Comparison of Access to Primary Care Medical and Dental Appointments Between Simulated Patients Who Were Deaf and Patients Who Could Hear

Abstract

IMPORTANCE Primary medical and dental clinics may accept fewer people who are deaf as patients than persons who can hear, and clinics may deny requests by patients who are deaf for American Sign Language (ASL) interpretation at appointments when necessary, creating diminished access to primary medical and dental care. OBJECTIVE To compare the rate at which patients who are deaf are offered primary care medical or dental appointments with the rate at which appointments are offered to patients who can hear in a real-world context. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study used a simulated patient (SP) call audit method. Simulated patients (4 who could hear and 4 who were deaf) followed a call script in which an adult sought to establish care, requesting new patient appointments from a statewide stratified random sample of clinicians listed in the Idaho Medical and Dental Associations member databases at 445 clinics (334 primary care and 111 general dentistry) throughout Idaho. Simulated patients who were deaf also requested interpreting services at the appointment. Calls were made between June 7 and December 6, 2018. Data analysis was conducted from December 2019 to April 2020. EXPOSURES Simulated patients who were deaf or could hear called primary care medical or dental clinics from the sampling frame and requested an appointment, supplying the same basic information. In addition, SPs who were deaf requested that an ASL interpreter be provided by the clinic for the appointment. MAIN OUTCOMES AND MEASURESRates of new appointments offered and, for SPs who were deaf, whether ASL interpreter services were confirmed for the appointment.RESULTS Two male and 2 female SPs who could hear were successful on 210 occasions (64.4%) when requesting a new patient appointment compared with 2 male and 2 female SPs who were deaf who were successful on 161 occasions (49.1%) (P < .001). Simulated patients who could hear were nearly 2 times more likely to secure appointments than were SPs who were deaf (adjusted odds ratio, 1.88; 95% CI, 1.27-2.79). For SPs who were deaf, 80 unsuccessful appointment requests (48.2%) were associated with a request for interpretation. CONCLUSIONS AND RELEVANCEThe findings suggest that in a statewide representative sample, access to primary medical and dental care for patients who are deaf is significantly reduced. Patients who are deaf may not receive an appointment if they request interpreter services, even when such services are required to provide effective communication.

Unmet Dental Needs Among Mid-to-Older Deaf and Hard of Hearing Women in the U.S.

“…A well-designed study conducted by Schneidewind et al, [ 15 ] simulated DHH patients who needed new appointments in health and dental offices. This study found that, compared to medical offices, dental offices were far more likely to deny appointment requests from new DHH patients because they needed an interpreter to communicate with the dentist, despite the existence of the federal law that requires effective communication in medical and dental offices.…”

“…It is not surprising that a subset of DHH ASL users with lower education are at higher risk for unmet dental care. Communication breakdowns between the patient and provider risk misdiagnosis and misconceptions regarding a DHH patient's health if accessible communication services are not readily available [ 15 ]. Given the link between communication health and unmet dental needs in our study, dental health professionals and advocates must work together to address the systemic gaps in dental health care and identify strategies to prevent communication barriers that may be associated with missed diagnoses and delayed oral treatments.…”

Increasing inclusivity in precision medicine research: Views of deaf and hard of hearing individuals

“…10 For instance, a study found that Deaf men feel less engaged in decision-making regarding prostate-specific antigen screening, 11 and a simulated, cross-sectional audit study found that access of Deaf patients to primary medical and dental care is significantly reduced compared with hearing patients. 12 Another complexity is possible disagreement over the conceptualization of deafness as a disability. In contrast to the medical perspective that views being deaf as a deficit that requires treatment, members of the Deaf community view their condition as a matter of identity and pride.…”

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