Pharmacists' considerations when serving Amish patients.

OBJECTIVES To introduce historical and sociocultural influences on health and health care decisions that should be considered by pharmacists and other health professionals when serving Amish patients and to describe the roles of pharmacists in working with Amish populations, as an example of culturally and linguistically appropriate care. SETTING Community independent pharmacy in Arthur, IL, from 1991 to 2008. PRACTICE DESCRIPTION Reflections of a pharmacist-owner whose community practice serves a sizeable Amish population. CASE SUMMARY The Old Order Amish are a religious group that values health and actively participates in its health care decisions. The Amish possess a strong sense of community responsibility and often seek advice of friends, family, and community in health care decisions. Their explanatory models of health and illness differ, in some respects, from the larger American society. The Amish are open to the use of folk medicine, complementary and alternative medicine, and conventional care when deemed necessary. They are receptive to health care information and explanations of options from trusted sources and use increased self-care modalities, including herbal remedies. RESULTS Knowledge of salient cultural differences is important, but care should be given to avoid stereotyping patients because Amish rules and customs differ across districts. Culturally competent pharmacist care should be individualized based on patient needs and in consideration of aspects of differences in Amish cultures and districts. When serving Amish patients, special consideration should be given to addressing potential barriers to health care use, such as unique dialects, affordability issues for largely cash-paying customers, lower prenatal care use, and lower vaccination rates. CONCLUSION Enhanced awareness and sensitivity to Amish lifestyles and beliefs can lessen misconceptions and minimize barriers that interfere with optimal provision of patient-centered pharmacy care and services. By working through established community norms, building trust, and effectively applying cultural competency techniques, pharmacists can best serve the Amish communities.