hablamos juntos – we speak together research conducted for proj #7666 october/november 2001 w i r...

Hablamos Juntos – We Speak Together

Research conducted for

Proj #7666

October/November 2001

W I R T H L I N W O R L D W I D E

W I R T H L I N W O R L D W I D E 2

Table of Contents

Methodology 3

Quality Backdrop 5

Issue Context 11

Language Barrier Issues: Spanish Speaking Patient Perspective 21

Language Barrier Issues: Provider Perspective 28

Solutions 38

Appendix: 47

Spanish Speaking Patients: Care Overview and Respondent Profile 48

Provider Environment 56


Methodology - Providers

During the months of October and November, 15 minute telephone interviews were conducted with health care professionals who practice in metro areas where Latinos comprise over 5% of the general population and have experienced growth over 75% between 1990 and 2000. Providers were divided into four segments:

Doctors (n=300)

– Primary Care Physicians n=95

– Specialists n=65

– Emergency Room Physicians n=99

– Physicians Practicing in Clinics n=41 Nurses (n=301)

– Must be at least a Registered Nurse Executives (n=200)

– Titles include: Chief Executive Officer, Chief Financial Officer, Chief of Medical Staff, Vice President, Director of Hospital Unit, Medical Director, Directors of Nursing

Pharmacists (n=201)

– Must work in a retail environment

All providers indicated that their patient base was at least 5% Spanish-speaking


Methodology – Spanish Speaking Public

During the months of October and November, 500 interviews were conducted with adults whose primary language is Spanish

Interviews were conducted in the same metro areas as the provider portion of the study; those with high percentage Hispanic population growth

Respondents completed the interview in Spanish

In order to qualify, respondents needed to indicate difficulty with communicating with a doctor in English

All respondents had visited a doctor or other health care provider for themselves or a family member within the past year

Quality Backdrop


44%

38%

18%

Very Good/ Excellent

Good

Not Good

More than Half of Providers Say Health Care Quality Doesn’t Earn the Highest Mark

PQ2: Please think broadly about the quality of health care offered in the United States today. By quality we mean health care that is safe, effective, patient-centered, timely, efficient, and equitable. Would you judge it to be:…

Quality Report

- Provider Data -


34%

32%

41%

25%

14%

9%

14%

9%

48%

40%

55%

34%

36%

39%

30%

46%

14%

18%

14%

17%

2%

2%

2%

2%19%

15%

20%

16% Physicians

Nurses

Executives

Negative PositiveProviders

Among Providers, Executives and Physicians Have Highest Perceptions of Quality

Neutral

- Provider Data By Segment -

PQ2: Please think broadly about the quality of health care offered in the United States today. By quality we mean health care that is safe, effective, patient-centered, timely, efficient, and equitable. Would you judge it to be:…

Pharmacists

Poor Fair Very Good ExcellentGood


Providers Have More Favorable Perceptions of Quality Than Spanish Speaking Public

PQ2/HQ2: Please think broadly about the quality of health care offered in the United States today. By quality we mean health care that is safe, effective, patient-centered, timely, efficient, and equitable. Would you judge it to be:…

27%

43%

30%


Good

Not Good

Providers Spanish Speaking Public

44%

38%

18%


Good

Not Good

- Provider Data / Spanish Speaking Public Data -


Among Spanish Speaking Public, No Quality Difference Perceived on National vs. Local Level

Rating of Quality in United States Rating of Quality at Community Level

HQ2: Please think broadly about the quality of health care offered in the United States today. By quality we mean health care that is safe, effective, patient-centered, timely, efficient, and equitable. Would you judge it to be:…

HQ9: Please think about the health care options in your community that are able to communicate with you in Spanish. How would you judge the overall quality of the care they provide? Would you judge it to be:

28%

27%

44%


Good

Not Good

27%

43%

30%


Good

Not Good

- Spanish Speaking Public Data -


Quality Backdrop: Summary Overview

Quality grade is mediocre overall

Health care providers have higher perceptions of quality than their Spanish speaking patients

Spanish speaking public identifies clear room for improvement

No clear distinction on quality levels between national and local health care

Issue Context

• Importance of Patient-Provider Communication

• Issue Priority

• Expectations of Responsibility

• How Well System Currently Operates


When it Comes to Quality, Providers Say Patient-Provider Communications is the Top Issue

94%

72%

69%

64%

52%

PQ3: When working to provide your patients with the highest quality care possible, how important are each of the following?

