Patient Satisfaction with Different Interpreting Methods: A Randomized Controlled Trial

Abstract

BACKGROUND: Growth of the foreign-born population in the U.S. has led to increasing numbers of limitedEnglish-proficient (LEP) patients. Innovative medical interpreting strategies, including remote simultaneous medical interpreting (RSMI), have arisen to address the language barrier. This study evaluates the impact of interpreting method on patient satisfaction.METHODS: 1,276 English-, Spanish-, Mandarin-, and Cantonese-speaking patients attending the primary care clinic and emergency department of a large New York City municipal hospital were screened for enrollment in a randomized controlled trial. Language-discordant patients were randomized to RSMI or usual and customary (U&C) interpreting. Patients with language-concordant providers received usual care. Demographic and patient satisfaction questionnaires were administered to all participants.RESULTS: 541 patients were language-concordant with their providers and not randomized; 371 were randomized to RSMI, 167 of whom were exposed to RSMI; and 364 were randomized to U&C, 198 of whom were exposed to U&C. Patients randomized to RSMI were more likely than those with U&C to think doctors treated them with respect (RSMI 71%, U&C 64%, p<0.05), but they did not differ in other measures of physician communication/ care. In a linear regression analysis, exposure to RSMI was significantly associated with an increase in overall satisfaction with physician communication/care (β 0.10, 95% CI 0.02-0.18, scale 0-1.0). Patients randomized to RSMI were more likely to think the interpreting method protected their privacy (RSMI 51%, U&C 38%, p<0.05). Patients randomized to either arm of interpretation reported less comprehension and satisfaction than patients in language-concordant encounters. CONCLUSIONS:While not a substitute for languageconcordant providers, RSMI can improve patient satisfaction and privacy among LEP patients. Implementing RSMI should be considered an important component of a multipronged approach to addressing language barriers in health care.

Changes in Language Services Use by US Pediatricians

“…33,34 Other remote interpretation methods, such as video or remote simultaneous medical interpreting, demonstrate promise in increasing interpreter use and patient satisfaction and may be an important way to increase interpreter use among pediatricians. 35,36 To date, evaluation of use of these interpretation methods has been in large, urban settings; more research is needed on how well remote interpretation methods can address financial and resource barriers to interpreter use in rural or small practices. There are also few examples of how practices or hospitals may collaborate to maximize interpreter availability and contain costs, which may be especially important for small or more rural practices.…”

Use of Interpreters by Physicians for Hospitalized Limited English Proficient Patients and Its Impact on Patient Outcomes

“…Recent studies have demonstrated that remote telephone or video conferencing modes are as effective as in-person interpretation as measured by communication quality and patient satisfaction. [34][35][36][37] Use of these non in-person methods should be encouraged in the hospital setting, where in-person interpretation may not be readily available throughout the 24-hour hospital continuum of care.…”

Alterations in Medical Interpretation During Routine Primary Care

“…In one study, communication problems contributed to adverse events at a much higher rate among LEP patients (52.4%) than English speakers (35.9%), with 49.1% of adverse events rising to the level of clinical significance in LEP populations, compared to 29.5% in English-speaking populations. 3 Many studies have shown that LEP patients tend to have lower rates of preventive screening and higher rates of hospitalization and drug complications 2,3,9,[11][12][13][14][15] . Lack of discussion and poor understanding of treatment plans, including medication side effects, are likely reasons for these concerning rates, as such factors can lead to patient dissatisfaction and reduce adherence to physician recommendations [16][17][18] .…”