Disparities in the Use of Internet and Telephone Medication Refills among Linguistically Diverse Patients

Abstract

BACKGROUND: Health systems are increasingly implementing remote telephone and Internet refill systems to enhance patient access to medication refills. Remote refill systems may provide an effective approach for improving medication non-adherence, but more research is needed among patients with limited English proficiency with poor access to remote refill systems. OBJECTIVE: To compare the use of remote medication refill systems among limited-English-proficiency (LEP) and English-proficient (EP) patients with chronic conditions. METHODS: Cross-sectional survey in six languages/ dialects (English, Cantonese, Mandarin, Korean, Vietnamese, and Spanish) of 509 adults with diabetes, hypertension, or hyperlipidemia. Primary study outcomes were self-reported use of 1) Internet refills, 2) telephone refills, and 3) any remote refill system. LEP was measured by patient self-identification of a primary language other than English and a claims record of use of an interpreter. Other measures were age, gender, education, years in the U.S., insurance, health status, chronic conditions, and number of prescribed medications. Analyses included multivariable logistic regression weighted for survey non-response. RESULTS: Overall, 33.1 % of patients refilled their medications by telephone and 31.6 % by Internet. Among LEP patients (n=328), 31.5 % refilled by telephone and 21.2 % by Internet, compared with 36.7 % by telephone and 52.7 % by Internet among EP patients (n=181). Internet refill by language groups were as follows: English (52.7 %), Cantonese (34.9 %), Mandarin (17.4 %), Korean (16.7 %), Vietnamese (24.4 %), and Spanish (12.6 %). Compared to EP patients, LEP patients had lower use of any remote refill system (adjusted odds ratio [AOR] 0.18; p<0.001), CONCLUSIONS: LEP patients are significantly less likely than EP patients to use any remote medication refill system. Increased reliance on current systems for remote medication refills may increase disparities in health outcomes affecting LEP patients with poor access to telephone and Internet medication refills.

A Digital Language Divide? The Relationship between Internet Medication Refills and Medication Adherence among Limited English Proficient (LEP) Patients

“…LEP patients were oversampled to attain representation by each language group, as reflected in the GHC. 6 …”

“…12–14 Prior research examined the relationship between English proficiency and use of Internet medication refill systems, and found that only 21% of LEP patients with chronic illness used the online service, compared to 53% of English proficient patients. 6 This discrepancy is not surprising, given that the majority of refill services through an online patient portal are exclusively delivered in English—but also because LEP patients are affected by many of the aforementioned sociodemographic factors that exacerbate the digital divide (lower education, lower income, foreign-born status, lower literacy levels and decreased access to technology). 6 …”

“…6 This discrepancy is not surprising, given that the majority of refill services through an online patient portal are exclusively delivered in English—but also because LEP patients are affected by many of the aforementioned sociodemographic factors that exacerbate the digital divide (lower education, lower income, foreign-born status, lower literacy levels and decreased access to technology). 6 …”

International Perspectives on General Internal Medicine

“…And despite the political rhetoric, the U.S. continues to be a destination for persons around the world, and these immigrants often experience significant health disparities. Moreno et al 3 compared the use of remote medication refill systems among patients with limited English proficiency. They found that while health plans were increasingly relying on remote medication refills, patients whose first language is not English (e.g.…”

Capsule Commentary on Moreno et al., Disparities in the Use of Internet and Telephone Medication Refills Among Linguistically Diverse Patients

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M oreno et al 1 examine the relationship between English proficiency and use of remote medication refill systems (that is, requesting to refill medications through automated phone or online systems rather than in person). They find that only 46 % of limited English proficient (LEP) patients with chronic illness use these services, compared to 83 % of English proficient patients.

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