Non-English-Speaking Patients Face Barriers to Health Care

MONDAY Nov. 19, 2007 -- Patients in the United States who speak little or no English are less likely to receive all recommended health care services than English-speaking patients, a new report finds.

Non-English speakers are also less likely to have received documentation that provides informed consent before they undergo invasive procedures, according to studies published in a special supplement of the Journal of General Internal Medicine.

Another study found that one in five hospital staff interpreters don't have competent bilingual skills.

It's estimated that about 20 million people (one in 15) in the United States speak and understand little or no English, according to background information in a news release about the special journal supplement.

In one study, researchers at the University of California, San Francisco, found that hospitalized patients who don't speak English are less likely to have signed consent forms in the their medical records.

The records of English-speaking patients were almost twice as likely (53 percent vs. 28 percent) as limited English proficiency (LEP) patients to contain all elements of informed consent.

The records of English-speaking patients were also more likely to contain a signed consent form in any language (85 percent vs. 70 percent) than the records of LEP patients. The findings suggest differences in practice, not just in documentation, the researchers said.

"Informed consent is a fundamental tenet of the U.S. health care system. While language barriers make obtaining informed consent more complex, it is still a legal and ethical requirement and is increasingly recognized as a key component of quality care and patient safety. Hospitals must work harder to break down the language barriers faced by LEP patients," lead researcher Dr. Yael Schenker said in a prepared statement.

Another study in the supplement found that Hispanics who don't speak English at home were much less likely (35 percent vs. 57 percent) to receive 10 recommended health care services than white, English-speaking patients.

"Clearly, language usage predicts the quality of clinical care that patients receive," lead researcher Dr. Eric M. Cheng of the VA Greater Los Angeles Healthcare System, said in a prepared statement. "While the reasons for this are being investigated, the consequences are unequivocally unacceptable. Expanding access to medical interpreters, as is currently required of hospitals that receive federal funding, in the outpatient setting will likely be an important component of interventions designed to improve the quality of health care in this population."

A third study examined the bilingual skills of "dual-role" health facility staff interpreters -- people whose primary responsibility is in another area but may also be pressed into service as medical interpreters for patients.

The researchers tested bilingual personnel -- administrative assistants, medical assistants and clinical staff -- for accuracy, comprehension, communication and medical terminology in both English and their second language. Two percent of them failed the competency test, and 21 percent had only a limited ability to read, write and speak both languages. The researchers also identified interpretation errors -- including omissions and word confusion -- that could negatively affect clinical outcomes and potentially cause medical errors.

"Having untested and untrained bilingual staff serving as medical interpreters presents a potential risk. Professional interpreter services increase physician-patient communication, safety and satisfaction," lead researcher Maria R. Moreno, of Sutter Health in Northern California, said in a prepared statement.

"With the absence of guidelines and a 'formal certification' process to demonstrate interpreter competence, many health care facilities across the country may not be providing the best possible care to all patients," she said.

More information

The U.S. Centers for Disease Control and Prevention has more about minority health.

Posted: November 2007


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