Patient-provider Communications

The cost of health care is manageable

Access to specialists

Access to the most current research and best practices

Liability issues are limited

- Provider Data, % Very Important –


7 in 10 Providers See Addressing Barrier Issue as an Important Priority

30%

58%

10%

2%

Level of Priority

Top priority

One of a number of important priorities

Moderately important priority

Not an important priority

68% Top/Important

Priority

PQ5: Among all the issues currently facing the health care delivery system, how much of a priority should helping primarily Spanish-speaking health care consumers better use and benefit from the health care system be? Do you think it should be…

- Provider Data -


Among Providers, Doctors and Pharmacists Show the Least Urgency in Addressing Language Issue

10%

11%

8%

11%

69%

65%

52%

46%

79%

76%

60%

57%

Executives

Nurses

Doctors

Pharmacists

Top Priority One of a large number of priorities

PQ5: Among all the issues currently facing the health care delivery system, how much of a priority should helping primarily Spanish-speaking health care consumers better use and benefit from the health care system be? Do you think it should be…

% Top/Important Priority

- Provider Data -


No Consensus on Where Responsibility for Accommodation Falls

Provider’sResponsibility

Patient’sResponsibility

PQ12A/HQ4: Understanding that your opinion might fall somewhere in the middle, which of the following comes closest to representing how you feel: 1) It’s primarily the patient’s responsibility to be able to function in an English-speaking environment. 2) It’s primarily the provider’s responsibility to assure the patient clearly understands them so they can be served most effectively.

Providers

Spanish Speaking Public

40%

60%

Provider’s Responsibility

Patient’s Responsibility

48%

49%


- Provider Data -


Different Expectations and Sense of Responsibility Exist Across Provider Segments

Provider’sResponsibility

Patient’sResponsibility

PQ12A: Understanding that your opinion might fall somewhere in the middle, which of the following comes closest to representing how you feel: 1) It’s primarily the patient’s responsibility to be able to function in an English-speaking environment. 2) It’s primarily the provider’s responsibility to assure the patient clearly understands them so they can be served most effectively.

- Provider Data by Segment -

25%

75%28%

72%

50%50%

54%

45%

Pharmacists

Hospital Executives

Nurses

Physicians


Providers Give Mixed Reviews on System’s Current Handling of Issue – Most Give Mediocre Grade

9%

44%

40%

6%

Accommodatesvery well

Accommodatesmoderately well

Accommodates notvery well

Accommodates notwell at all

PQ6: Overall, how well do you feel the health care system is set up to accommodate this group?

System’s Level of Accommodation for Spanish Speaking Public

- Provider Data -


45%

35%

44%

38%

9%

5%

5%

4%

40%

54%

43%

48%

39%

47%

42%

49%

12%

10%

8%

59%

52%

57%

7% 46%Physicians

Nurses

Executives

Providers

- Provider Data By Respondent Type -

PQ6: Overall, how well do you feel the health care system is set up to accommodate this group?

Pharmacists

Nurses View System As Most Accommodating, Physicians See Room for Improvement

Not Well At All Not Very Well Moderately Well Very Well


Despite the More Critical Evaluation of Providers, Spanish Speaking Consumers Say System Accommodates Them Well

9%

44%

40%

6%

Very well

Moderatelywell

Not verywell

Not well atall

PQ6, HQ3: Overall, how well do you feel the health care system is set up to accommodate this group?

Providers Spanish-Speaking Public

- Provider Data / Spanish Speaking Public Data -

31%

41%

17%

7%

Very well

Moderatelywell

Not verywell

Not well atall


Issue Context: Summary Overview

Physician-patient communication – the issue most compromised when a language barrier exists – is strongly seen as a driving force behind patient outcomes

The clear majority of providers see improving the ability of Spanish-speaking patients to benefit from the health care system as an important priority

Hospital executives are particularly interested in improvements in this area, and - when compared with doctors on the front line - more often accept responsibility for accommodating the language barrier. Doctors more often feel that it’s the patient’s responsibility to function within the existing system

Providers see significant opportunities to improve the system’s ability to accommodate its Spanish-speaking patients (only 9% say currently doing this very well – nearly half say it doesn’t do this well)

From a patient perspective, however, there is not a clear cry for improvements. They often feel that the current system accommodates them well

Language Barrier Issues: Spanish Speaking Patient Perspective

• Incidence of Accommodation

• Areas Most Impacted

• Coping Strategies


52%

18%

6%

12%

12%

Most Spanish Speakers Are Faced with Provider Alternatives Where The Majority Are Unable to Speak/Translate Spanish

HQ8: Overall, when you visit health care professionals and pharmacists in your community, how many do you find are able to speak Spanish themselves or have someone on staff that can help with translation or interpretation?

