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Identifying and Addressing Language Needs in Primary Care: a Pilot Implementation Study

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Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Background

Medical interpreters improve care for patients with Limited English Proficiency but are underused. Protocols to improve interpreter use in primary care are needed.

Methods

Medical Assistants (MAs) screened patients for language needs and arranged for telephone interpreters during rooming in two pilot clinics (PCs). We interviewed MAs and providers and analyzed interviews using modified grounded theory, linking themes to the Promoting Action on Research Implementation in Health Services (PARiHS) framework categories of Context, Evidence, and Facilitation. Providers in PCs and four comparison clinics were surveyed.

Results

Context themes included issues with the telephone interpreter vendor; having established teams, roles and workflows; and difficulty incorporating time-sensitive tasks. Evidence themes included engagement in language screening; preferring in-person interpreters; improving the patient experience; and having mixed responses to the protocol. Facilitation themes included MAs needing more support. PC providers were more satisfied with care (OR = 12.7) and communication (OR = 7.6) than comparison clinic providers.

Conclusions

The protocol may improve patient care and communication, but implementation was inconsistent. Language screening is a complex process and further research is needed to improve screening questions and procedures. Future interventions should capitalize on team members’ drives to improve patient care and control costs but also need to consider the impacts of health system changes, and to consider the culture, training needs, roles, and relationships of team members.

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Acknowledgements

The contents of this study are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or HRSA.

Funding

Dr. Murphy was funded by a training grant from the Health Resources and Services Administration (HRSA), through the Boston Medical Center Grant Number D33HP25766. This project was also supported by the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), through the BU-CTSI Grant Number 1UL1TR001430.

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Authors and Affiliations

  1. Section of General Internal Medicine, Warren Alpert Medical School of Brown University, 245 Chapman Street, Suite 300, Providence, RI, 02905, USA

    Jessica E. Murphy

  2. Department of General Internal Medicine and Pediatrics, Texas Gulf Coast Medical System, 250 Blossom Street, Suite 400, Webster, TX, 77598, USA

    David Washington

  3. Department of General Internal Medicine and Pediatrics, Bay Area Regional Medical Center, 200 Blossom Street, Webster, TX, 77598, USA

    David Washington

  4. Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, 02118, USA

    Ziming Xuan

  5. Section of General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Ave, Boston, MA, 02118, USA

    Michael K. Paasche-Orlow

  6. Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA

    Mari-Lynn Drainoni

  7. Section of Infectious Diseases, Boston University School of Medicine, 72 E. Concord Street, Boston, MA, 02118, USA

    Mari-Lynn Drainoni

  8. Center for Implementation and Improvement Sciences, Boston University School of Medicine, 72 E. Concord Street, Boston, MA, 02118, USA

    Mari-Lynn Drainoni

  9. Center for Healthcare Organization and Implementation Research, ENRM VA Hospital, 200 Springs Rd, Building 70, Bedford, MA, 01730, USA

    Mari-Lynn Drainoni

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  1. Jessica E. Murphy
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  2. David Washington
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  3. Ziming Xuan
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Corresponding author

Correspondence to Jessica E. Murphy.

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The authors declare that they have no conflicts of interest.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Murphy, J.E., Washington, D., Xuan, Z. et al. Identifying and Addressing Language Needs in Primary Care: a Pilot Implementation Study. J. Racial and Ethnic Health Disparities 6, 505–516 (2019). https://doi.org/10.1007/s40615-018-00549-6

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  • DOI: https://doi.org/10.1007/s40615-018-00549-6

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