Language Barrier - WordPress.com...20. Regenstein M, Andres E, Wynia MK. Appropriate use of...
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Providing Care with a Language Barrier
Sarah Bade, SPTClinical Instructor: Val
Clinic: NAU Neuro
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Objectives1. Describe the different methods a
provider might use to communicate with an LEP (low English-proficient) patient.
2. State the benefits of using professional vs. nonprofessional services.
3. When faced with an LEP patient encounter, be equipped to provide the best care to that patient.
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Introduction ● 300 languages spoken in the US● 60 million people do not speak
English in the home○ About 22% of these either
can’t speak English or do not speak it well
○ Over 20 million LEP patients in the US
● LEP patients typically seen weekly, if not daily
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Definitions
● LEP/EP● Language concordant or
bilingual provider● Interpreter● Professional services● Nonprofessional services
○ Ad hoc interpreter
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¡Digan Hola a JT!- 38 yo Hispanic male- Suffered R CVA about 3 ya - Left with gait and balance impairments
- Uses an AFO on the L and either a FWW or Lofstrand crutches
- Speaks some English, but communicates much easier in Spanish
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So We Have Several Options Here1. Talk slower or louder to JT in English and
hope he understands2. Try and use whatever Spanish we
remember from high school to communicate
3. Invite a family member or friend to come in and interpret
4. Find a bilingual therapist5. Find a professional interpreter
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PICO QuestionWhen working with an LEP patient, are there differences in patient satisfaction and safety between using professional
options (bilingual therapist, professional interpreter) versus non-professional options (ad hoc interpreter,
minimal ability in their language, etc.)?
OR (Layman’s Term)
What do you do when they can’t talk to you?
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Study 1● Professional interpreters vs. Ad Hoc Interpreters vs.
No interpreter○ Ad Hoc and No Interpreter categories = 2x as
many errors as Professional ○ 18% of errors had serious medical
consequences ● Ad Hoc interpretation = greater embarrassment● Professional interpreter/Bilingual provider = better
treatment outcomes, greater patient satisfaction, optimal communication
Flores G, Abreu M, Barone CP, Bachur R, Lin H. Errors of medical interpretation and their potential clinical consequences: A comparison of professional versus ad hoc versus no interpreters. Annals of Emergency Medicine. 2012;60(5):545-553.
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Study 2● Systematic review of 28 articles looking at
interpreter outcomes● Language concordance
○ Greater satisfaction (equal to EP)○ Better treatment adherence ○ Greater chance of follow-up○ More speaking and interaction○ Greater comprehension of condition○ Better overall treatment outcomes and health○ Raises treatment quality to that of EP
Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited english proficiency? A systematic review of the literature. Health Services Research. 2007;42(2):727-754.
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Answer to PICO Question = YES!
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So, Back to those Options1. Talk slower or louder to JT in English
and hope he understands2. Try and use whatever Spanish we
remember from high school to communicate
3. Invite a family member to come in and interpret
4. Find a bilingual therapist5. Find a professional interpreter
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So Does this Mean I Should Run out and Sign Up for a Spanish Class RIGHT NOW?!
● ...Possibly● Can actually be more dangerous - false
sense of security ● Helpful to help establish rapport (and
check to make sure the interpreter is saying what you them to)
● Still should use an interpreter unless you make the effort to be truly bilingual though
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Cost-Benefit Analysis of Interpreter Use● No comprehensive one yet
○ One study indicates it’s beneficial, at least for large organizations
● Medicaid and Medicare do reimburse for it
● Most third-party payers do not● Eventually may be worth it to avoid
liability issues and lawsuits and to draw more patients○ $71 million lawsuit over
misinterpreted word urban legend
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Questions?
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