language barriers in health care spanish speaking patients (w/ limited english proficiency) &...
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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. 2004.