Primary Care Utilization and Mental Health Diagnoses Among Adult Patients Requiring Interpreters: a Retrospective Cohort Study

Abstract

BACKGROUND: Patients requiring interpreters may utilize the health care system differently or more frequently than patients not requiring interpreters; those with mental health issues may be particularly difficult to diagnose. OBJECTIVE: To determine whether adult patients requiring interpreters exhibit different health care utilization patterns and rates of mental health diagnoses than their counterparts. DESIGN: Retrospective cohort study examining patient visits to primary care (PC), express care (EC), or the emergency department (ED) of a large group practice within 1 year. PATIENTS: Adult outpatients (n=63,525) with at least one visit within the study interval and information regarding interpreter need. MAIN MEASURES: Mean visit counts, counts of mental disorders, and somatic symptom diagnoses between patients requiring interpreters (IS patients) and not requiring interpreters (non-IS patients). KEY RESULTS: IS patients (n=1,566) had a higher mean number of visits overall (3.10 vs. 2.52), in PC (2.54 vs. 1.95), and in ED (0.53 vs. 0.44) than non-IS patients (all p<0.01). IS patients had a lower mean number of visits in EC than non-IS patients (0.03 vs. 0.13; p<0.01). Interpreter need remained a significant predictor of visit count in multivariate analyses including age, sex, insurance, and clinical complexity. A greater proportion of IS patients were high utilizers (10+ visits) than non-IS patients (3.6 % vs. 1.7 %; p< 0.01). IS patients had a lower frequency of mental health diagnoses (13.9 % vs. 16.7 %), but a higher frequency of diagnoses recognized as potential somatic symptoms including diseases of the nervous (29.3 % vs. 24.2 %), digestive (22.6 % vs. 14.5 %), and musculoskeletal systems (43.2 % vs. 34.5 %), and ill-defined conditions (61 % vs. 49.9 %), all p<0.01. CONCLUSIONS: IS patients visited PC more often than their counterparts and were more often high utilizers of care. Two sources of high utilization, mental health diagnoses and somatic symptoms, differed appreciably between our populations and may be contributing factors.

Telephone triage utilization among patients with limited English proficiency

“…Previous studies have shown patterns of inefficient healthcare utilization among patients with LEP compared with patients who are English-proficient. These studies reveal higher rates of use for diagnostic studies and increased ED visit times for patients with LEP, higher rates of outpatient and inpatient health care utilization [ 25 – 27 ], and longer hospital stays [ 28 ]. The results of this study support these previous findings, and suggest that these inefficiencies may be mediated, in part, by the tendency of primary care systems to disproportionately recommend higher acuity services to patients with LEP.…”

Impact of Language Barriers on Quality of Care and Patient Safety for Official Language Minority Francophones in Canada

“…Language concordance between patient and provider is essential for effective communication to ensure accurate patient assessment, appropriate examinations, ancillary testing, diagnosis, and prescribed treatment (9 -11). Language barriers also impact chronic disease management such as for asthma and diabetes (3,12 -14), as well as end-of-life care (15) and pain management (16). Increased risk of failure to obtain informed consent (17,18) and protect patient privacy and confidentiality (19,20) when language barriers are present are also reported.…”

Language Barriers in Hispanic Patients: Relation to Upper-Extremity Disability

“…Several limitations of the study should be kept in mind to better interpret our results. First, although we dichotomized language proficiency, many would argue that it is a more continuous concept [6, 12]. Second, similar musculoskeletal disability may be rated different by disparate cultural groups owing to their inherent conceptualization of how the measure should be anchored [6].…”