Patient Perception, Preference and ParticipationThe impact of limited English proficiency and physician language concordance on reports of clinical interactions among patients with diabetes: The DISTANCE study
Section snippets
Background
Providing care that is both responsive to and respectful of patient preferences and cultural values is recognized by the Institute of Medicine as a core component of healthcare quality and an area in which improvements are needed [1]. Interpersonal aspects of the medical encounter predict patient satisfaction [2], [3] and have been associated with adherence and self-management [4], [5], [6], [7], [8], [9] and improved clinical outcomes [10], [11], [12] among patients with chronic diseases.
Subjects and setting
The Diabetes Study of Northern California (DISTANCE) is a survey follow-up cohort study designed to assess the association of a wide range of social and behavioral factors with disparities in healthcare processes and outcomes for patients with diabetes. Study recruitment procedures have been published previously [28]. Briefly, study subjects were members of Kaiser Permanente Northern California (KPNC), a large not-for-profit health plan serving over 3 million members in Northern California.
Results
Our study sample included 8638 patients cared for by 1333 primary care physicians from 48 facilities. Of these patients, 8116 were English-proficient and 522 reported limited English proficiency. Seventy percent (N = 363) of the patients with limited English proficiency answered the question on physician language skills. Of these, 210 had a language concordant physician (LEP-concordant) and 153 did not have a language concordant physician (LEP-discordant). LEP-concordant patients were cared for
Discussion
We found that limited English proficiency was independently associated with reports of suboptimal clinician–patient interactions among patients with diabetes receiving uniform access to care at healthcare facilities offering several forms of interpreter services. However, reports of suboptimal communication, trust, and perceived healthcare system discrimination among patients with LEP differed significantly by physicians’ language concordance and were more common among those with
Acknowledgements
Funds for the DISTANCE Study were provided by National Institute of Diabetes, Digestive and Kidney Diseases [R01 DK65664] and National Institute of Child Health and Human Development [R01 HD046113].
Dr. Schenker was supported by the General Internal Medicine Fellowship at UCSF, funded by the Department of Health and Human Services, Health Resources and Services Administration (DHHS HRSA D55HP05165).
Dr. Schillinger was supported by a grant from the NIH (UL1 RR02413).
Dr. Karter, Warton MPH, Moffet
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