Language Barriers among Patients in Boston Emergency Departments: Use of Medical Interpreters After Passage of Interpreter Legislation
ABSTRACT Since 2001, Massachusetts state law dictates that emergency department (ED) patients with limited English proficiency have the right to a professional interpreter.
One year later, for two 24-h periods, we interviewed adult patients presenting to four Boston EDs. We assessed language barriers and compared this need with the observed use and type of interpreter during the ED visit.
We interviewed 530 patients (70% of eligible) and estimated that an interpreter was needed for 60 (11%; 95% confidence interval, 7-12%) patients. The primary interpreter for these clinical encounters was a physician (30%), friend or family member age >or=18 years (22%), hospital interpreter services (15%), younger family member (11%), or other hospital staff (17%).
We found that 11% of ED patients had significant language barriers, but use of professional medical interpreters remained low. One year after passage of legislation mandating access, use of professional medical interpreters remained inadequate.
Full-textDOI: · Available from: Carlos A Camargo, Aug 31, 2015
- SourceAvailable from: Elizabeth A Jacobs
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- "We chose these measures based on our hypotheses that when able to readily access interpreters to speak with LEP patients via the video-interpreting network, the ED clinicians would feel less need to rely on test ordering and time in the ED for diagnosis and evaluation and that admission to the hospital would be reduced as the physician would feel more comfortable that instructions and follow-up appointments would be understood by the patient upon discharge home. We chose the ED for this study, as it is known that interpreter services are in great demand in the ED setting and not always readily accessible, important outcomes can be measured for within the context of one visit, and the relationship between language barriers and increased diagnostic testing has been previously documented in the setting of the ED (Baker et al. 1996; Hampers et al. 1999; Hampers and McNulty 2002; Ramirez, Engel, and Tang 2008; Ginde, Clark, and Camargo 2009). METHODS Video-Interpreting Network We studied a large system of shared remote interpreter services organized in a collaborative network of 14 public and nonprofit hospitals in California with technical support from a private company, Paras and Associates. "
ABSTRACT: To measure the impact of a policy change from use of telephonic and face-to-face interpreting to use of a video-interpreting network on Emergency Department (ED) care. Observational study of ED care at two California hospitals. We compared tests ordered, time in the ED, and admission rates for English- and Spanish-speaking patients presenting with chest pain and abdominal pain before and after the policy change. Data were extracted from electronic medical and billing records. Mean time in the ED, mean number of laboratory tests, radiology services, electrocardiograms, and echocardiograms, and rates of hospital admission for both language groups at both hospitals went down in the post-video-interpreting network period compared with the pre-video-interpreting network period. The percentage of patients leaving the ED against medical advice (AMA) increased in one hospital for both language groups; this increase was statistically significantly smaller in the Spanish-language group compared with the English group (p = .04). The studied video-interpreting network had minimal impact on health care outcomes in the ED.Health Services Research 10/2011; 47(1 Pt 2):509-22. DOI:10.1111/j.1475-6773.2011.01329.x · 2.49 Impact Factor
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- "The appropriateness and effectiveness of a family interpreter in each context will be very different, while also depending on the individuals involved. Despite the acknowledged risks, many studies have found that family interpreters remain widely used in many situations (Auckland Area Health Board 1990; Chan et al. 1999; Gerrish 2001; Kuo et al. 2007; Atkin 2008; Garrett et al. 2008; Diamond et al. 2009; Ginde et al. 2009). Doctors often normalise the fact that trained interpreters are underused and often lack awareness of the difficulties and risks, learning of these only through experience (Diamond et al. 2009). "
ABSTRACT: Australia and New Zealand both have large populations of people with limited English proficiency (LEP). Australia's free telephone interpreter service, which is also used by New Zealand through Language Line (LL) but at a cost to the practices, is underused in both countries. Interpreter guidelines warn against the use of family members, yet the lack of uptake of interpreter services must mean that they are still often used. This paper reviews the literature on medical interpreter use and reports the results of a week-long audit of interpreted consultations in an urban New Zealand primary health centre with a high proportion of refugee and migrant patients. The centre's (annualised) tally of professionally interpreted consultations was three times more than that of LL consultations by all other NZ practices put together. Despite this relatively high usage, 49% of all interpreted consultations used untrained interpreters (mostly family), with more used in 'on-the-day' (OTD) clinics. Clinicians rated such interpreters as working well 88% of the time in the OTD consultations, and 36% of the time in booked consultations. An in-house interpreter (28% of consultations) was rated as working well 100% of the time. Telephone interpreters (21% of consultations) received mixed ratings. The use of trained interpreters is woefully inadequate and needs to be vigorously promoted. In primary care settings where on-going relationships, continuity and trust are important - the ideal option (often not possible) is an in-house trained interpreter. The complexity of interpreted consultations needs to be appreciated in making good judgements when choosing the best option to optimise communication and in assessing when there may be a place for family interpreting. This paper examines the elements of making such a judgement.Australian Journal of Primary Health 01/2011; 17(3):240-9. DOI:10.1071/PY10075 · 1.22 Impact Factor
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- "These laws and recommendations typically apply to health care settings which receive public funding, and in theory should reduce or eliminate language barriers to care in settings such as hospital emergency departments. Yet professional interpreter services are underused in these settings, even when mandated by law, implying that limited-English patients continue to experience less than optimal access to and quality of care (Baker et al. 1996, Ginde et al. 2008). "
ABSTRACT: The number of individuals with limited English proficiency in the USA is large and rapidly growing. Consequently, addressing language barriers in access to medical care is becoming increasingly important. Previous studies have reported that individuals with limited English proficiency have more difficulty gaining access to care, compared to English-proficient individuals. We assessed the impact of English language proficiency on access to medical care, accounting for health and socioeconomic status, using nationally representative data. Cross-sectional data from the 2006 National Health Interview Survey (n=29,868). The main outcome measures of interest were self-reported delayed medical care, forgone needed care, and visits to a health care professional. In unadjusted analyses, individuals with limited English proficiency were more likely to forgo needed medical care and less likely to have a health care visit, compared to individuals who were proficient in English. There was no significant association between language proficiency and reports of delayed care. After accounting for individuals' health and socioeconomic status, only the relationship between limited English proficiency and health care visits remained statistically significant. Most associations between language proficiency and access to care did not differ across various racial/ethnic groups. Results indicate that the choice of access measure may influence conclusions about language barriers in health care. Given the growing proportion of US residents with limited English proficiency, health care settings need to better address potential language barriers.Ethnicity and Health 12/2009; 14(6):625-42. DOI:10.1080/13557850903248639 · 1.28 Impact Factor