All

Most

Half

Some

None


Proportion of local health care professionals who speak Spanish or have someone on their staff who can

36% half or more

64% some or less


Clear Majority of Spanish Speaking Public Say Achieving Positive Outcomes Compromised by Language Barrier

HQ12: Now, please think about a time when you were with a doctor, nurse, pharmacist or other health care provider who only spoke English and there was no translator available. Please tell me for each of the areas, was it …


31%: Language has no impact on care outcomes

68%: Positive outcomes are made more difficult when providers neither speak

Spanish nor offer translators


Areas Where Language Barrier Has Most Negative Impact: Patient View

37%

33%

32%

31%

30%

32%

35%

31%

25%

43%

38%

38%

37%

37%

32%

26%

30%

25%

80%

71%

70%

68%

67%

64%

62%

61%

51%

A little more difficult Much more difficult


Ability to fully explain symptoms/ask questions

Ability to follow-through with filling prescriptions

Trusting doctor understands your medical needs

Care provided resulted in positive outcomes

Ability to understand doctor’s recommendations

Seeing doctors as often as needed

Following up with recommended appointments

-Spanish Speaking Public Data –

- % more difficult when with English-speaking only provider -

Easily scheduling appointments

Taking medications according to instructions

Total % More Difficult


One in Five Have Gone Without Care When Needed Due to Language Obstacles

- Spanish Speaking Latino Data -

HQ11: In the course of the past year, how many times were you sick, but decided not to visit a doctor because the doctor didn’t speak Spanish or have an interpreter?

19% Have not sought care when needed due to language barrier


Bringing Along a Translator Tops List of Strategies for Spanish-Speaking Patients

46%

33%

15%

4%

1%

HQ10: When faced with the possibility of visiting a doctor’s office where no one speaks Spanish and no interpreter is provided, what do you usually do?

Go, but bring along someone to help with translations

Go alone anyway and try to make it work

Not go, but find a different doctors office that could communicate in Spanish

Never faced with this situation

Not go, instead care for yourself at home



Language Barrier Issues - Spanish Speaking Patient Perspective: Summary Overview

Despite the feeling that they’re “accommodated,” the vast majority of Spanish-speaking patients are faced with provider alternatives in their community that generally do not speak Spanish or offer translators

The clear majority of Spanish-speaking patients (68%) feel that the language barrier makes positive outcomes from their care experience more difficult to achieve

Problems with communication have resulted in one in five Spanish-speaking patients not pursuing care when it was needed

Nearly half of patients routinely bring along someone to help with translations during doctor visits in an attempt to function within the system

Language Barrier Issues: Provider Perspective

• Incidence of Accommodation

• Areas Most Impacted

• How It Is Handled

• Barriers


Majority of Provider Environments Include Spanish Speaking Staff

PQ16: Do you have someone on your full time staff, including yourself, that can help with interpretations for Spanish-speaking patients? PQ17: How would you describe your own Spanish skills?

7%

59%

34%

Fluent

Speak /understand

someSpanish

Don’tunderstand

the languageat all

No20%

Yes79%

- Provider Data -

Have Someone on Staff to Help Providers’ Own Skills


Where Providers Say System Fall Short

PQ7: In what specific ways, areas, or process does the health care system not accommodate this group? Where exactly does it fall short?

40% - Barriers to Communication with Patients

“I think that because the patient cannot communicate with the provider they do not get the quality of care that they deserve.”

37% - Lack of Interpreters

“It's still hard to find interpreters at the time of service.”“There aren't always Spanish speaking persons available on hand.”

26% Problems Treating Patients

“If you cannot communicate with the patient you cannot adequately prescribe. Most Hispanics have not had a wellness screening approach to medicine, they only had a crisis approach -- they only continue to come in when they are sick.”

24% - Lack of Bilingual Staff

“Primarily we don't have physicians that speak Spanish. We have support staff, but not the primary physicians.”

13% Lack of Spanish Materials

“I think sometimes as long as you have communication pamphlets or audio visuals that explain things to patients and if you're bilingual it makes the communication more effective.”

12% - Financial Concerns

“Access to medication due to financial difficulties.”

