Impact of Language Barriers on Quality of Care and Patient Safety for Official Language Minority Francophones in Canada

Moissac, Danielle de; Bowen, Sarah

doi:10.1177/2374373518769008

Cited by 173 publications

(121 citation statements)

References 43 publications

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“…However in Nepal, this is impaired by short consultation times and limited skills of practitioners in behavioural management. These barriers were identified in the previous studies from Nepal and other settings38–41 and could negatively affect the patient’s ability to communicate and to understand the information effectively, resulting in poor patient’s engagement in self-management 42–45. Similarly, there was inadequate motivational support from the provider side to encourage patients in shared decision-making, health-related behaviours and self-management.…”

Section: Discussionmentioning

confidence: 99%

Facilitators and barriers to the self-management of COPD: a qualitative study from rural Nepal

et al. 2020

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ObjectiveTo understand the facilitators and barriers to the self-management of chronic obstructive pulmonary disease (COPD) in rural Nepal.SettingsCommunity and primary care centres in rural Nepal.ParticipantsA total of 14 participants (10 people with COPD and 4 health care providers) were interviewed.Primary and secondary outcome measure(s)People with COPD and healthcare provider’s experience of COPD self-management in rural Nepal.ResultsFacilitators and barriers affecting COPD self-management in Nepal operated at the patient-family, community and service provider levels. People with COPD were found to have a limited understanding of COPD and medications. Some participants reported receiving inadequate family support and described poor emotional health. At the community level, widespread use of complementary and alternative treatment was found to be driven by social networks and was used instead of western medicine. There were limited quality controls in place to monitor the safe use of alternative treatment. While a number of service level factors were identified by all participants, the pertinent concerns were the levels of trust and respect between doctors and their patients. Service level factors included patients’ demands for doctor time and attention, limited confidence of people with COPD in communicating confidently and openly with their doctor, limited skills and expertise of the doctors in promoting behavioural change, frustration with doctors prescribing too many medicines and the length of time to diagnose the disease. These service level factors were underpinned by resource constraints operating in rural areas. These included inadequate infrastructure and resources, limited skills of primary level providers and lack of educational materials for COPD.ConclusionsThe study findings suggest the need for a more integrated model of care with multiple strategies targeting all three levels in order to improve the self-management practices among people with COPD.

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Section: Discussionmentioning

confidence: 99%

Facilitators and barriers to the self-management of COPD: a qualitative study from rural Nepal

et al. 2020

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“…Communication barriers can be exacerbated by language discordance [13], which occurs when a patient and their provider lack proficiency in a shared language. Language discordance can negatively impact access to healthcare services, quality of healthcare services, and patient outcomes [14,15]. Previous studies have shown that residents who live in minority language situations face barriers when accessing healthcare services [16,17], have longer emergency department visits and hospitals stays [18,19], have higher rates of hospital admissions and re-admissions [20][21][22], and experience more harmful events in hospitals [23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

The impact of dementia and language on hospitalizations: a retrospective cohort of long-term care residents

