The impact of limited English proficiency and physician language concordance on reports of clinical interactions among patients with diabetes: The DISTANCE study

Schenker, Yael; Karter, Andrew J.; Schillinger, Dean; Warton, E. Margaret; Adler, Nancy E.; Moffet, Howard H.; Ahmed, Ameena T.; Fernandez, Alicia

doi:10.1016/j.pec.2010.02.005

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Volume 81, Issue 2 , Pages 222-228, November 2010

The impact of limited English proficiency and physician language concordance on reports of clinical interactions among patients with diabetes: The DISTANCE study

Yael Schenker
- Department of Medicine, University of California, San Francisco, USA
- Department of Epidemiology, University of California, San Francisco, USA
- Corresponding author at: University of California, San Francisco, Box 1364, San Francisco, CA 94143, USA. Tel.: +1 415 254 9958; fax: +1 415 206 5586.
Andrew J. Karter
- Kaiser Permanente, Division of Research, Oakland, USA
Dean Schillinger
- Department of Medicine, University of California, San Francisco, USA
- Center for Vulnerable Populations at San Francisco General Hospital, University of California, San Francisco, USA
E. Margaret Warton
- Kaiser Permanente, Division of Research, Oakland, USA
Nancy E. Adler
- Center for Health and Community, University of California, San Francisco, USA
Howard H. Moffet
- Kaiser Permanente, Division of Research, Oakland, USA
Ameena T. Ahmed
- Kaiser Permanente, Division of Research, Oakland, USA
Alicia Fernandez
- Department of Medicine, University of California, San Francisco, USA

Received 7 October 2009; received in revised form 2 February 2010; accepted 4 February 2010. published online 12 March 2010.

Abstract

Objective

To assess the association of limited English proficiency (LEP) and physician language concordance with patient reports of clinical interactions.

Methods

Cross-sectional survey of 8638 Kaiser Permanente Northern California patients with diabetes. Patient responses were used to define English proficiency and physician language concordance. Quality of clinical interactions was based on 5 questions drawn from validated scales on communication, 2 on trust, and 3 on discrimination.

Results

Respondents included 8116 English-proficient and 522 LEP patients. Among LEP patients, 210 were language concordant and 153 were language discordant. In fully adjusted models, LEP patients were more likely than English-proficient patients to report suboptimal interactions on 3 out of 10 outcomes, including 1 communication and 2 discrimination items. In separate analyses, LEP-discordant patients were more likely than English-proficient patients to report suboptimal clinician–patient interactions on 7 out of 10 outcomes, including 2 communication, 2 trust, and 3 discrimination items. In contrast, LEP-concordant patients reported similar interactions to English-proficient patients.

Conclusions

Reports of suboptimal interactions among patients with LEP were more common among those with language-discordant physicians.

Practice implications

Expanding access to language concordant physicians may improve clinical interactions among patients with LEP. Quality and performance assessments should consider physician–patient language concordance.

Keywords: Limited English proficiency, Language concordance, Communication, Trust, Discrimination