- Provider Data / Open End Response Categories -


Areas Where Language Barrier Most Compromises Outcomes

PQ11: When you think about aspects of health care that are compromised due to the existence of a language barrier, which aspects are most compromised? Please indicate the degree of compromise you feel a language barrier has on outcomes for each aspect mentioned.

50% or more feel significantly

compromises outcomes

Fully understanding doctor’s treatment advice and medical condition/disease

Fully explaining symptoms/problem/concerns to provider Increased risk of complications when concurrent medications or home

remedies being used are not discovered Incomplete or inaccurate medical history

40-50% or more significantly


Follow-through on doctor recommended advice Taking medications according to instructions Limited knowledge of services that are available or how to access care Unable to identify cognitive or functional impairment.

Less than 40% feel significantly


Following up with recommended appointments with specialists Overall, going to see doctors as often as they should when needed Unable to obtain informed consent and patients are offered fewer

treatment alternatives Unable to establish trust/confidentiality with patient due to use of a third

party to communicate Unable to properly diagnose Problems making appointments

- Provider Data -


Areas Where Language Barrier Most Compromises Outcomes: Provider View

52%

51%

51%

50%

43%

42%

41%

PQ11: When you think about aspects of health care that are compromised due to the existence of a language barrier, which aspects are most compromised? Please indicate the degree of compromise you feel a language barrier has on outcomes for each aspect mentioned. Use a 7-point scale, where 1 means “language barrier does not compromise outcomes at all” and 7 means “language barrier compromises outcomes significantly.”

Follow-through on doctor recommended advice

Fully explaining symptoms/problem/concerns to provider

Fully understanding doctor’s treatment advice and medical condition/disease

Limited knowledge of services that are available or how to access care

Taking medications according to instructions

- Provider Data / % Top 2 (Rating 6/7) on scale -

Increased risk of complications when concurrent medications or home remedies being used are not discovered

Incomplete or inaccurate medical history


40%

36%

31%

30%

29%

28%

26%


Problems making appointments

Unable to properly diagnose

Unable to obtain informed consent and patients are offered fewer treatment alternatives

Unable to identify cognitive or functional impairment

Unable to establish trust/confidentiality with patient due to use of a third party to communicate

- Provider Data / % Top 2 (Rating 6/7) on scale -

Areas Where Language Barrier Most Compromises Outcomes: Provider View (Cont’d)

Following up with recommended appointments with specialists

Overall, going to see doctors as often as they should when needed


Providers Approach the Language Barrier With A Range of Strategies

PQ10: Different (hospitals/clinics/offices) handle getting around the language barrier in different ways. If a patient that speaks only Spanish comes into your practice or hospital, what usually happens?

56% Spanish Speaking Staff

“We get one of the staff members who is Spanish speaking to translate.”

“I grab a Spanish-speaking employee and ask for help.”

39% Provide Interpreter/Translator

“We usually try to find someone who can interpret for us, and we usually have someone who can do that.”

“We usually try to find someone to translate. We have Spanish translators over the phone and also books to help. “

22% Patient Provides Interpreter

“Well, if somebody's on staff that can speak Spanish we grab them. If not then we have a family member or friend translate. If we can't do that then we use pictures, but boy is it difficult.”

20% Telephone Language Service

“We have dedicated translators, and we also use the AT&T language line to back it up.”

16% Provide Written/Visual Help

“We can use a lot of pictures and diagrams. We can print stuff both in Spanish in English using the computer.”

11% Call for Translator/Interpreter

“If we have a Spanish speaking patient we assign them to a Spanish speaking specialist and we call in a person to translate. “



Current Translation Approach Relies Heavily on Informal Methods

4%

15%

29%

51%

PQ10A-A: There are a number of ways interpretive services can happen in health care organizations. I’m going to describe four models. Please tell me which best describes how your organization currently operates.

Patients bring family/ friends to translate

Patients bring family/ friends to translate

Retain external group to provide interpreting services on-site or remotely

Retain external group to provide interpreting services on-site or remotely

Staff such as doctors, nurses, clerks help with translations

Staff such as doctors, nurses, clerks help with translations

dolor

piernahinchazón

Foreign language training for health professionals offered

Foreign language training for health professionals offered

- Provider Data -


According to Providers, Cost Dominates List of Barriers to Doing More

53%

13%

6%

6%

6%

6%

5%

3%

3%

PQ14: Please think for a moment about why more steps aren’t taken to better accommodate the primarily Spanish speaking patient. What do you feel is the main barrier preventing organizations from doing more in this area?

