Language Barriers Put CALD Australians at Heightened Risk of Medicine Harm, PSA Report Finds

Language barriers are placing culturally and linguistically diverse (CALD) Australians at significantly heightened risk of medicine-related harm, according to a new report from the Pharmaceutical Society of Australia (搜索)搜索该词条 (PSA). The eighth installment in PSA's Medicine Safety series, titled Medicine Safety: Culturally and Linguistically Diverse Community Care, was developed with support from Pharmaceutical Defence Limited (搜索)搜索该词条 (PDL) and launched at PSA26.

The report documents a series of alarming real-world medicine misadventures. In one case, a refugee teenager was handed another patient's antidepressant prescription, doubling his dose while believing it was acne medicine. In another, a refugee discharged with a complex regimen for hepatitis C (搜索)搜索该疾病 and HIV (搜索)搜索该疾病 was not taking any of his medicines because no one in his household could read the instructions. A third case involved a woman relying on more than 20 non-prescription products who developed rhinitis medicamentosa (搜索)搜索该疾病 from decongestant overuse.

"It's not just about accessing medicines – it's how they're used, and you can only use them safely if they're understood," said PSA National President Professor Mark Naunton MPS. "It's rarely just a drug issue. It's often a communication and systems issue."

A Growing Population with Complex Medicine Needs

Australia's demographic landscape underscores the urgency of the findings. In 2021, more than 7 million people – 27.6% of the population – were born overseas, with 22.8% speaking a language other than English at home. In 2022, approximately 29% of all Pharmaceutical Benefits Scheme (PBS) medicine recipients were born overseas, 13% spoke a language other than English at home, and 3% reported limited English proficiency.

Among PBS recipients with limited English proficiency, nearly half (45%) were dispensed six or more different medicines in 2022, indicating a substantial polypharmacy burden. Notably, among people born in Asia, Africa, and the Middle East, around 70% of PBS medicine recipients were of working age (18–64 years), with less than 20% aged 65 or over – suggesting younger CALD populations may have distinct medicine information needs.

High-Risk Medicine Use and Socioeconomic Disadvantage

The report flags particular concern around high-risk medicines. Among people born in Europe and those with limited English proficiency, 13% were dispensed antithrombotic agents (搜索)搜索该药品. Opioids (搜索)搜索该药品 were dispensed to 19% of European-born individuals, 15% of those born in Africa or the Middle East, and 11% of people with limited English proficiency. Both classes carry serious adverse effect risks including bleeding, falls, sedation, and overdose.

Socioeconomic disadvantage compounds these risks. Two in five (42%) PBS medicine recipients with limited English proficiency live in areas classified as the most disadvantaged, compared to 29% for the overall Australian population. Almost half (41%) of people with limited English proficiency report fair or poor health. Studies referenced in the report found that Arabic-speaking, Vietnamese, Indian, and Chinese migrant populations with diabetes (搜索)搜索该疾病 or hypertension (搜索)搜索该疾病 have reported missed doses, delayed treatment initiation, and discontinuation of prescribed medicines.

Communication Breakdowns in Practice

Evelyn Pe, a bilingual health worker and Burmese interpreter, highlighted how even simple dosing instructions can be dangerously misread. "You say 'twice a day' for the medication and pharmacists think everyone understands. But some people hear 'two times' and take it 2 hours apart. That's very dangerous."

Ms Pe also noted that fear, not just language, prevents many patients from asking questions. "Some people believe that if they ask something wrong, they'll be deported back to their country. That kind of fear stops them asking." Cultural stigma around mental illness adds another barrier: "In my culture, we don't really have the [concept] of mental health. People believe it is a punishment from God."

Curtis Ruhnau MPS, a community pharmacist of more than 40 years and President of the Pharmacists' Support Service, warned against over-relying on family members as interpreters. "A family member will, of course, filter any information we give through their own belief system before passing it on. Even using a trusted family member is a fraught thing."

Underutilised Medication Review Services

Home Medicines Reviews (HMRs) remain potentially underutilised among CALD communities, with consultations revealing limited awareness of the service. Dr Deborah Hillman-White, a GP working entirely in refugee health, called for earlier pharmacist involvement: "You've got Abdul here on 18 different medicines. Is this needed? How about we do an HMR?"

Divya Lal, PSA NSW/ACT State Manager and community pharmacist of nearly 20 years, emphasised the pharmacist's unique position: "We're accessible. We're the central point – whether they go to a GP, a specialist, an optometrist or a physio, at the end of the day they're going to come to the pharmacy regardless."

Five Priority Recommendations

The PSA report sets out five recommendations for immediate implementation: embed culturally responsive communication and interpreter use as standard care; strengthen pharmacist-led medicine review services; improve data collection and monitoring; expand access to culturally appropriate medicines information; and integrate cultural safety into pharmacist education and practice standards.

Upon reading the report, Mr Ruhnau reflected: "I realised how many things I've got wrong over the last 40-odd years. We don't have to keep making those mistakes one at a time. We can learn from this together, so we can build better, together."

Ms Pe's advice to fellow pharmacists was straightforward: "Just take 2 or 3 extra minutes to explain the medication – what it's for, whether it needs to be taken with food. That little bit of extra time changes everything."