Study Finds Physicians' Efforts to Reduce Disparities 'Modest and Uneven'
New Mexico FP Says Cost Can Be a Problem
By Barbara Bein
Although many U.S. physicians identify language or cultural barriers as obstacles to providing high-quality care to minorities, their adoption of practices to reduce these barriers is "modest and uneven," according to an issue brief based on the 2008 HSC Health Tracking Physician Survey (70-page PDF; About PDFs) from the Center for Studying Health System Change, or HSC.
According to the issue brief, the medical community broadly agrees on measures to address and reduce racial and ethnic disparities, but the proportion of physicians who adopt various practices to improve care for minority patients has a wide range. For example, although slightly more than half of the surveyed physicians reported they provide some interpreter service, only 7 percent reported that they could track a patient's preferred language.
"Although disparities certainly stem from factors beyond the physician-patient encounter, the ability of physicians to communicate effectively with patients from diverse backgrounds is important to providing high-quality care," said James Reschovsky, Ph.D., HSC senior researcher and study co-author, in a Feb. 10 news release.
According to the issue brief, the federal government has documented wide disparities in the quality of health care received by different racial and ethnic groups since 2003. But little progress has been made in closing these quality gaps.
Based on measures outlined by the Institute of Medicine, the National Quality Forum and other groups that physicians and practices can use to reduce language and cultural barriers, study researchers asked more than 4,700 physicians what steps they and their practices have taken to reduce barriers, including whether
"Although disparities certainly stem from factors beyond the physician-patient encounter, the ability of physicians to communicate effectively with patients from diverse backgrounds is important to providing high-quality care," said James Reschovsky, Ph.D., HSC senior researcher and study co-author, in a Feb. 10 news release.
According to the issue brief, the federal government has documented wide disparities in the quality of health care received by different racial and ethnic groups since 2003. But little progress has been made in closing these quality gaps.
Based on measures outlined by the Institute of Medicine, the National Quality Forum and other groups that physicians and practices can use to reduce language and cultural barriers, study researchers asked more than 4,700 physicians what steps they and their practices have taken to reduce barriers, including whether
- their practice provides interpreter services;
- their practice provides patient education materials in languages other than English;
- they have received training in minority health issues; and
- their practice has health information technology to identify a patient's preferred language.
The study found that nearly 97 percent of the surveyed physicians had at least some non-English speaking patients, but only slightly more than half (56 percent) were in practices that provided interpreter services in 2008.
In addition, although many practices that treat patients for asthma, diabetes, congestive heart failure and depression indicated that they provide patient education materials, only 40 percent provide materials in languages other than English.
Only about 40 percent of physicians reported receiving some training in minority health, such as cultural competency training. Even in practices with a high number of minority patients, defined as a patient census consisting of 50 percent or more minority patients, only half of the physicians said they had received such training.
Physicians in solo and group practices also were less likely to adopt measures to address disparities than those in institutional practices, such as hospitals, HMOs and medical schools. For example, almost 90 percent of physicians in group- or staff-model HMOs reported providing interpreter services, compared with 34 percent of physicians in solo or two-physician practices.
According to Linda Gonzales Stogner, M.D., a member of the AAFP Commission on Public Health and Science Subcommittee on Disparities and Underserved Populations, that may have a lot to do with the cost of providing such services in smaller practices.
Stogner is a solo practitioner at the Presbyterian Medical Services Esperanza Family Health Center in rural Estancia, N.M., a town of about 1,600 people located about 55 miles southeast of Albuquerque. Between 40 percent and 45 percent of her patients are Hispanic and about 15 percent speak Spanish as their first language.
Stogner said she and some of her staff speak Spanish, and some phone translation services are available. However, these services aren't practical because they would require phone lines in every exam room.
Many university-based or large practices can absorb the cost of interpreters to accompany patients, said Stogner, but her small practice cannot. "I don't have the dollars for it. There's no way I can charge for those services," she said. "For the most part, I think we're able to do a better job in our office because we do have the support staff that can communicate with folks. Other offices don't have that."
In addition, the practice's electronic health record system can provide patient education materials in both English and Spanish.
Stogner said it's important for family physicians to be sensitive to cultural issue because it encourages patients to seek health care. Some minorities might not be comfortable in an office where no one speaks Spanish, and they won't come back for follow-up visits.
"The reason they don't come in for a follow-up (visit) is because they don't feel welcome and they don't understand the follow-up communications," said Stogner. "Patients want to see physicians like themselves, or ones who are accepting of their culture, instead of feeling they are a burden on the practice. If they go to an office where no one speaks Spanish or people get angry because they haven't learned English, the patients don't feel they're getting good care."
In addition, although many practices that treat patients for asthma, diabetes, congestive heart failure and depression indicated that they provide patient education materials, only 40 percent provide materials in languages other than English.
Only about 40 percent of physicians reported receiving some training in minority health, such as cultural competency training. Even in practices with a high number of minority patients, defined as a patient census consisting of 50 percent or more minority patients, only half of the physicians said they had received such training.
Physicians in solo and group practices also were less likely to adopt measures to address disparities than those in institutional practices, such as hospitals, HMOs and medical schools. For example, almost 90 percent of physicians in group- or staff-model HMOs reported providing interpreter services, compared with 34 percent of physicians in solo or two-physician practices.
According to Linda Gonzales Stogner, M.D., a member of the AAFP Commission on Public Health and Science Subcommittee on Disparities and Underserved Populations, that may have a lot to do with the cost of providing such services in smaller practices.
Stogner is a solo practitioner at the Presbyterian Medical Services Esperanza Family Health Center in rural Estancia, N.M., a town of about 1,600 people located about 55 miles southeast of Albuquerque. Between 40 percent and 45 percent of her patients are Hispanic and about 15 percent speak Spanish as their first language.
Stogner said she and some of her staff speak Spanish, and some phone translation services are available. However, these services aren't practical because they would require phone lines in every exam room.
Many university-based or large practices can absorb the cost of interpreters to accompany patients, said Stogner, but her small practice cannot. "I don't have the dollars for it. There's no way I can charge for those services," she said. "For the most part, I think we're able to do a better job in our office because we do have the support staff that can communicate with folks. Other offices don't have that."
In addition, the practice's electronic health record system can provide patient education materials in both English and Spanish.
Stogner said it's important for family physicians to be sensitive to cultural issue because it encourages patients to seek health care. Some minorities might not be comfortable in an office where no one speaks Spanish, and they won't come back for follow-up visits.
"The reason they don't come in for a follow-up (visit) is because they don't feel welcome and they don't understand the follow-up communications," said Stogner. "Patients want to see physicians like themselves, or ones who are accepting of their culture, instead of feeling they are a burden on the practice. If they go to an office where no one speaks Spanish or people get angry because they haven't learned English, the patients don't feel they're getting good care."