Cost issues

No language skills on staff

Not enough doctor/nurse/staff

No resources/ideas for dealing with the problem

Not an institutional priority/lack of focus

Lack of training/knowledge about how to accommodate

Not enough time

Patient responsibility

Prejudice/cultural issues

- Provider Data -


Language Barrier Issues - Provider Perspective: Summary Overview

In these high-need communities, the majority of provider organizations have someone on staff that is able to speak Spanish to serve as an interpreter.

The area most compromised by the language barrier is the obvious one: problems with adequate communication. Providers are not confident that they fully understand the patient’s situation, nor are they confident that the patient is able to understand their explanations and instructions pertaining to treatment.

At provider organizations, staff in all positions - from nurse to janitor – are relied on for help with interpretation and translation as a “band-aid” measure. This is currently the main way these provider organizations are handling the issue.

Providers see cost issues as the major impediment to effectively solving the problem.

Solutions


Most Effective Steps to Help: Patient’s View

HQ13: Obviously, it creates a problem for both doctor and patient when there is a language barrier. What do you think offices should provide to patients such as yourself who are comfortable speaking only Spanish? What should they do to make it easier?

49%

Bilingual Providers/Staff

“Employ people that speak Spanish. Always have someone who can communicate with the patients that speak Spanish.”

“Have more bilingual people to help them when someone needs medicine or is going to communicate with the doctor.”

45%

Interpreters

“They must have an interpreter for those who come and can't speak English. So everything will go all right.”

“They should have interpreters if the doctor doesn't speak Spanish and the person doesn't speak English.”

15%

Patients Should Learn English /

Language Education

” The responsibility is the patients’. Yes, you should put more interest in learning English, the language is English here and we should communicate.”

“Learn the language of the doctor in order to be able to express oneself better in the language of the doctor.”

12%

Doctors Should Speak Spanish

“The doctor could be bilingual so that we Hispanics could communicate with other Americans.”

“I feel a little uncomfortable. Have a doctor that speaks Spanish.”

- Spanish Speaking Public Data / Open End Response Categories -


Trained interpreters to tell the doctor everything you say

What Would Be Helpful?: Patient’s View

88%

86%

80%

78%

66%

34%

HQ14: There are a number of steps that could be taken to help Spanish-speaking patients and English-speaking doctors better communicate. Tell me how helpful each of the following would be to you. Use a 1 to 5 scale where 1 means not at all helpful and 5 means significantly helpful.

Standard care instructions translated into Spanish

Training doctors to look at/talk to you when using an interpreter

Doctor’s office staff that can explain in Spanish appointments/exams

Doctors to better understand home remedies and folk healers

- Spanish Speaking Public Data / % Top 2 (4/5 Rating) on scale -

Hand-held electronic devices available to translate a

conversation


• Interpreters wouldn’t explain things to patient clearly• Interpreter would omit info/not tell everything• Patients wouldn’t tell the whole truth• Privacy• Embarrassment• Interpreters would use terms that are new or unfamiliar• Interpreter doesn’t understand patient• Doctor will look at/talk to interpreter, not patient• No Interpreter Available• No Trust/Confidence in Interpreter/Doctor communication• Patient wouldn’t talk about personal things when translator present

No Concerns

35% Have Concerns

65%

Interpreters: A Patient’s Perspective

HQ15: How important do you feel it is that you talk directly to a doctor or nurse when getting care, rather than through an interpreter? HQ16: Some people have concerns about using an interpreter during a doctor visit, others don’t. What specific concerns, if any, do you

have about having an interpreter help doctors and patients communicate?

Concerns About Using an Interpreter

Importance of Talking Directly to ProviderVery Important

Not Important

At All

92% 7%1%

Very Important Somewhat important Not very important Not at all important

99% 1%



Most Effective Steps to Help: Provider’s View

PQ13: Next, we’d like to better understand some of the steps that providers can take to address the language barrier presented in the care of those who speak primarily Spanish. What are the most effective steps you have taken or know of that can help this group better use and benefit from the health care system?

38%

Use Interpreters

“Using professional translators -- people who understand every nuance of the language.”

“The use of interpreters and less reliance on a person who works in the hospital like a clerk, or cleaning staff because of confidentiality -- so we bring in trained professional interpreters.”

