Language Barriers in Health Care Spanish speaking patients (w/ limited English proficiency) & English speaking medical personnel

Effective communication is the cornerstone to functional patient care Language is a common barrier in an increasingly more diverse U.S. population It is a legal obligation to provide language interpretation per Title VI of the Civil Rights Act It is noted that translation tools are not always utilized in the hospital setting due to: - lack of funding - untrained medical personnel - time to implement services

Effective communication is the cornerstone to functional patient care Do Spanish speaking patients, with limited English proficiency, have decreased satisfaction with their quality of care based on the methods of interpretation services utilized by medical personnel?

PICO(T) Spanish Speaking Patient Population, with Limited English Proficiency 1 in 5 residents in the U.S. speak a language other than English within the home Spanish is the most common language spoken, second to English In 2005 there were 31 million Spanish speaking residents, this will increase to be 30% of the population by 2050 *Satistics from Hebert, Becky. 2006

PICO(T) Interventions to Improve Communication Staff training AT & T interpreter phone Video interpreter phone In-house trained interpreters Online English/Spanish medical terminology

PICO(T) Comparison Fewer than 25% of hospitals in the USA provide training for medical interpreters Ad-hoc Interpreters: family members, untrained hospital personal, etc. One hazard of using untrained interpreters translational errors that the provider is unaware of Patient reluctant to share relevant personal information No uniform policies and guidance for implementation exist *Satistics from Hebert, Becky. 2006

PICO(T) Outcomes of Accurate Translation Better patient outcomes Increased patient and medical provider satisfaction Decreased diagnostic testing Better health maintenance because of improved understanding of their condition

Review of Literature: The impact of language barriers on the health care of Latinos in the U.S.: a review of the literature and guidelines for practice Less access to screening, preventive, and primary health care services Prohibits women from seeking preventive services such as reproductive and cancer screening Reduced ability to practice health promotion and risk avoidance based on health education Increased use of expensive diagnostic tests Decreased use of primary care services and increased use of emergency services Poor or no patient follow-up when follow-up is indicated Inappropriate or unnecessary testing and misdiagnosis. * Timmins, C. 2002

Review of Literature: Language proficiency and adverse events in US hospitals: a pilot study Language barriers increase the likelihood of a harmful adverse events 49.1% of reported adverse events were in patients with limited English proficiency and only 29.5% of adverse events were in patients who spoke English Questionable healthcare advice Questionable patient interpretation Questionable assessment of patient needs *Divi, C., Koss, G., Schmaltz, S., Loeb, J. 2007

Review of Literature: Effect of Spanish Interpretation Method Patient Satisfaction in Urban Walk-in Clinic Goal: compare patient satisfaction using different translation tools Satisfaction vs. Dissatisfaction: lower rates of compliance, more frequent “doctor-shopping,” and poorer health outcomes. Satisfaction with overall clinic visit with 7 provider characteristics evaluated: listening, answers, explanations, support, discussion, skills, manner Results: Patients with Spanish speaking care providers and those that had AT&T phone interpreters were equally satisfied. Those that did not have formal interpreters were less satisfied *Lee, L., Batal, H., Maselli, J., Kutner, J. 2002

Review of Literature: Bridging the language barrier: the use of interpreters in primary care nursing Three sets of focus groups were interviewed (minority patients, nurses, interpreters) and agreed that poor communication leads to detrimental consequences in quality care. Many nurses did not know interpreting services were available and those who did know were unsure how to access it. Interpreters recognized nurses did not generate the demand of their services Patients felt they were not getting adequate health information from their providers because of poor communication Practitioners who used interpreting services and undergone training appeared to exert a strong influence on their practice. *Gerrish, K., Chau, R., Sobowale, A., Birks, E

Conclusion Additional research is needed to clarify the role of language barriers on healthcare outcomes, but solid evidence supports that poor communication can adversely effect health care quality. There is more than enough evidence to motivate addressing better use of translation services.