Dental School Patients with Limited English Proficiency: The California Experience

Abstract

California is home to one-third of the U.S. population with limited English proficiency (LEP). Studies indicate that treating LEP patients without professional interpreters can result in miscommunication, decreased patient satisfaction, and serious medical errors. To address this problem, federal laws require all health care institutions receiving federal monies to provide interpretation services to their LEP patients at no cost to the patient. In this study we surveyed 122 students and fifty-six faculty members from the five California dental schools with respect to number, communication strategies, impact on education and clinic finances, and student and faculty perceptions regarding serving LEP patients in their clinics. Over 50 percent of students surveyed spoke a foreign language either fluently or moderately fluently. Students reported that about 10 percent of their patients required interpreters, that untrained interpreters (e.g., family, friends, bilingual students) worked adequately, but that LEP patients were more difficult to treat. To comply with federal laws, dental schools are confronted with the challenge of covering the cost of providing language services to LEP patients.

Access to Interpreter Services at U.S. Dental School Clinics

“…Beyond formal curricula, the majority of respondents (84.8%) in our study indicated that their students had access to formal interpreter services to communicate with their LEP patients while in clinic. This finding is in contrast to a 2009 survey of California dental schools, in which only ad hoc interpreters were reported to be in use 15 *. Use of interpreters improves LEP patients’ satisfaction with their care and their health outcomes, although this practice has not been studied in the dental setting 5 * , 35 *.…”

“…The respondents to our survey estimated that the percentage of LEP patients seen in their dental school clinics was 22.4%, suggesting this level may be nearly three times the national average. The demographics of patients seen at dental school clinics have not been well described in the literature, but a survey of California dental students found that 10–20% of their patients required an interpreter 14 * , 15 *. Given these high rates of LEP patients, curricular competencies pertaining to these populations are critical for appropriate patient care.…”

“…While these Policy Guidelines emphasized the legal obligation of federally funded institutions to provide equal access to LEP individuals, no specific legal guidelines exist; indeed, the most recent Policy Guidelines acknowledge that smaller institutions may have different accommodations for LEP individuals than larger institutions 6 *. Moreover, only 12 states and the District of Columbia provide reimbursement through Medicaid for interpreter services 15 *. It is perhaps unsurprising given these inconsistencies that one‐third of North Carolina safety net dental providers were not aware of the legal mandate to provide access to LEP patients 8 *…”

Training to Care for Limited English Proficient Patients and Provision of Interpreter Services at U.S. Dental School Clinics

“…Dental school clinics are a distinctive health care setting in which patients receive affordable dental services from students supervised by licensed dentists. These clinics often attract a greater proportion of patients from underserved populations, including patients with LEP 17 . Trainees who have experience caring for the underserved while in dental school have been found to be more likely to express interest in doing so when they enter practice 18 , 19 .…”

Characteristics of Patients Discontinuing Care

“…This suggests that changes in the current DSC environment or the process of obtaining care at a DSC may make dental care in this setting more accessible for these groups. The Harvard School of Dental Medicine has no formal interpreter services available for LEP patients, and this situation is consistent with the presence of less-than-ideal interpretation practices previously documented to occur in many DSCs in the US [25,33]. Patient satisfaction has been shown to be higher when professional interpreter services are made available, with satisfaction equally high when telephone interpreter services are used as when in-person interpreters are present [34].…”