33%

Bilingual Staff

“I think if you are in a location that has a high volume of Spanish speaking patients you should have at least one employee who speaks Spanish.”

32%

Employee Education (Spanish Classes)

“Training in medical Spanish is critical.”“We have initiated classes for more people to speak and understand

Spanish.”

32%

Materials in Spanish

“We had a lot of written information in Spanish for ailments and disease prevention.”

12%

Patient Education

“They need to learn the language.”“Language classes in schools or churches.”



What Would Be Helpful?: Provider’s View

69%

61%

56%

50%

50%

47%

45%

39%

35%

32%

PQ15A: Next, I’m going to read a number of things that could be provided to you to help this communication. Please tell me which of the following would be significantly helpful to you on a 1 to 7 scale where 1 means not at all helpful and 7 means significantly helpful in communicating with Spanish-speaking patients.

Accessible services to non English-speaking patients

Help with assessing your language competencies

Background on subpopulation differences/behavior

Spanish language standard care instructions

Materials/tapes for Spanish speaking patients

Funding to develop medical interpreter capacity

Help distinguish good interpreters from poor ones

- Provider Data / % Top 2 (6/7 Rating) on scale -

Instruction on using interpreters successfully

Identify language banks or technology

Funding for computer-aided interpretation equipment


What Would Be Helpful?: Provider’s View- Provider Data by Segment -

Physicians Nurses Hosp. Admin. Pharmacists

Spanish language standard care instructions 65% 74% 67% 69%

Materials/tapes for Spanish speaking patients 50% 75% 62% 57%

Funding to develop medical interpreter capacity 48% 62% 70% 48%

Help distinguish good interpreters from poor ones 43% 60% 47% 48%

Identify language banks or technology 38% 57% 47% 59%

Funding for computer-aided interpretation equipment 28% 54% 52% 60%

Accessible services to non English-speaking patients 32% 52% 52% 48%

Instruction on using interpreters successfully 31% 49% 31% 43%

Help with assessing your language competencies 28% 39% 31% 44%

Background on subpopulation differences/behavior 26% 41% 34% 25%

PQ15A: Next, I’m going to read a number of things that could be provided to you to help this communication. Please tell me which of the following would be significantly helpful to you on a 1 to 7 scale where 1 means not at all helpful and 7 means significantly helpful in communicating with Spanish-speaking patients.


Interpretive Service Approaches: Current vs. Ideal

4%

15%

29%

51%

PQ10A-A: There are a number of ways interpretive services can happen in health care organizations. I’m going to describe four models. Please tell me which best describes how your organization currently operates.

PQ10A-B: Which you feel is the best solution to the language barrier.

24%

15%

19%

41%

Currently Operate Best Option

Offer language trainingUse contract services

Use family provided

Use employees

- Provider Data -


Solutions: Summary Overview

Patients most often call for bilingual medical staff as the solution that would work best for them and also for interpreters. Providing standard materials in Spanish also is a valued resource

There is only moderate interest among Spanish-speaking patients in technology-based solutions

Despite the call for interpreters, patients have strong opinions about the importance of communicating directly with their providers. Most have concerns about using a translator. Concerns are primarily focused on the clarity/accuracy of both sides of the communication exchange and issues pertaining to privacy

Providers also envision solutions focusing on staff’s language abilities and use of translators. Many – one-third – mention language training for staff in Spanish (including medical Spanish) as something that would be valued

When specific solutions are posed, providers are most responsive to those that answer needs immediately – providing of specific materials in Spanish for patient reference. The focus is on helping the provider help the patient

Although providers exhibit slightly more openness to technology-based solutions, they clearly do not view it as the first line of defense

Appendix

Spanish Speaking Patients

• Care Overview: Usage Patterns

• Care Locations: Where and Why

• Reasons for Not Seeking Care

• Respondent Profile


Many Spanish Speaking Patients Rarely Visit Doctor

HQ5: Please think about your experience visiting doctors, hospitals, clinics, or pharmacists in your community. Which best describes you personally…

I rarely visit a doctor, only when it’s absolutely

necessary

I visit doctors when I’m sick, and try to

go before the problem gets too

bad

I visit doctors fairly regularly, including

when I’m sick and for routine check-ups and

other preventative care

41% 29% 30%



Care Location: Where and Why?

37%

36%

16%

6%

34%

32%

12%

3%

For Yourself For Your Child/Children

HQ6: Most often, what type of place to do you go to for your health care? For your children? ( Reduced Base n=393)HQ7: Please think about the health care facility you go to most often. How did you choose this location?

