PTSD and depression
and chronic physical health problems such as cardiovascular problems,
high blood pressure, and diabetes. We are examining those issues in
Cambodian-American survivors of the Khmer Rouge Killing Fields.”
The RAND study was the first prevalence study of mental health
problems in a random sample of Cambodian-American survivors of the Khmer
Rouge genocide. Initial findings were published in the Journal of the American Medical Association
in 2005. As part of the second wave of research, Berthold is looking at
long-term mental and physical health issues in the sample population,
and, in a separate study, the mental and physical health of
Cambodian-American youth born in the U.S.
Building capacity
Berthold is also the principal investigator on a community-based
participatory research project in partnership with KHA and Cambodian
NGOs around the country. KHA project director SengLy Kong is
co-investigator. The study, funded by a UConn Faculty Large Grant,
involves testing the feasibility and effectiveness of training Cambodian
community health workers to collect data using iPad tablet computers.
The project aims to gauge Cambodian-Americans’ concerns about the
health of their communities, as well as their perceptions about barriers
to effective healthcare. Community members are able to interact with
the devices in their native Cambodian language Khmer. The results will
be interpreted by Cambodian-American community leaders around the
country who are partners on the project, and used by the community to
develop a comprehensive plan to reduce health disparities and improve
health outcomes in this population.
“Cambodian-American health outcomes are especially bad because of the treatment they received under the Khmer Rouge. … Although the genocide of the Khmer Rouge happened 30 years ago, the after-effect is still manifesting itself now.”
“We are trying to build capacity in the Cambodian-American community
across the country to conduct research and address the significant
health disparities they face,” says Berthold, who was named the National
Association of Social Workers 2009 Social Worker of the Year.
“Cambodian-American leaders from six states who run Cambodian-American
NGOs have collaborated as partners in the development and implementation
of every stage of this project. We plan to share the data through
telephone conference meetings, and ask for stakeholders’ help in
interpreting the data and identifying a focus for further research that
is meaningful and important to the Cambodian-American community.”
UConn experiential education field coordinator Lisa Bragaw and
associate clinical professor of pharmacy Devra Dang are assisting with
the research, as are UConn Health Center licensed clinical psychologists
Julie Wagner and Elizabeth Schilling, and Thiruchandurai Rajan,
professor of pathology and laboratory medicine.
Mary Scully, programs director for KHA and an advanced practice
registered nurse, says the work is greatly appreciated. “I think having
pharmacists more involved in health care is a very practical solution to
helping people with their medical problems,” she says. “The pharmacists
in our program have done a great job talking with the community. They
are very knowledgeable, and the community really picked up on that. They
loved the service and when they saw the drop in the depression rate, it
seemed to really empower them.”
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