Understanding Medication Adherence in Patients with Limited English Proficiency

Introduction. Approximately 41.6% of the US population who speak a language other than English (20% over all) and have limited English proficiency (LEP) status.1 Health outcomes for patients with LEP status or who are language discordant (speak a different language than their clinicians) have been studied in several settings, including the hospital and outpatient, with results widely demonstrating that these patients have worse outcomes when a professional interpreter is not used consistently. 2,3 The aim of this study was to investigate the impact of preferred language and language discordance on medication adherence. Methods. Data were collected via review of pharmacy-acquired medication profiles for three primary language cohorts: Nepali, Spanish, and English. Total Days of Adherence, Adherence Ratio, and Maximum Days Non-adherent were calculated and compared between language groups. We examined these statistics for regular and long-acting insulin, metformin and ACE inhibitors, testing for differences between language groups and those who experienced greater vs less than the median value for language concordant clinical encounters. Results. The most adherent group over all (highest adherence-ratio) were the Nepali-speaking, but the results showed high variability across outcomes and medications. Conclusions. After adjustment and stratification for greater vs lesser language concordant patient visit experience, we found that language-spoken plays an important role in the clinical encounter, and that LEP patients could have improved outcomes in their adherence to medications by having providers who speak their language or use an interpreter.

Measuring quality and patient satisfaction in healthcare communication with foreign-language speakers

Healthcare services face increasing challenges to provide accessible care to an equally increasing diversity ofpatient populations. This is clearly reflected in the linguistic diversity ofpeople living in Switzerland and can be seen mostplainly in the country ’s public hospitals. After a literature review on language barriers in clinical services and the potential impact that interpreters can have in clinical outcomes, we describe how interpreters can be introduced in a primary care setting and how the quality of communication with foreign-language-speaking patients as well as their satisfaction with communication can be improved. Changes in the quality of inter - preter-mediated communication, as rated by the patients themselves, can be monitored and have a beneficial impact on the quality of care. This is important at a time of growing cultural and linguistic diversity in Switzerland and other countries, which requires healthcare systems to implement highquality professional interpreter services that ensure effective communication withforeign-language-speakingpatients.

Association of telemedicine use with disparities in cancer distress screening for patients with limited English proficiency.

147 Background: Distress has a significant impact on the quality of life for patients with cancer, however, implementation of such screening is variable. There is limited data in this area for patients who have limited English proficiency (LEP). Given data suggesting worsening disparities in medical care with telemedicine use, we evaluated the completion of distress screening and interpreter use for LEP patients with telemedicine. Methods: We analyzed assigned (complete and incomplete) questionnaires from 10/2019-3/2021 at Stanford Cancer Center (n = 181,105). We defined LEP as a patient electronic health record (EHR) demographic listing either a non-English preferred language or a request for an interpreter. We defined telemedicine as any video or phone visit. Data was analyzed with Fisher's test for differences. Given limitations in EHR data, we conducted a validation subset chart review for LEP patients in Thoracic and Gastrointestinal (GI) oncology which have the two highest % of LEP patients (n = 177 patients). The subset list was obtained for the above timeframe from the interpreter services group. We analyzed EHR notes from visit day for written mention of professional vs family interpreter use. Results: Overall, 14% of our cohort had LEP, highest prevalence in the Thoracic (21%) and GI groups (16%), with a total of 48 languages represented (Spanish, Mandarin & Vietnamese as the 3 most common). There was a significant difference in the English and Non-English groups in overall completion rates of the screening questionnaire (62% in English population vs 49% for LEP, p < 0.001). Completion rates for telemedicine vs. in person visits were overall higher for both English (78.9% vs. 55%, p < 0.001) and LEP (65.1% vs. 43.7%, p < 0.001) groups respectively. The overall screening completion rate for all visits was 57%, with a 62% completion rate with telemedicine and 51% completion with in-person visits (p = 0.2). In the LEP validation subset, there were 18 languages represented with the similar distribution as the larger cohort. Of all clinical notes reviewed, 48.8% included written mention of professional interpreter use, while 25.5% noted interpretation by a family member. There was no difference in professional interpreter use between visit types (̃50%), but with higher rate of family interpretation with telemedicine (35%) vs with in person visits (21%) (p = 0.04). Conclusions: Patients who have some level of limited English proficiency complete distress screening questionnaires less frequently compared to English speaking patients, which highlights the need to improve access to distress screening and supportive care. However, we found similar completion rates with in person vs telemedicine visits, with a signal for increased use of family members as interpreter with telemedicine. This warrants further analysis of the family role and patient understanding during these virtual visits.