Where Consumers Go for Healthcare Why They Go There

33%

23%

13%

5%

4%

4%

4%

3%

Doctor’s OfficeRecommendation

Insurance covered it

Close to home

They speak Spanish/have interpreter

Lower cost

Good providers

Referral

Spanish Advertisement


Hospital-based clinic

Clinic

Hospital ER


Reasons for Not Seeking Health Care in the Past 12 Months

Reduced Base (n=222) Asked of those who did not qualify for survey because they haven’t visited a doctor or health care provider in the past yearQE: What is the main reason you have not visited a doctor in the past year?

76%

10%

2%

1%

1%

No one got sick

Too expensive/costmoney

Not sure where to go

Treat illness at home

Language barrier

Reasons for Not Visiting A Health Care Provider in the Past Year



Respondent Profile: Spanish-Speaking Consumers

Someone in immediate family suffers from chronic illness (% Yes) 28%

Number of years lived in the U.S. 9.9 Yrs.

Average Age 36.5 Yrs.

Country of origin:

Colombia 2% Mexico 76% Nicaragua 1%

Cuba 3% Puerto Rico 7% Peru 1%

El Salvador 3% Dominican Rep. 2% Venezuela 1%

Guatemala 2% Honduras 1% USA 1%

Gender:

Male 34%

Female 66%



Spanish Speaking Patients: Level of Exposure to Health Care System

- Spanish Speaking Public Data by Level of Exposure -

High Exposure(n=138)

Low Exposure (n=360)

Incidence of Accommodation:

More than Half Speak Spanish 38% 34%

Less than Half Speak Spanish 62% 65%

Overall Care --Quality in Community:

Excellent/Very Good 30% 28%

Good 39% 46%

Fair/Poor 29% 26%

Go alone and try to make it work 38% 32%

Go, bring along someone to translate 43% 48%

Not go, find a different doctor’s office that could communicate in Spanish

17% 15%

Didn’t pursue care due to language 23% 17%

No Notable Differences

No Notable Differences


Areas Where Language Barrier Has Most Negative Impact: Patient View by Exposure Level


-Spanish Speaking Public Data by Exposure Level–

- % more difficult when with English-speaking only provider -

High Exposure (n=111)

Low Exposure (n=281)

Ability to fully explain symptoms/ask questions 85% 79%

Ability to follow-through with filling prescriptions 68% 72%

Trusting doctor understands your medical needs 73% 69%

Care provided results in positive outcomes 72% 66%

Ability to understand doctor’s recommendations 75% 64%

Seeing doctors as often as needed 66% 63%

Following up with recommended appointments 66% 60%

Easily scheduling appointments 66% 58%

Taking medications according to instructions 47% 52%

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Spanish Speaking Patients: Level of Exposure to Health Care System

-Spanish Speaking Public Data by Exposure Level -

High Exposure (n=138)

Low Exposure(n=360)

Importance of talking directly to doctor/nurse when getting care (% Very Important)

93% 91%

Have concerns with interpreters 71% 63%

Top 3 Concerns:

Interpreter wouldn’t explain things to patient clearly/understandably

34% 31%

Interpreter would omit info/Not tell everything 33% 29%

Patients wouldn’t tell the whole truth 7% 6%

Top 3 Steps to Better Communication:

Trained interpreters to tell the doctor everything you say 87% 88%

Doctor’s office staff that can explain in Spanish appointments/exams

85% 87%

Standard care instructions translated into Spanish 78% 81%

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The Provider Environment

• The Provider’s Changing World

• Respondent Profile

• Outcomes by Provider Segment


Providers Indicate Increasing Numbers of Spanish Speaking Patients; A Group That Presents Them With a Challenge

37% 39% 76%

1%

22%

1%

22%

Increased

Stayed theSame

Decreased

PQ8: You indicated earlier that a proportion of your patient base speaks primarily Spanish. Compared to three years ago, do you think that the frequency with which your organization is personally treating these health care consumers has…

PQ9: In your personal practice or work environment, how big of a challenge does dealing with primarily Spanish-speaking consumers present relative to the challenge of your English-speaking clientele?

