A Systematic Review of the Impact of Patient–Physician Non-English Language Concordance on Quality of Care and Outcomes

Diamond, Lisa; Izquierdo, Karen; Canfield, Dana R.; Matsoukas, Konstantina; Gany, Francesca

doi:10.1007/s11606-019-04847-5

Cited by 329 publications

(221 citation statements)

References 51 publications

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“…A multitude of factors contribute to health inequity amongst ethnic minority populations including limited social support, lower health literacy, lower socioeconomic status, greater incidence of ill health and a sense of disempowerment [1][2][3][4]. Access to care and language barriers have been the predominant focus of research, with evidence of failure to provide qualified interpreting services to people with limited English proficiency (LEP) as a key contributor to poor care outcomes [5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

The safety of health care for ethnic minority patients: a systematic review

Chauhan

Walton

Manias

et al. 2020

Int J Equity Health

153

157

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Introduction: Evidence to date indicates that patients from ethnic minority backgrounds may experience disparity in the quality and safety of health care they receive due to a range of socio-cultural factors. Although heightened risk of patient safety events is of key concern, there is a dearth of evidence regarding the nature and rate of patient safety events occurring amongst ethnic minority consumers, which is critical for the development of relevant intervention approaches to enhance the safety of their care. Objectives: To establish how ethnic minority populations are conceptualised in the international literature, and the implications of this in shaping of our findings; the evidence of patient safety events arising among ethnic minority healthcare consumers internationally; and the individual, service and system factors that contribute to unsafe care. Method: A systematic review of five databases (MEDLINE, PUBMED, PsycINFO, EMBASE and CINAHL) were undertaken using subject headings (MeSH) and keywords to identify studies relevant to our objectives. Inclusion criteria were applied independently by two researchers. A narrative synthesis was undertaken due to heterogeneity of the study designs of included studies followed by a study appraisal process. Results: Forty-five studies were included in this review. Findings indicate that: (1) those from ethnic minority backgrounds were conceptualised variably; (2) people from ethnic minority backgrounds had higher rates of hospital acquired infections, complications, adverse drug events and dosing errors when compared to the wider population; and (3) factors including language proficiency, beliefs about illness and treatment, formal and informal interpreter use, consumer engagement, and interactions with health professionals contributed to increased risk of safety events amongst these populations. Conclusion: Ethnic minority consumers may experience inequity in the safety of care and be at higher risk of patient safety events. Health services and systems must consider the individual, inter-and intra-ethnic variations in the nature of safety events to understand the where and how to invest resource to enhance equity in the safety of care. Review registration: This systematic review is registered with Research Registry: reviewregistry761.

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Section: Introductionmentioning

confidence: 99%

The safety of health care for ethnic minority patients: a systematic review

Chauhan

Walton

Manias

et al. 2020

Int J Equity Health

153

157

View full text Add to dashboard Cite

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“…Health disparities and poor health outcomes among immigrant populations are associated with limited English proficiency and discordant languages between providers and immigrant patients [17][18][19], racism and lack of cultural diversity among providers [20], poor health literacy correlated to poverty [18], lack of insurance coverage [20,21], and citizenship status [18,21]. Barriers to health care and lack of access to preventive health services have been described for immigrant populations, but few studies have investigated barriers to receiving travel medicine services and prevention of malaria among VFRs.…”

Section: Introductionmentioning

confidence: 99%

Barriers to malaria prevention among immigrant travelers in the United States who visit friends and relatives in sub-Saharan Africa: A cross-sectional, multi-setting survey of knowledge, attitudes, and practices

et al. 2020

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Background Despite achievements in the reduction of malaria globally, imported malaria cases to the United States by returning international travelers continue to increase. Immigrants to the United States from sub-Saharan Africa (SSA) who then travel back to their homelands to visit friends and relatives (VFRs) experience a disproportionate burden of malaria illness. Various studies have explored barriers to malaria prevention among VFRs and non-VFRstravelers to the same destinations with other purpose for travel-but few employed robust epidemiologic study designs or performed comparative analyses of these two groups. To better quantify the key barriers that VFRs face to implement effective malaria prevention measures, we conducted a comprehensive community-based, cross-sectional, survey to identify differences in malaria prevention knowledge, attitudes, and practices (KAP) among VFRs and others traveling to Africa and describe the differences between VFRs and other types of international travelers. Methods and findings Three distinct populations of travelers with past or planned travel to malaria-endemic countries of SSA were surveyed: VFRs diagnosed with malaria as reported through a state health

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“…Language-discordant care, in which providers and patients are not proficient in a common language, leads to adverse health outcomes, such as physical harm, obstetric trauma, medication errors, communication barriers, minimal health education, and limited medical comprehension [ 4 – 9 ]. Conversely, language-concordant care has been associated with improved patient satisfaction, access and utilization of care, patient understanding of medical conditions, and objective clinical metrics (such as improved hemoglobin A1C levels) [ 10 ]. In addition, language-concordant care strengthens the therapeutic alliance between the physician and patient, as patients who perceive similarities with their providers are more likely to trust and adhere to recommended therapies [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Professional language use by alumni of the Harvard Medical School Medical Language Program

et al. 2020

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Background Despite the growing number of patients with limited English proficiency in the United States, not all medical schools offer medical language courses to train future physicians in practicing language-concordant care. Little is known about the long-term use of non-English languages among physicians who took language courses in medical school. We conducted a cross-sectional study to characterize the professional language use of Harvard Medical School (HMS) alumni who took a medical language course at HMS and identify opportunities to improve the HMS Medical Language Program. Methods Between October and November 2019, we sent an electronic survey to 803 HMS alumni who took a medical language course at HMS between 1991 and 2019 and collected responses. The survey had questions about the language courses and language use in the professional setting. We analyzed the data using descriptive statistics and McNemar’s test for comparing proportions with paired data. The study was determined not to constitute human subjects research. Results The response rate was 26% (206/803). More than half of respondents (n = 118, 57%) cited their desire to use the language in their future careers as the motivation for taking the language courses. Twenty-eight (14%) respondents indicated a change from not proficient before taking the course to proficient at the time of survey whereas only one (0.5%) respondent changed from proficient to not proficient (McNemar’s p-value < 0.0001). Respondents (n = 113, 56%) reported that clinical electives abroad influenced their cultural understanding of the local in-country population and their language proficiency. Only 13% (n = 27) of respondents have worked in a setting that required formal assessments of non-English language proficiency. Conclusions HMS alumni of the Medical Language Program reported improved language proficiency after the medical language courses’ conclusion, suggesting that the courses may catalyze long-term language learning. We found that a majority of respondents reported that the medical language courses influenced their desire to work with individuals who spoke the language of the courses they took. Medical language courses may equip physicians to practice language-concordant care in their careers.

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A Systematic Review of the Impact of Patient–Physician Non-English Language Concordance on Quality of Care and Outcomes

Cited by 329 publications

References 51 publications

The safety of health care for ethnic minority patients: a systematic review

The safety of health care for ethnic minority patients: a systematic review

Barriers to malaria prevention among immigrant travelers in the United States who visit friends and relatives in sub-Saharan Africa: A cross-sectional, multi-setting survey of knowledge, attitudes, and practices

Professional language use by alumni of the Harvard Medical School Medical Language Program

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