Hablamos Juntos (Together We Speak): Interpreters, Provider Communication, and Satisfaction with Care

The Hablamos Juntos—Together We Speak (HJ)—national demonstration project targeted the improvement of language access for Spanish-speaking Latinos in areas with rapidly growing Latino populations. The objective of HJ was to improve doctor-patient communication by increasing access to and quality of interpreter services for Spanish-speaking patients. To investigate how access to interpreters for adult Spanish-speaking Latinos is associated with ratings of doctor/office staff communication and satisfaction with care. Cross-sectional cohort study. A total of 1,590 Spanish-speaking Latino adults from eight sites across the United States who participated in the outpatient HJ evaluation. We analyzed two multi-item measures of doctor communication (4 items) and office staff helpfulness (2 items), and one global item of satisfaction with care by interpreter use. We performed regression analyses to control for patient sociodemographic characteristics, survey year, and clustering at the site of care. Ninety-five percent of participants were born outside the US, 81% were females, and survey response rates ranged from 45% to 85% across sites. In this cohort of Spanish-speaking patients, those who needed and always used interpreters reported better experiences with care than their counterparts who needed but had interpreters unavailable. Patients who always used an interpreter had better adjusted ratings of doctor communication [effect size (ES = 0.51)], office staff helpfulness (ES = 0.37), and satisfaction with care (ES = 0.37) than patients who needed but did not always use an interpreter. Patients who needed and always used interpreters also reported better experiences with care in all three domains measured [doctor communication (ES = 0.30), office staff helpfulness (ES = 0.21), and satisfaction with care (ES = 0.23)] than patients who did not need interpreters. Among adult Spanish-speaking Latinos, interpreter use is independently associated with higher satisfaction with doctor communication, office staff helpfulness, and ambulatory care. Increased attention to the need for effective interpreter services is warranted in areas with rapidly growing Spanish-speaking populations

Living with diabetes: rationale, study design and baseline characteristics for an Australian prospective cohort study

Background: Diabetes mellitus is a major global public health threat. In Australia, as elsewhere, it is responsible for a sizeable portion of the overall burden of disease, and significant costs. The psychological and social impact of diabetes on individuals with the disease can be severe, and if not adequately addressed, can lead to the worsening of the overall disease picture. The Living With Diabetes Study aims to contribute to a holistic understanding of the psychological and social aspects of diabetes mellitus

Satisfaction With Provider Communication Among Spanish-Speaking Medicaid Enrollees

OBJECTIVE: To determine if differences between English- and Spanish-speaking parents in ratings of their children\u27s health care can be explained by need for interpretive services. METHODS: Using the Consumer Assessment of Health Plans Survey-Child-Survey (CAHPS), reports about provider communication were compared among 3 groups of parents enrolled in a Medicaid managed care health plan: 1) English speakers, 2) Spanish speakers with no self-reported need for interpretive services, and 3) Spanish speakers with self-reported need for interpretive services. Parents were asked to report how well their providers 1) listened carefully to what was being said, 2) explained things in a way that could be understood, 3) respected their comments and concerns, and 4) spent enough time during medical encounters. Multivariate logistic regression was used to compare the ratings of each of the 3 groups while controlling for child\u27s gender, parent\u27s gender, parent\u27s educational attainment, child\u27s health status, and survey year. RESULTS: Spanish-speaking parents in need of interpretive services were less likely to report that providers spent enough time with their children (odds ratio = 0.34, 95% confidence interval = 0.17-0.68) compared to English-speaking parents. There was no statistically significant difference found between Spanish-speaking parents with no need of interpretive services and English-speaking parents. CONCLUSIONS: Among Spanish- versus English-speaking parents, differences in ratings of whether providers spent enough time with children during medical encounters appear to be explained, in part, by need for interpretive services. No other differences in ratings of provider communication were found

