Providing Care with a Language Barrier

Sarah Bade, SPTClinical Instructor: Val

Clinic: NAU Neuro

Objectives1. Describe the different methods a

provider might use to communicate with an LEP (low English-proficient) patient.

2. State the benefits of using professional vs. nonprofessional services.

3. When faced with an LEP patient encounter, be equipped to provide the best care to that patient.

Introduction ● 300 languages spoken in the US● 60 million people do not speak

English in the home○ About 22% of these either

can’t speak English or do not speak it well

○ Over 20 million LEP patients in the US

● LEP patients typically seen weekly, if not daily

Definitions

● LEP/EP● Language concordant or

bilingual provider● Interpreter● Professional services● Nonprofessional services

○ Ad hoc interpreter

¡Digan Hola a JT!- 38 yo Hispanic male- Suffered R CVA about 3 ya - Left with gait and balance impairments

- Uses an AFO on the L and either a FWW or Lofstrand crutches

- Speaks some English, but communicates much easier in Spanish

So We Have Several Options Here1. Talk slower or louder to JT in English and

hope he understands2. Try and use whatever Spanish we

remember from high school to communicate

3. Invite a family member or friend to come in and interpret

4. Find a bilingual therapist5. Find a professional interpreter

PICO QuestionWhen working with an LEP patient, are there differences in patient satisfaction and safety between using professional

options (bilingual therapist, professional interpreter) versus non-professional options (ad hoc interpreter,

minimal ability in their language, etc.)?

OR (Layman’s Term)

What do you do when they can’t talk to you?

Study 1● Professional interpreters vs. Ad Hoc Interpreters vs.

No interpreter○ Ad Hoc and No Interpreter categories = 2x as

many errors as Professional ○ 18% of errors had serious medical

consequences ● Ad Hoc interpretation = greater embarrassment● Professional interpreter/Bilingual provider = better

treatment outcomes, greater patient satisfaction, optimal communication

Flores G, Abreu M, Barone CP, Bachur R, Lin H. Errors of medical interpretation and their potential clinical consequences: A comparison of professional versus ad hoc versus no interpreters. Annals of Emergency Medicine. 2012;60(5):545-553.

Study 2● Systematic review of 28 articles looking at

interpreter outcomes● Language concordance

○ Greater satisfaction (equal to EP)○ Better treatment adherence ○ Greater chance of follow-up○ More speaking and interaction○ Greater comprehension of condition○ Better overall treatment outcomes and health○ Raises treatment quality to that of EP

Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited english proficiency? A systematic review of the literature. Health Services Research. 2007;42(2):727-754.

Answer to PICO Question = YES!

So, Back to those Options1. Talk slower or louder to JT in English

and hope he understands2. Try and use whatever Spanish we

remember from high school to communicate

3. Invite a family member to come in and interpret

4. Find a bilingual therapist5. Find a professional interpreter

So Does this Mean I Should Run out and Sign Up for a Spanish Class RIGHT NOW?!

● ...Possibly● Can actually be more dangerous - false

sense of security ● Helpful to help establish rapport (and

check to make sure the interpreter is saying what you them to)

● Still should use an interpreter unless you make the effort to be truly bilingual though

Cost-Benefit Analysis of Interpreter Use● No comprehensive one yet

○ One study indicates it’s beneficial, at least for large organizations

● Medicaid and Medicare do reimburse for it

● Most third-party payers do not● Eventually may be worth it to avoid

liability issues and lawsuits and to draw more patients○ $71 million lawsuit over

misinterpreted word urban legend

Questions?

References1. Baker DW, Parker RM, Williams MV, Coates WC, Pitkin K. Use and effectiveness of interpreters in an emergency department. JAMA. 1996;275(10):783-788.2. Cioffi J. Communicating with culturally and linguistically diverse patients in an acute care setting: Nurses’ experiences. 2003. Int J of Nursing Studies;40:299-306.3. Cohen AL, Rivara F, Marcuse EK, McPhillips H, Davis R. Are language barriers associated with serious medical events in hospitalized pediatric patients? Pediatrics. 2005;116(3):575-579.4. Diamond LC, Jacobs EA. Let’s not contribute to disparities: The best methods for teaching clinicians how to overcome language barriers to health care. J Gen Intern Med. 2009;25(Suppl 2):189-193.5. Divi C, Koss RG, Schmaltz SP, Loeb JM. Language proficiency and adverse events in US hospitals: A pilot study. Int J for Qual in Health Care. 2007;19(2):60-67.6. Doshania A, Pitchforthb E, Maynea CJ, Tincello DG. Culturally sensitive continence care: A qualitative study among south asian indian women in leicester. Fam Prac. 2007;24:585-593.7. Ebden P, Bhatt A, Carey OJ, Harrison B. The bilingual consultation. The Lancet. 1988:347.8. Flores G. The impact of medical interpreter services on the quality of health care: A systematic review. Med Care Res Rev. 2005;62(3):255-299.9. Flores G, Abreu M, Barone CP, Bachur R, Lin H. Errors of medical interpretation and their potential clinical consequences: A comparison of professional versus ad hoc versus no interpreters. Annals of Emergency Medicine. 2012;60(5):545-553.10. Flores G, Laws MB, Mayo SJ, et al. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics. 2003;111(1):6-14.11. Gerrish K, Chau R, Sobowale A, Birks E. Bridging the language barrier: The use of interpreters in primary care nursing. Health and Social Care in the Community. 2004;12(5):407-413.12. John-Baptiste A, Naglie G, Tomlinson G, et al. The effect of english language proficiency on length of stay and in-hospital mortality. J Gen Intern Med. 2004;19:221-228.13. Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited english proficiency? A systematic review of the literature. Health Services Research. 2007;42(2):727-754.14. Lawton J, Ahmad N, Hanna L, Douglas M, Hallowell N. Diabetes service provision: A qualitative study of the experiences and views of pakistani and indian patients with type 2 diabetes. Diabetic Medicine. 2006;23:1003-1007.15. Lee TS, Lansbury G, Sullivan G. Health care interpreters: A physiotherapy perspective. Aust J of Physiotherapy. 2005;51:161-165.16. Morales LS, Cunningham WE, Brown JA, Liu H, Hays RD. Are latinos less satisfied with communication by health care providers? J Gen Intern Med. 1999(14):409-417.17. Ngo-Metzer Q, Massagli MP, Clarridge BR, et al. Linguistic and cultural barriers to care: Perspectives of chinese and vietnamese immigrants. J Gen Intern Med. 2003;18:44-52.18. Pérez-Stable EJ, Nápoles-Springer A, Miramontes JM. The effects of ethnicity and language on medical outcomes of patients withHypertension or diabetes. Medical Care. 1997;35(12):1212-1219.19. Ramirez D, Engel KG, Tang TS. Language interpreter utilization in the emergency department setting: A clinical review. J of Health Care for the Poor and Underserved. 2008;19:352-362.20. Regenstein M, Andres E, Wynia MK. Appropriate use of non-english-language skills in clinical care. JAMA. 2013;309(2):145-146.21. Summers C, Gonzalez E, Pechak C. How should we prepare rehabilitation sciences students to work with low english-proficient spanish-speaking patients? J of Allied Health. 2015;44(2):17-21.22. Wilson E, Chen AH, Grumbach K, Wang F, Hernandez A. Effects of limited english proficiency and physician language on health care comprehension. J Gen Intern Med. 2005;20:800-806.23. Woloshin S, Schwartz LM, Katz SJ, Welch HG. Is language a barrier to preventive services? J Gen Intern Med. 1997;12:472-477.