Medication minority populations

Heart failure is more prevalent and associated with a worse prognosis in African-Americans compared to the general population.1 Unfortunately, deficiencies in disease prevention, detection, and access to treatment are well documented in minority populations. African-Americans and other races are underrepresented in clinical trials, compromising the extrapolation of results from these studies to ethnic subpopulations. The influence of race on efficacy and safety of medications used in HF treatment has received additional attention with... 

These caveats noted, there are several areas that deserve special attention, where analyses and social-cultural factors and sources of influence need to be better understood. How are we to understand minority and ethnic differences in decreased medication use, above and beyond their likelihood of use of medications for other conditions While these analyses have not yet been confirmed across a wide range of data sets, such findings are provocative, and may warrant more systematic studies of atttitudes, barriers, and stigma within some minority communities. If such findings are confirmed in other statewide and national medication data bases, more in-depth studies of specific minority populations seem warranted. 

Popli et al., 1997 Henderson, 2002 Sernyak et al., 2002), minority patients maybe more hesitant to take these medications compared to White patients. Alternatively, physicians may be less likely to prescribe them in this at-risk population. 

These population changes have important implications for pharmacotherapy. It is now widely accepted that genetic differences between the various ethnic groups are quite small and probably less than individual differences. The recent experience with the newly approved congestive heart failure medication, BiDil, suggests that even minor differences can have significant pharmacological consequences. 

The UK NHS is financed primarily out of taxation and is available to all permanent residents. Most people are registered with a general medical practitioner (imder contract with the NHS and paid mainly on a capitation basis), who provides primary care and is the normal route of referral to hospital and specialist services, whether in the NHS or the private sector. A small minority of the population obtain some or all of their medical treatment privately, mainly through insurance schemes. 

British Heart Foundation Statistics Database (1998). Coronary Heart Disease Statistics 1998. London British Heart Foundation Cappuccio FP (1997). Ethnicity and cardiovascular risk variations in people of African ancestry and South Asian origin. Journal of Human Hypertension 11 571-576 Connor MD, Walker R, Modi G et aL (2007). Burden of stroke in black populations in sub-Saharan Africa. Lancet Neurology 6 269-278 Coull AJ, Lovett JK, Rothwell PM et al. (2004). Population based study of early risk of stroke after transient ischaemic attack or minor stroke implications for public education and organisation of services. British Medical Journal 328 326... 

The Early Use of Existing Preventive Strategies for Stroke (EXPRESS) study aimed to determine the effect of more rapid treatment after TIA and minor stroke in patients who were treated in a specialist neurovascular cUnic (Rothwell et al. 2007) within OXVASC. In a prospective, population-based, sequential comparison study, the effect on the process of care and outcome of either urgent access and immediate treatment in a dedicated neurovascular clinic or an appointment-based access and routine treatment initiated in primary care were compared for all patients with TIA or minor stroke who did not need hospital admission. The primary outcome was the risk of stroke during the 90 days after first seeking medical attention. 

These benefits not only accrue to the individual, but to society as well. The resource savings to the healthcare system through responsible self-medication allows better allocation of limited healthcare resources and physicians time to important issues beyond the scope of self-care. It is inconceivable to consider the tremendous economic strain it could impose on the healthcare system if every consumer chose to visit a physician for every minor illness. Health centers would be overwhelmed and would not be able to work efficiently as illustrated by the fact that on an average each American experiences one potential self-treatable health problem every 3 days. Additionally, approximately 90% of the Americans consider themselves in poor health at least one or more times each month. Approximately 70% of consumers self-medicate on a regular basis, and an estimated 40% of the U.S. population uses at least one non-prescription drug within any given 48-hr period.Hence, easy access to nonprescription products is likely to be a priority for the American consumer. 

Caffeine is an extremely important drug because of its widespread use. Overall it also seems to be a relatively safe drug. Despite the many years of research that have been devoted to caffeine, however, we still have a lot to learn about it. Probably the most essential research concerns tfcveloping better ways to obtain accurate measures of caffeine consumption. Such advances would help us answer important research questions. F or example, we need to know more about the long-term effects of caffeine use in children, the development of tolerance to caffeine, and the prevalence of more minor symptoms of higher, but not extreme, levels of caffeine use. Another question is how caffeine affects people in special populations, such as those who arc medically or psychiatrically ill. 

A ubiquitous disease of aging men, symptomatic BPH requires medical attention to preserve patient quality of life and avoid complications, many of which can be life-threatening in this patient population. In men who have no or minor symptoms, watchful waiting is the therapeutic option of choice, as BPH remains stable or even regresses in about one-half of these men. 

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