Limited English Proficiency as a Barrier to Therapeutic Compliance

Limited English Proficiency as a Barrier to Therapeutic Compliance

Background and Significance

Despite the advancements in treatment methodologies over the years, the use of technologies such as Artificial Intelligence (AI) and Machine Learning in medical practice and diagnosis, even the fact that healthcare workers continue to embrace Evidence-Based Practice (EBP), there is still enormous cases of unexplained poor therapeutic outcomes. Several studies prove that the difference in whether a patient will survive or not after therapy to a large extent depends on race and ethnicity, sociodemographic factors, literacy, and education. Few circumstances of poor therapeutic outcomes are due to factors such as the stage of the disease at presentation, mode of therapy, and the role of existing co-morbidities. As a result, there is concern that Limited English Proficiency could be a determinant in the factors that contribute to poor therapeutic effects. This means that patients have difficulty with complicated treatment plans as directed by physicians and other clinicians. Therefore, this study is motivated by the poor outcomes of therapy despite the advancements in the healthcare system. In this case, Limited English Proficiency potentially influences the satisfaction of the patient, the decisions of the physicians, and results in unwarranted execution of therapy leading to undesired consequences.

The United States Health Research and Quality Agency define Limited English Proficiency as being able to speak Englis “less than very well.” Additionally, Limited English proficiency is debated as a contributing factor to health disparities. Patients who are unable to speak proficient English are less likely to have a regular source of quality care and standard therapy for chronic medical illness (Taira et al. 2019). As a result, LEP causes several poor health outcomes, including increased incidences of disability, psychological distress, mental illnesses, inability to visit a physician, or access to regular care (Qureshi et al. 2014).

The poor results are due to reports of poor communication and inability to comprehend medical information from caregivers, which includes a harsh environment with no interpreters. The American Community Survey (ACS) (2014), is a survey of the U.S population for language preference, and health insurance status and gives information about Limited English proficiency (Proctor, 2018). The ACS relates that the most affected population comprise the Hispanics, and the non-Hispanics (Blacks, Asians, American Indians, and other multiracial groups) to be the most affected. Similarly, Denver, Colorado, from where the study will be done, has a high population of immigrants from Africa and other parts of the world who speak English as their second language. The population of immigrants in Colorado makes up to 10% of the population.

Alignment with the organizational plan

Errors due to miscommunication in the clinical setting can lead to loss of lives. The demographics of countries change and thus that of the healthcare delivery system. Therefore, several people who do not understand or cannot speak English visit the hospitals. Hospitals are focusing on this challenge imposed on healthcare by LEP since hospitals rely on effective communication. Currently, hospitals embark on bridging the cultural gap by funding for studies and developing models for language competency. Moreover, healthcare organizations hire bilingual staff to work as interpreters. Other interventions include standardization of language assessments test, creation of hospital language banks, and training volunteers to work as interpreters.

The depth of the problem

Patients with Limited English Proficiency continue to increase, making the problem a critical issue in healthcare. As the number of LEP patients grows, the chances for encountering LEP in the surgical, as well as outpatient settings and the emergency departments, also increase. Therefore, to improve the results of therapeutic interventions, it is inevitable for healthcare organizations to study the area and formulate protocols and guidelines that concern LEP patients. Accessing multicultural populations within healthcare is an unavoidable phenomenon that prompts the expansion of the scope of healthcare delivery through interpretation and translation.

Needs Assessment

In January 2012, a study was conducted at a hospital in New York City with approximately 100,000 annual visits. The hospital reviewed 62,000 out of 100, 101 visits to the emergency section. 2, 943 (7.1%) of the patients reviewed had LEP. Interpreters were used in 2,209 (52.3%) of the cases (Ngai et al. 2016). The study found that 5% of patients with LEP were likely to have a revisit. Evidence from other several studies shows an improvement when the hospital provides convenient interpreters. In another study that enrolled 163 patients, 66% of the patients were proficient speakers of English. Thirty-four percent of the patients had LEP. Moreover, the U.S census department of 2012 reported that Latino/Hispanics were 53 million, 17% of the total U.S population of which 75% spoke Spanish as the primary language while 25% only spoke Spanish (BalaKrishnan et al. 2016).

Therefore, the problem of LEP is widespread and an issue of concern that healthcare personnel should consider. LEP poses a significant communication challenge among healthcare workers and patients. LEP Patients experience problems complying with medications. LEP patients also report drug complications, understanding instructions during dispensation and prescription. Communicating is essential to the outcome of therapy (Abdelmesih et al. 2019). This study will elaborate on the depth of the influence of Limited English Proficiency as a barrier to therapeutic outcome primarily since concerns are raised that LEP influences the outcome of therapy. This study is also inclined towards an understanding of how a solution to the problem will impact healthcare.

References

Abdelmessih, E., Simpson, M. D., Cox, J., & Guisard, Y. (2019). Exploring the Health Care Challenges and Health Care Needs of Arabic-Speaking Immigrants with Cardiovascular Disease in Australia. Pharmacy, 7(4), 151.

Balakrishnan, V., Roper, J., Cossey, K., Roman, C., & Jeanmonod, R. (2016). Misidentification of English language proficiency in triage: impact on satisfaction and door-to-room time. Journal of immigrant and minority health, 18(2), 369-373.

Ngai, K. M., Grudzen, C. R., Lee, R., Tong, V. Y., Richardson, L. D., & Fernandez, A. (2016). The association between limited English proficiency and unplanned emergency department revisit within 72 hours. Annals of emergency medicine, 68(2), 213-221.

Proctor, K., Wilson-Frederick, S. M., & Haffer, S. C. (2018). The Limited English Proficient Population: Describing Medicare, Medicaid, and Dual Beneficiaries. Health equity, 2(1), 82-89.

Qureshi, M. M., Romesser, P. B., Jalisi, S., Zaner, K. S., Cooley, T. P., Grillone, G., … & Truong, M. T. (2014). The influence of limited English proficiency on outcome in patients treated with radiotherapy for head and neck cancer. Patient education and counseling, 97(2), 276-282.

Taira, B. R., & Orue, A. (2019). Language assistance for limited English proficiency patients in a public ED: determining the unmet need. BMC health services research, 19(1), 56.

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