Postulat usunięcia terminu obyczajność z Kodeksu karnego

In my article, I formulate and describe the demand to remove the term obyczajność (propriety) from the Penal Code. In the course of the analysis, I will attempt to prove that its presence in the Act is an example of cultivating a terminological tradition that dates back to the partitions period and was started for a reason that is currently out­dated – the general language was insufficient to describe sexual crimes. I also show that due to the discrepancy between the general and legal language, the use of the term obyczajność may mislead a non-professional interpreter of a legal text. The text con­cludes with a more precise description of the titular demand, i.e. a proposal to change the title of Chapter 25 of the Penal Code.

Competences of the interpreter

The article describes the practical skills of the interpreter. It reviews necessary professional skills essential for the interpreter. The author describes professional and innate abilities as vital when mastering and improving one’s skills of the simultaneous interpretation: mental alertness, long-term and operational memories, diaphragm breathing, and communication skills. The presentation plays a decisive role in the interpretation, in this regard, the author speaks about the problem of the working tool of the interpreter: voice hygiene. A special place in the article is devoted to the concept of the background knowledge, cultural competence, and their practical significance for the interpreter. The author concludes that range and richness of the background knowledge means more than recent news from media. The article also depicts the grounds of common mistakes in studying interpretation. In conclusion, the author emphasises the necessity of interpreters’ motivation and qualified training that together with personal development and experience of intercultural communication can result in a competent professional interpreter.

Newly Arrived Migrant Women’s Experience of Maternity Health Information: A Face-to-Face Questionnaire Study in Norway

Limited understanding of health information may contribute to an increased risk of adverse maternal outcomes among migrant women. We explored factors associated with migrant women’s understanding of the information provided by maternity staff, and determined which maternal health topics the women had received insufficient coverage of. We included 401 newly migrated women (≤5 years) who gave birth in Oslo, excluding migrants born in high-income countries. Using a modified version of the Migrant Friendly Maternity Care Questionnaire, we face-to-face interviewed the women postnatally. The risk of poor understanding of the information provided by maternity staff was assessed in logistic regression models, presented as adjusted odds ratios (aORs), with 95% confidence intervals (CI). The majority of the 401 women were born in European and Central Asian regions, followed by South Asia and North Africa/the Middle East. One-third (33.4%) reported a poor understanding of the information given to them. Low Norwegian language proficiency, refugee status, no completed education, unemployment, and reported interpreter need were associated with poor understanding. Refugee status (aOR 2.23, 95% CI 1.01–4.91), as well as a reported interpreter need, were independently associated with poor understanding. Women who needed but did not get a professional interpreter were at the highest risk (aOR 2.83, 95% CI 1.59–5.02). Family planning, infant formula feeding, and postpartum mood changes were reported as the most frequent insufficiently covered topics. To achieve optimal understanding, increased awareness of the needs of a growing, linguistically diverse population, and the benefits of interpretation services in health service policies and among healthcare workers, are needed.

“We couldn’t talk to her”: a qualitative exploration of the experiences of UK midwives when navigating women’s care without language

Purpose Women with little-to-no English continue to have poor birth outcomes and low service user satisfaction. When language support services are used it enhances the relationship between the midwife and the woman, improves outcomes and ensures safer practice. However, this study has shown a reluctance to use professional interpreter services by midwives. This study aims to understand the experiences of midwives using language support services. Design/methodology/approach A maximum variation purposive sampling strategy was used to recruit midwives (N = 12) to a qualitative, semi-structured interview study. Data were analysed using thematic analysis. Findings Four themes were generated from the data analysis with a central organising concept of “Navigating Care Without Language”. These themes were: “Continuity as Key”, “Facilitating Tools”, “Networks of Support” and “Innovative Planning”. Each of these themes had between three and four sub-themes. It was found midwives are keen to support women with language barriers. However, support can be difficult due to the unavailability of equipment and resources; lack of continuity (of interpreter and midwife); inability to plan for the acute care of women who require interpreter services; and the system not being accessible enough to women who require language support services, thus causing them to fall through the net. Originality/value Continuity of carer appears to be a protective factor due to the flexibility, relationship and continuum of support. This study will aid the development of education for undergraduate, post-graduate and practising midwives. It will also inform policymakers working to improve the service offered to women who speak little-to-no English.

The ethics of interpreter use

Consulting with a patient where there is a language barrier is unethical unless the barrier is overcome. Every patient with a language barrier should have this prominently documented on their file. Much of the literature relating to working with interpreters suggests that a professional interpreter should be used all the time, although in practice this is far from standard practice. In this paper we look at the issue using normative ethics, utilitarian ethics, an argument based on equality of health outcomes before making an argument for an approach based on clinical judgement in each consultation of what form of language assistance is acceptable.