Treatment in primary healthcare (for prescribing practitioners)

Information on ethnopharmacology has been provided in the CALD 9 learning programme. The following are pointers for practitioners working in primary health and those who have limited time for consultation:

• Involve family members in the process.
• Ensure goals are client-centred.
• Determine duration of therapy and number of sessions.
• Consider home visits where needed.
• Provide information about the biological causes of mental illness to assist de-stigmatisation.
• Because Asian clients may not ask enough questions out of respect for the authority of the clinician, provide psycho-education on:
  • completing the dose, or consulting with a clinician before changing the dose (it is reported that Asians often discontinue use when symptoms improve, Te Pou, 2010).
  • drug effectiveness (Western medication is often seen as an instant cure).
  • side-effects (monitoring side-effects requires active enquiry as Asian clients are often loathe to admit to side-effects and will just discontinue use).
  • Asian's concerns about their perception of the 'addictive' properties of drugs.
  • possible interactions with other drugs (including herbs).
  • Fasting (adjustments are needed to time intervals).
• As the diet becomes more Westernised the impact on the pharmokinetics changes. Dose increases may be needed.
• If insufficient English proficiency, use an interpreter.
• Offer translated pamphlets where available.
• Include traditional and holistic interventions in the plan, as needed.
• Be aware that when using psychotherapy, or referring for psychotherapy, acceptance will depend to some degree on the level of acculturation, as well as on language.