Providing High-Quality Care for Limited English Proficient Patients: The Importance of Language Concordance and Interpreter Use

Background: Provider–patient language discordance is related to worse quality care for limited English proficient (LEP) patients who speak Spanish. However, little is known about language barriers among LEP Asian-American patients. Objective: We examined the effects of language discordance on the degree of health education and the quality of interpersonal care that patients received, and examined its effect on patient satisfaction. We also evaluated how the presence/absence of a clinic interpreter affected these outcomes. Design: Cross-sectional survey, response rate 74%. Participants: A total of 2,746 Chinese and Vietnamese patients receiving care at 11 health centers in 8 cities. Measurements: Provider–patient language concordance, health education received, quality of interpersonal care, patient ratings of providers, and the presence/absence of a clinic interpreter. Regression analyses were used to adjust for potential confounding. Results: Patients with language-discordant providers reported receiving less health education (β = 0.17, p < 0.05) compared to those with language-concordant providers. This effect was mitigated with the use of a clinic interpreter. Patients with language-discordant providers also reported worse interpersonal care (β = 0.28, p < 0.05), and were more likely to give low ratings to their providers (odds ratio [OR] = 1.61; CI = 0.97–2.67). Using a clinic interpreter did not mitigate these effects and in fact exacerbated disparities in patients’ perceptions of their providers. Conclusion: Language barriers are associated with less health education, worse interpersonal care, and lower patient satisfaction. Having access to a clinic interpreter can facilitate the transmission of health education. However, in terms of patients’ ratings of their providers and the quality of interpersonal care, having an interpreter present does not serve as a substitute for language concordance between patient and provider

What triggers requests for ethics consultations?

Objective To investigate what triggers clinicians' requests for ethics consultations. Design Cross-sectional telephone survey. Setting and participants Randomly selected physicians throughout the United States who practice in internal medicine, oncology, and critical care. Main measurements Sociodemographic characteristics, training in medicine and ethics, and practice characteristics; types of ethical problems that prompt requests for consultation, and factors triggering consultation requests. Results Of 344 responding physicians, 190 (55.2%) reported requesting ethics consultations. Most commonly these were for ethical dilemmas related to end-of-life decision making, patient autonomy issues, and conflict. The most common triggers that led to consultation requests were wanting help resolving a conflict; wanting assistance with interactions with a difficult family, patient, or surrogate; wanting help with making a decision or planning care; and emotional triggers. Physicians who were ethnically in the minority, practiced in communities under 500,000 population, or who were trained in the United States were more likely to request consultations to resolve conflict. Conclusions Conflicts and other emotionally charged concerns more commonly trigger consultation requests than other cognitively based concerns. When consulting, ethicists need to be prepared to mediate conflicts and handle sometimes difficult emotional situations. The data suggest that ethics consultants might serve clinicians well by consulting on a more proactive basis to avoid conflicts and by educating clinicians to develop mediation skills

Complementary and Alternative Medical Therapy Use Among Chinese and Vietnamese Americans: Prevalence, Associated Factors, and Effects of Patient–Clinician Communication

Objective. We examined the use of complementary and alternative medical (CAM) therapies among Chinese and Vietnamese Americans who had limited proficiency with the English language and explore the association between patient–clinician discussions about CAM therapy use and patient assessments of quality of care. Methods. We surveyed Chinese and Vietnamese Americans who visited 11 community health centers in 8 major cities throughout the United States. Results. Of the 4410 patients surveyed, 3258 (74%) returned completed questionnaires. Two thirds of respondents reported they had “ever used” some form of CAM therapy; however, only 7.6% of these patients had discussed their use of CAM therapies with clinicians. Among patients who had used CAM therapies during the week before their most recent visits, clinician–patient discussions about CAM therapy use were associated with better overall patient ratings of quality of care. Conclusion. Use of CAM therapies was common among Chinese and Vietnamese Americans who had limited proficiency with the English language. Although discussions about CAM therapy use with clinicians were uncommon, these discussions were associated with better ratings of quality of care