35%

54%

11%

Slightly Significantly

- Provider Data -

Significantly more of a challenge

Slightly more of a challenge

No more challenge than English-speaking pat


Respondent Profile: Providers

Physicians Nurses Hosp. Admin. Pharmacists

Average number of years in the field 19 23 22 16

Patient base with English difficulty:

5-10% 53% 33% 39% 44%

10% or more 47% 67% 61% 56%

Primary Hospital Type:

Community Hospital 74% 64% 65% —

Government Hospital 2% 4% 8% —

For Profit 37% 32% 18% —

Practice Setting: Office-based 65% 29% — —

Average number of customers served in a week N/A N/A N/A 981

- Provider Data -


Areas Where Language Barrier Most Compromises Outcomes: Provider View

- Provider Data by Segment - -% Top 2 (Rating 6/7) on scale-


Physicians Nurses Hosp. Admin. PharmacistsFully understanding doctor’s treatment advice and medical condition/disease 43% 57% 56% 54%

Fully explaining symptoms/problem/concerns to provider 44% 53% 54% 53%

Increased risk of complications when concurrent medications or home remedies being used are not discovered 39% 53% 52% 66%

Incomplete or inaccurate medical history 44% 55% 52% N/A

Follow-through on doctor recommended advice 36% 46% 45% 47%

Taking medications according to instructions 32% 48% 44% 47%

Limited knowledge of services that are available or how to access care 36% 43% 41% 47%

Unable to identify cognitive or functional impairment 39% 38% 44% N/A

Following up with recommended appointments with specialists 32% 39% 40% 34%

Overall, going to see doctors as often as they should when needed 24% 36% 33% 32%

Unable to obtain informed consent and patients are offered fewer treatment alternatives 25% 35% 30% N/A

Unable to establish trust/confidentiality with patient due to use of a third party to communicate 23% 35% 31% N/A

Unable to diagnosis properly 23% 32% 29% N/A

Problems making appointments 18% 32% 31% N/A


Providers: Regional Differences

Northeast(n=30)

Midwest(n=109)

South(n=486)

West(n=377)

Overall Care – Quality

Excellent/VG 77% 88% 83% 80%

Good 37% 39% 39% 36%

Fair/Poor 23% 12% 17% 20%

Communications -- % Very Important 93% 94% 94% 94%

Barrier Issue -- % Top/Very Important Priority 70% 68% 64% 73%

Responsibility:

Provider’s Responsibility 57% 61% 57% 64%

Patient’s Responsibility 43% 39% 42% 36%

Level of Accommodation:

% Accommodate Very/Moderately Well 57% 58% 50% 55%

% Accommodate Not Very Well/Not Well At All 43% 42% 49% 45%

Hispanic Patient Base Increased in Past 3 Years 70% 85% 80% 69%

-Provider Data by Region -

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Providers: Regional Differences

Northeast(n=30)

Midwest(n=109)

South(n=486)

West(n=377)

Have someone on staff to help with interpretations -- % Yes

57% 74% 77% 86%

Top 5 Impacts of Language Barrier (Top 2 Box %):

1. Fully understand doctor’s treatment advice and medical condition/disease

60% 53% 54% 48%

2. Fully explaining symptoms/problems/ concerns to provider 53% 57% 52% 46%

3. Increased risk of complications when concurrent medications or home remedies being used are not discovered

43% 49% 54% 49%

4. Incomplete or inaccurate medical history 47% 50% 51% 49%

5. Follow through on doctor recommended advice 43% 43% 45% 39%

Current Translation Model:

Workforce Model 53% 47% 47% 56%

Patient-Based Model 47% 23% 35% 22%

Contract Service Model — 25% 13% 15%

Language Training Model — 4% 3% 5%

Cost Issues as Barrier 57% 50% 51% 58%


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What Would Be Helpful: Provider’s View of Solutions by Region

Northeast(n=30)

Midwest(n=109)

South(n=486)

West(n=377)

Spanish language standard care instructions 60% 70% 69% 70%

Materials/tapes for Spanish speaking patients 53% 63% 63% 59%

Funding to develop medical interpreter capacity 60% 56% 56% 56%

Help distinguish good interpreters from poor ones 60% 53% 49% 49%

Identify language banks or technology 43% 50% 56% 42%

Funding for computer-aided interpretation equipment 43% 50% 51% 40%

Accessible services to non English-speaking patients 37% 45% 48% 43%

Instruction on using interpreters successfully 47% 37% 41% 35%

Help with assessing your language competencies 13% 38% 38% 33%

Background on subpopulation differences/behavior 43% 31% 32% 31%


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hablamos juntos – we speak together research conducted for proj #7666 october/november 2001 w i r...

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