Disparities in Glycemic Control Among Hispanic Adults With Diabetes

Background/Aims: Poor glycemic control is associated with increased morbidity and mortality for adults with diabetes mellitus (DM). Little research has examined disparities in glycemic control among Hispanics with DM compared to whites. The objective of this work was to determine: 1) whether disparities in glycemic control exist among Hispanics versus whites; and 2) whether demographics, socioeconomic status, disease characteristics, health care utilization (primary care, specialty care, care management services) and treatment characteristics (oral hypoglycemic medications, insulin use) explain differences in glycemic control. Methods: Using an observational study design, we studied 29,825 adults on the Kaiser Permanente Northwest DM registry as of January 1, 2013, with a valid HbA1c test during calendar year 2013. Good glycemic control was defined as HbA1c 30 (vs. body mass index \u3c 30), Charlson comorbidity score (continuous), primary care utilization in 2013 (1+ visits vs. none), specialty care utilization (1+ visits vs. none), use of DM care management services (1+ services vs. none), use of oral hypoglycemic medications (1+ medications fills vs. none) and insulin use (any insulin use vs. none). Seven logistic models were constructed: model 1 (race/ethnicity), model 2 (model 1 + demographics), model 3 (model 2 + SES), model 4 (model 3 + disease characteristics), model 5 (model 4 + health care utilization) and model 6 (model 5 + treatment characteristics). Results: Hispanics were less likely to have good glycemic control in unadjusted models (odds ratio: 0.56, 95% confidence interval [CI]: 0.51–0.61; P\u3c0.0001). This point estimate remained consisted across all logistic models examined, even after adjusting for covariate measures (odds ratio: 0.69, 95% CI: 0.62–0.77; P\u3c0.0001). Discussion: Our findings suggest that disparities in glycemic control among Hispanics compared to whites remain even after adjusting for critical covariate measures. More work is needed to understand whether lifestyle choices and other factors explain differences and whether targeted interventions can reduce these disparities

Effect of once-daily FDC treatment era on initiation of cART

David M Mosen1, Michael Horberg2, Douglas Roblin3, Christina M Gullion1, Richard Meenan1, Wendy Leyden2, Weiming Hu11Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA; 2Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; 3Center for Health Research, Kaiser Permanente Georgia, Atlanta, GA, USAObjectives: Combination antiretroviral therapy (cART) is associated with increased survival among HIV-infected persons. Yet, no research to date has examined whether introduction of once-daily fixed-dosed combinations (FDC) affects the likelihood of cART initiation. We aimed to determine whether implementation of once-daily FDC regimens was associated with changes to cART initiation. We also identified clinical, treatment regimen, and provider characteristics possibly associated with cART initiation. Study design: Retrospective observational analysis.Methods: We queried electronic medical records between July 1999–June 2006 to identify incident cases of detectable HIV infection in antiretroviral-naïve adults. Cox regression with time-dependent covariates was used to examine the effects of once-daily FDC era, clinical, provider, and treatment regimen characteristics on cART initiation.Results: Once-daily FDC availability did not change the likelihood of cART initiation, but other characteristics were associated with an increased likelihood: AIDS diagnosis, above-median daily pill consumption, and 16+ yrs of physician HIV experience. Decreased likelihood of cART initiation was associated with CD4 201–350 cells/µL, HIV RNA < 100,000 copies/mL, and with CD4 > 350 cells/µL (any HIV RNA level), compared to CD4 ≤ 200 cells/µL.Conclusion: Availability of once-daily FDC-based regimens did not affect likelihood of cART initiation. Patient clinical characteristics appear to be more important predictors of cART initiation.Keywords: ARV treatment, once-daily FDC therapies, ARV-naïv

A Computerized Asthma Outcomes Measure Is Feasible for Disease Management

OBJECTIVE: To develop and test an online assessment referred to as the ASTHMA-CAT (computerized adaptive testing), a patient-based asthma impact, control, and generic health-related quality of life (HRQOL) measure. STUDY DESIGN: Cross-sectional pilot study of the ASTHMA-CAT\u27s administrative feasibility in a disease management population. METHODS: The ASTHMA-CAT included a dynamic or static Asthma Impact Survey (AIS), Asthma Control Test, and SF-8 Health Survey. A sample of clinician-diagnosed adult asthmatic patients (N = 114) completed the ASTHMA-CAT. Results were used to evaluate administrative feasibility of the instrument and psychometric performance of the dynamic AIS relative to the static AIS. A prototype aggregate (group-level) report was developed and reviewed by care providers. RESULTS: Online administration of the ASTHMA-CAT was feasible for patients in disease management. The dynamic AIS functioned well compared with the static AIS in preliminary studies evaluating response burden, precision, and validity. Providers found reports to be relevant, useful, and applicable for care management. CONCLUSION: The ASTHMA-CAT may facilitate asthma care management