Disparities in eye clinic patient encounters among patients requiring language interpreter services

(2023) 23:82 Mudie et al. BMC Ophthalmology https://doi.org/10.1186/s12886-022-02756-6 BMC Ophthalmology Open Access RESEARCH Disparities in eye clinic patient encounters among patients requiring language interpreter services Lucy I. Mudie1, Jennifer L. Patnaik1, Zafar Gill1, Marissa Wagner1, Karen L. Christopher1, Leonard K. Seibold1 and Cristos Ifantides1,2* Abstract Background Communication barriers are a major cause of health disparities for patients with limited English proficiency (LEP). Medical interpreters play an important role in bridging this gap, however the impact of interpreters on outpatient eye center visits has not been studied. We aimed to evaluate the differences in length of eyecare visits between LEP patients self-identifying as requiring a medical interpreter and English speakers at a tertiary, safety-net hospital in the United States. Methods A retrospective review of patient encounter metrics collected by our electronic medical record was conducted for all visits between January 1, 2016 and March 13, 2020. Patient demographics, primary language spoken, self-identified need for interpreter and encounter characteristics including new patient status, patient time waiting for providers and time in room were collected. We compared visit times by patient’s self-identification of need for an interpreter, with our main outcomes being time spent with ophthalmic technician, time spent with eyecare provider, and time waiting for eyecare provider. Interpreter services at our hospital are typically remote (via phone or video). Results A total of 87,157 patient encounters were analyzed, of which 26,443 (30.3%) involved LEP patients identifying as requiring an interpreter. After adjusting for patient age at visit, new patient status, physician status (attending or resident), and repeated patient visits, there was no difference in the length of time spent with technician or physician, or time spent waiting for physician, between English speakers and patients identifying as needing an interpreter. Patients who self-identified as requiring an interpreter were more likely to have an after-visit summary printed for them, and were also more likely to keep their appointment once it was made when compared to English speakers. Conclusions Encounters with LEP patients who identify as requiring an interpreter were expected to be longer than those who did not indicate need for an interpreter, however we found that there was no difference in the length of time spent with technician or physician. This suggests providers may adjust their communication strategy during encounters with LEP patients identifying as needing an interpreter. Eyecare providers must be aware of this to prevent negative impacts on patient care. Equally important, healthcare systems should consider ways to prevent unreimbursed extra time from being a financial disincentive for seeing patients who request interpreter services. Keywords Medical interpreters, Limited english proficiency patients, Ophthalmology *Correspondence: Cristos Ifantides 1 Department of Ophthalmology, University of Colorado, 1675 Aurora Court F731, Aurora, CO 80045, USA 2 Department of Surgery, Denver Health Medical Center, 660 Bannock Street, Denver, CO 80204, USA © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Mudie et al. BMC Ophthalmology (2023) 23:82 Background It has long been known that racial and ethnic disparities exist in access to medical care [1–3]. The Agency for Healthcare Research and Quality (AHRQ) reports annually on healthcare disparities. AHRQ data from 2019 showed racial and ethnic minorities receive worse care than white patients for 33 to 40% of quality measures (which includes private insurance coverage, access to specialist medical care, and receiving routine preventative care such as influenza vaccine and pap smears) [4]. Although many quality measures have improved over the past two decades, disparities persist, and for some the gap has widened [4]. Among the many reasons for disparities in healthcare, communication barriers, often secondary to limited English proficiency (LEP), are high on the list [3]. Language barriers can lead to poor understanding of diagnoses, poor treatment alliance between the patient and provider, and suboptimal care with poorer health outcomes [5]. LEP can trigger cognitive bias by providers, and may deter patients from presenting for help in a timely manner. In a study of migrant workers, perceived lack of interpreter was the number one barrier to accessing health care [6]. Prior studies of Emergency Room (ER) visits have reported that patients who don’t speak English are 24% more likely to have an unplanned second ER visit within 3 days [7], and in one study their average cost of an ER visit was around $40 more [8]. If the language barrier is eased, many care disparities can also be reduced; for example, Jacobs et al. [9] reported a cost saving of $100/visit if the treating ER physician was bilingual in English and Spanish. Another study found that Hispanics who spoke English received the same care as non-Hispanic English speakers [10]. Certified interpreters have been suggested as a way to overcome language barriers, however their use varies dramatically. Blay et al. [11] reported variation in the use of interpreters from 16 to 71% depending on the hospital setting. The often cited reasons for not using a formal interpreter service are lack of availability, perceived time or budget constraints, or a lack of training in the use of interpreters [11]. Even if an interpreter is used, some studies suggests that practitioners and interpreters experience difficulties in their collaboration such as cross-cultural translation, emotional and interpersonal challenges, all of which can negatively affect services to patients with LEP [12]. In ophthalmology, high-risk factors for eye disease and/or vision loss that have consistently been identified include incre (...truncated)