et al. 2020

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Background Hospitalizations carry considerable risks for frail, elderly patients; this is especially true for patients with dementia, who are more likely to experience delirium, falls, functional decline, iatrogenic complications, and infections when compared to their peers without dementia. Since up to two thirds of patients in long-term care (LTC) facilities have dementia, there is interest in identifying factors associated with transitions from LTC facilities to hospitals. The purpose of this study was to investigate the association between dementia status and incidence of hospitalization among residents in LTC facilities in Ontario, Canada, and to determine whether this association is modified by linguistic factors. Methods We used linked administrative databases to establish a prevalent cohort of 81,188 residents in 628 LTC facilities from April 1st 2014 to March 31, 2017. Diagnoses of dementia were identified with a previously validated algorithm; all other patient characteristics were obtained from in-person assessments. Residents’ primary language was coded as English or French; facility language (English or French) was determined using language designation status according to the French Language Services Act. We identified all hospitalizations within 3 months of the first assessment performed after April 1st 2014. We performed multivariate logistic regression analyses to determine the impact of dementia and resident language on the incidence of hospitalization; we also considered interactions between dementia and both resident language and resident-facility language discordance. Results The odds of hospitalization were 39% lower for residents with dementia compared to residents without dementia (OR 0.61, 95% CI 0.57–0.65). Francophones had lower odds of hospitalization than Anglophones, but this difference was not statistically significant (OR 0.91, 95% CI 0.81–1.03). However, Francophones without dementia were significantly less likely to be hospitalized compared to Anglophones without dementia (OR 0.71, 95% CI 0.53–0.94). Resident-facility language discordance did not significantly affect hospitalizations. Conclusions Residents in LTC facilities were generally less likely to be hospitalized if they had dementia, or if their primary language was French and they did not have dementia. These findings could be explained by differences in end-of-life care goals; however, they could also be the result of poor patient-provider communication.

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“…There is some precedent for an association between patient language and patient harm: Patients with limited English proficiency may experience more severe adverse events than patients whose primary language is English, and the errors experienced by non-English speaking patients are more likely to be attributed to communication failure. 30,31 We speculate that non-English-language-speaking patients may experience challenges related to catheter maintenance practices that English-speaking patients (and their families) do not experience. For example, nursing discussions with patients and families about the importance of daily chlorhexidine bathing, or the need to keep soft limb restraints in place to ensure a patient does not inadvertently dislodge or disconnect a catheter, may be more difficult if the team is having to wait on the arrival of an interpreter or may be truncated if conducted via interpreter telephone service.…”

Section: Discussionmentioning

confidence: 98%

Novel risk factors for central-line associated bloodstream infections in critically ill children

Woods-Hill

Srinivasan

Schriver

et al. 2019

Infect. Control Hosp. Epidemiol.

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Objective:Central-line–associated bloodstream infections (CLABSI) cause morbidity and mortality in critically ill children. We examined novel and/or modifiable risk factors for CLABSI to identify new potential targets for infection prevention strategies.Methods:This single-center retrospective matched case-control study of pediatric intensive care unit (PICU) patients was conducted in a 60-bed PICU from April 1, 2013, to December 31, 2017. Case patients were in the PICU, had a central venous catheter (CVC), and developed a CLABSI. Control patients were in the PICU for ≥2 days, had a CVC for ≥3 days, and did not develop a CLABSI. Cases and controls were matched 1:4 on age, number of complex chronic conditions, and hospital length of stay.Results:Overall, 72 CLABSIs were matched to 281 controls. Univariate analysis revealed 14 risk factors, and 4 remained significant in multivariable analysis: total number of central line accesses in the 3 days preceding CLABSI (80+ accesses: OR, 4.8; P = .01), acute behavioral health needs (OR, 3.2; P = .02), CVC duration >7 days (8–14 days: OR, 4.2; P = .01; 15–29 days: OR, 9.8; P < .01; 30–59 days: OR, 17.3; P < .01; 60–89 days: OR, 39.8; P < .01; 90+ days: OR, 4.9; P = .01), and hematologic/immunologic disease (OR, 1.5; P = .05).Conclusions:Novel risk factors for CLABSI in PICU patients include acute behavioral health needs and >80 CVC accesses in the 3 days before CLABSI. Interventions focused on these factors may reduce CLABSIs in this high-risk population.

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Impact of Language Barriers on Quality of Care and Patient Safety for Official Language Minority Francophones in Canada

Cited by 173 publications

References 43 publications

Facilitators and barriers to the self-management of COPD: a qualitative study from rural Nepal

Facilitators and barriers to the self-management of COPD: a qualitative study from rural Nepal

The impact of dementia and language on hospitalizations: a retrospective cohort of long-term care residents

Novel risk factors for central-line associated bloodstream infections in critically ill children

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