The Effect of Initiatives to Overcome Language Barriers and Improve Attendance: A Cross-Sectional Analysis of Adherence in an Inner City Chronic Pain Clinic

Andreae, Michael H.; White, Robert S.; Chen, Kelly Yan; Nair, Saraswathy; Hall, Charles B.; Shaparin, Naum

doi:10.1093/pm/pnw161

Cited by 32 publications

(29 citation statements)

References 35 publications

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“…The aforementioned associations hold in subgroup analyses, which lend additional credence to our concept that the important component of the intervention is the attunement, which is in line with the importance of cultural and language concordance for patient-provider interactions, especially in the Hispanic immigrant populations[1,2,7,23]. We note that Spanish was only used in about 29 percent of the calls made.…”

Section: Resultssupporting

confidence: 75%

“…We hypothesized that patient concerns about cultural incongruence may be ameliorated by human outreach in the patient’s preferred language[1,7]. Based on retrospective cohort studies, we demonstrated that targeted health system improvements can improve access[2]. …”

Section: Introductionmentioning

confidence: 99%

“…those born outside the United States, may be especially vulnerable to discouraging experiences already during the pre-encounter process [7]. Actual or perceived discrimination in the pain clinic [14–17], for example concerns about opioid addiction or dependence triggered by minority status[18,19], can estrange patients[20] from their physicians and providers in addition to cultural and language barriers [2] and concerns about healthcare insurance coverage.…”

Section: Introductionmentioning

confidence: 99%

“…With limited evidence available on how to influence the demand side of health care disparity in pain medicine[7,14,22], we postulated that native language personnel and unified clinics (seeing all patients in the same outpatient location with equitable access) helps to overcome such barriers, but that individualized outreach to patients by phone[13], in a language the patient understands, prior to scheduled appointments would establish a human rapport[23] before the actual encounter and improve adherence[1,2]. While PASA certainly imparts considerable costs to the institution[24], counter measures also consume resources and need to be justified to be financially sustainable considering the current pressures to cut cost[25].…”

Section: Introductionmentioning

confidence: 99%

“…We seek to investigate in sequential pragmatic clinical trials (PCT), which of the several language-targeted adjustments (Spanish certified staff, reminder calls in the preferred language, unified scheduling and clinic system for insured and uninsured, financial incentives to cover transport expenses…) to the appointment process [1,2] is most effective. In this first RCT, we investigate if a human reminder phone call, the day before their first appointment, in the patient’s preferred language (Spanish versus English), improves attendance in our inner-city academic chronic pain clinic in the Bronx, NY, serving a resource poor, racially and ethnically diverse, predominantly Hispanic population.…”

Section: Introductionmentioning

confidence: 99%

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A pragmatic trial to improve adherence with scheduled appointments in an inner-city pain clinic by human phone calls in the patient's preferred language

Andreae

Nair

Gabry

et al. 2017

Journal of Clinical Anesthesia

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Study Objective We investigated if human reminder phone calls in the patient’s preferred language increase adherence with scheduled appointments in an inner-city chronic pain clinic. We hypothesized that language and cultural incongruence is the underlying mechanism to explain poor attendance at clinic appointments in underserved Hispanic populations. Design Pragmatic randomized controlled clinical trial Setting Innercity academic chronic pain clinic with a diverse, predominantly African-American and Hispanic population Patients All (n=963) adult patients with a scheduled first appointment between October 2014 and October 2015 at the Montefiore Pain Center in the Bronx, New York were enrolled. Interventions Patients were randomized to receive a human reminder call in their preferred language before their appointment, or no contact. Measurements We recorded patients’ demographic characteristics and as primary outcome attendance as scheduled, failure to attend and/or cancellation calls. We fit Bayesian and classical multinomial logistic regression models to test if the intervention improved adherence with scheduled appointments. Main Results Among the 953 predominantly African American and Hispanic/Latino patients, 475 patients were randomly selected to receive a language-congruent, human reminder call, while 478 were assigned to receive no prior contact, (after we excluded 10 patients, scheduled for repeat appointments). In the experimental group, 275 patients adhered to their scheduled appointment, while 84 cancelled and 116 failed to attend. In the control group, 249 patients adhered to their scheduled appointment, 31 cancelled and 198 failed to attend. Human phone reminders in the preferred language increased adherence (RR 1.89, CI95% [1.42, 1.42], (p<0.01). The intervention seemed particularly effective in Hispanic patients, supporting our hypothesis of cultural congruence as possible underlying mechanism. Conclusions Human reminder phone calls prior in the patient’s preferred language increased adherence with scheduled appointments. The intervention facilitated access to much needed care in an ethnically diverse, resource poor population, presumably by overcoming language barriers.

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