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Language Barriers in Healthcare

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on 3 December 2013

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Transcript of Language Barriers in Healthcare

Overcoming Language Barriers in Healthcare
By: Prestige Worldwide

Statistics and History
The Consequences
Medical errors
Patients less frequently access preventive and primary care services
Incorrect medical instructions
Increased risk to nonadherence to medication
Increased confusion about medication
Unnecessary surgeries are performed
Patients are less likely to return for follow up appointments
Patients are less likely to receive lifestyle counseling such as exercise, smoking, and diet
An average of
47 million
U.S citizens reported english was not their primary Language
Nearly
21 million
reported speaking English less than "very well"
3.5 million
U.S school children are LEP (limited in English proficiency)
The number of LEP citizens
increased 14%
from 31.8 million in 1980 to 47 million in 2000
A study shows no interpreter was used during
46%
of emergency department cases involving LEP patients
Only
23%
of teaching hospitals train physicians how to work with an interpreter
Gemma's first hand experience
A Growing Concern...
Laws and Mandates
Title VI of the Civil Rights Act of 1964
Facilities receiving Medicaid or Medicare must provide interpretation assistance
The Joint Commission
Consent Forms
A depressed young woman was incarcerated in a psychiatric hospital because her doctors erroneously assumed that her unknown language was a symptom of psychosis.

After decades of confinement, she was finally identified as an immigrant who spoke only Ukrainian and who became distraught after her husband and child died.

She was released and sent to a nursing home.
Current Solution Attempts
The solution: Professional Medical Interpreters
A federally funded and regulated intensive training program for medical interpreters

An in-depth certification process at the end of training

Pinpoint the areas that have a dense population of LEP patients and strategically insert the professional medical interpreters into the local hospitals and doctors offices

Though rates change between institutions Studies show that the cost of outpatient interpreter services averaged $279 per LEP patient per year

Cost of inpatient interpreter services accounted for only 1.5% of the total cost of patient care

Potential savings in things such as fewer ordered tests, and treatments in offices rather than emergency departments
According to the U.S. Census Bureau, Hispanics will make up
30%
of the nation's population in 2050

In 2008, the American Medical Association reported that only
5%
of the nation's physicians were of Hispanic origin

Bilingual Doctors
Ad-Hoc Interpreters
The amount of LEP patients in the U.S is rapidly growing, and the amount of bilingual doctors entering into the medical field remains the same
Providers should be compensated for this service
Still may not accurately translating medical terms and medications clearly
Not connecting on a cultural level
More stress on doctors
Prevents staff from completing other duties, or adds to their tasks at hand
Telephone Interpreters and Other Last Resort Solutions
Importance of the Spanish Language in the U.S.
Moral theories regarding our final solution
Utilitarianism
Deontologism
Figures and Video
Includes bilingual hospital or clinic staff, and patients family or friend
Some hospitals have gone as far as using strangers found in the waiting room or taxi cab drivers in the street
Lack training in interpretation
Unfamiliar with medical terminology
More likely to result in errors of interpretation which can lead to adverse medical consequences
Creates conflict when dealing with privacy
Gives physicians and nurses the ability to access interpreters for nearly 200 languages 24 hours of the day.
Proved to be helpful during interpretations but not reliable when medical evaluations need to be decided promptly.
Unable to physically evaluate the patients mannerisms
Actual Case Resulting in Adverse Clinical Treatment
Jacobs 2004
US Census Bureau;The Joint Commission
U.S Dept of Justice; Hunt 2007
US Dept of Health and Human Services
Hunt 2007; Flores 2005
Divi 2009; Kuo 1999
Kuo 1999
Jacobs 2004; Jacobs 2007
Citations
• Carrasquillo , O., Brennan, T. A., & Burstin, H. R. (1999). Impact of language barriers on patient satisfaction in an emergency department. Journal of General Internal Medicine, 14(2), 82-87. doi: 10.1046/j.1525-1497.1999.00293.x
• Divi, C., Koss, R. G., Schmaltz, S. P., & Loeb, J. M. (2001). Language proficiency and adverse events in us hospitals: A pilot study. International Journal for Quality Healthcare, 19(2), 60-67. doi: 10.1093/intqhc/mzl069
• Flores, G. (2006). Language barriers to health care in the united states. The New England Journal of Medicine, 355, 229-231. doi: 10.1056/NEJMp058316
• Jacobs, E., Shepard, S.D,. Suaya, A.J,. & Stone, E. (2004) Overcoming language barriers in health care: Costs and benefits of interpreter services. American Journal of Public Health, 94(5), 866-869. doi:10.2105/AJPH.94.5.866
• Jones, D. (1998). Breaking down language barriers. BMJ: British Medical Journal, 316(7143), 1476-1480. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113154/
• U.S. Department of Health & Human Services , (2012).Improving patient safety systems for patients with limited english proficency. Retrieved from Agency for Healthcare Research and Quality website: http://www.ahrq.gov/professionals/systems/hospital/lepguide/lepguide1.html
• Doyle, K. (2013, july 10). Pediatricians still rely on family members to communicate with patients who dont speak english well. Retrieved from http://medcitynews.com/2013/07/pediatricians-still-relying-on-family-members-to-communicate-with-patients-who-dont-speak-english-well/
• Margolis, E. (2013). Do you have to be bilingual to be a doctor?. Retrieved from http://work.chron.com/bilingual-doctor-10613.html
• Hunt LM, de Voogd KB. Are Good Intentions Enough?: Informed Consent Without Trained Interpreters. J Gen Intern Med. 2007;22:598-605
• Kuo D, Fagan MJ. Satisfaction with Methods of Spanish Interpretation in an Ambulatory Care Clinic. J Gen Intern Med. 1999;14:547-550.
• Jacobs EA, Sadowski LS, Rathouz PJ. The Impact of an Enhanced Interpreter Service Intervention on Hospital Costs and Patient Satisfaction. J Gen Intern Med. 2007;22(Suppl 2):306-311
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