The impact of limited English proficiency and physician language concordance on reports of clinical interactions among patients with diabetes: The DISTANCE study

doi:10.1016/j.pec.2010.02.005

Patient Education and Counseling

Volume 81, Issue 2, November 2010, Pages 222-228

https://doi.org/10.1016/j.pec.2010.02.005 Get rights and content

Abstract

Objective

To assess the association of limited English proficiency (LEP) and physician language concordance with patient reports of clinical interactions.

Methods

Cross-sectional survey of 8638 Kaiser Permanente Northern California patients with diabetes. Patient responses were used to define English proficiency and physician language concordance. Quality of clinical interactions was based on 5 questions drawn from validated scales on communication, 2 on trust, and 3 on discrimination.

Results

Respondents included 8116 English-proficient and 522 LEP patients. Among LEP patients, 210 were language concordant and 153 were language discordant. In fully adjusted models, LEP patients were more likely than English-proficient patients to report suboptimal interactions on 3 out of 10 outcomes, including 1 communication and 2 discrimination items. In separate analyses, LEP-discordant patients were more likely than English-proficient patients to report suboptimal clinician–patient interactions on 7 out of 10 outcomes, including 2 communication, 2 trust, and 3 discrimination items. In contrast, LEP-concordant patients reported similar interactions to English-proficient patients.

Conclusions

Reports of suboptimal interactions among patients with LEP were more common among those with language-discordant physicians.

Practice implications

Expanding access to language concordant physicians may improve clinical interactions among patients with LEP. Quality and performance assessments should consider physician–patient language concordance.

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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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

Abstract

Objective

Methods

Results

Conclusions

Practice implications

Section snippets

Background

Subjects and setting

Results

Discussion

Acknowledgements

Patient Educ Couns

Patient Educ Couns

Soc Sci Med

J Affect Disord

Patient Educ Couns

Am J Med

Crossing the quality chasm: a new health system for the 21st century

Patients’ preferences for technical versus interpersonal quality when selecting a primary care physician

Health Serv Res

Impoverished diabetic patients whose doctors facilitate their participation in medical decision making are more satisfied with their care

J Gen Intern Med

The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management

J Gen Intern Med

Dimensions of patient-provider communication and diabetes self-care in an ethnically diverse population

J Gen Intern Med

The effects of perceived discrimination on diabetes management

J Health Care Poor Underserved

The role of patient–physician trust in moderating medication nonadherence due to cost pressures

Arch Intern Med

The association of patient trust and self-care among patients with diabetes mellitus

BMC Fam Pract

Closing the loop: physician communication with diabetic patients who have low health literacy

Arch Intern Med

Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes

J Gen Intern Med

CAHPS: assessing healthcare quality from the patient's perspective

Navigating language barriers under difficult circumstances

Ann Intern Med

Are Latinos less satisfied with communication by health care providers?

J Gen Intern Med

Impact of language barriers on patient satisfaction in an emergency department

J Gen Intern Med

Effects of limited English proficiency and physician language on health care comprehension

J Gen Intern Med

Use and effectiveness of interpreters in an emergency department

J Amer Med Assoc

Effect of language barriers on follow-up appointments after an emergency department visit

J Gen Intern Med

Patient Perception, Preference and Participation
The impact of limited English proficiency and physician language concordance on reports of clinical interactions among patients with diabetes: The DISTANCE study