In this study, we examine the influence of interpreter use on new medication advising for Spanish-speaking Latinos. We find that Latino patients who use interpreters receive significantly more verbal information when a new medication is prescribed than Latino patients who do not need interpreters. This is important because better patient-provider communication and more detailed medication explanations may improve patient medication adherence24-26
and clinical outcomes.27-29
Thus, physicians should not only convey important medication-related information, but also ensure that patients understand the information given.
Patients who reported needing an interpreter but not using one also received more medication advice than those who did not need an interpreter. This was only statistically significant for discussions about medication directions, but the trend suggests enhanced provider attention to medication-related communication when treating patients with LEP. This is encouraging because it shows that providers may be amenable to interventions to improve communication with non-English speaking patients. Similarly, the finding that patients without health insurance are given more verbal information on medication directions suggests that providers may give more information when they think patients might have difficulties with their follow-up care. Alternatively, providers in the private setting who see primarily insured patients may not be sensitized to more vulnerable LEP patients and may not have interpreters as readily available to communicate information. Potential bias from the sample’s high insurance coverage rate also may contribute to this finding.
Despite communicating more information to Spanish-speaking Latinos who used or needed interpreters, physicians and pharmacists still conveyed key medication information30,31
very inconsistently to all patients in our study sample. Medication side effects are communicated to patients more frequently, whereas medication purpose and directions are communicated less often compared with previous direct observation studies focused on physicians and English-speaking patients.12,13,15,24
This is particularly concerning given that patient responses in this study incorporate both physician and pharmacist information provision, and reflects what generally happens in the community, where patients obtain counseling from both parties. Comparable with our analysis of Spanish-speaking Latinos, a previous survey of English-speakers also showed that about one-third of patients do not receive new medication instructions.32
Our results show that pharmacies often fail to provide Spanish-speaking Latinos with information that may be needed to safely use new medications. More than half of patients reported not getting a Spanish language medicine bottle label and medication information written in Spanish. Our results are in agreement with other survey studies examining non-English language pharmacy services.33,34
Compared with English-speakers in the 2004 Food and Drug Administration survey, Spanish-speaking Latinos in this study report receiving less language concordant written information from pharmacies (77% vs. 44%, respectively).14
These findings are concerning and call for attention to the challenges pharmacies face in adapting to rapidly changing community demographics and in providing adequate language access services to non-English speaking patients. Although patients need an adequate level of health literacy to understand written information, our findings suggest that the heath care system is failing to deliver even basic information that patients with LEP may need to safely self-administer prescribed medication.
For this study, patients were only asked if they used interpreters during their physician visits. Yet, the results demonstrate that interpreter use during physician visits is also associated with the provision of better pharmacy services. One of 3 possible explanations for this finding is that patients who report using interpreters in the doctor’s office may also have access to interpreters in pharmacies. Second, physicians who use interpreters may be more sensitive to patient language barriers and therefore be more likely to check mark or write a note on the prescription that identifies the patient’s need for non-English language services. A third possible explanation is that patients who use interpreters during a physician visit are aware and attuned to the benefits of interpreters. These patients may take an interpreter to the pharmacy or ask for materials written in Spanish. The findings suggest that patients who take interpreters with them or access available interpreters in pharmacies are more likely to receive higher quality pharmacy services. We also cannot discount the possibility, however, that some patients received information in Spanish because they self-identified to the pharmacist that they did not speak any English.
All patients in our sample chose to respond to the survey questionnaire in Spanish – even those who reported not needing an interpreter. Previous studies have found survey language to be an important predictor of health status, access to care, and barriers to care among Latinos.35
This suggests that even Spanish-speaking patients who do not identify themselves as needing an interpreter may actually benefit from one. Zun et al found that a significant number of Latino patients who report being competent English-speakers do not have adequate health literacy levels, and that physicians and nurses do not accurately recognize patient English proficiency levels.36
Our results support a more liberal approach to offering interpreters to patients who speak a primary language other than English. Such a strategy, however, may require reimbursement of interpreter services and educational interventions targeting physicians that provide medical care to linguistically diverse populations.
This study focuses on Spanish-speaking Latino patients, and may not be generalizable to other populations and languages. Although the study sample is from multiple sites, participants may not be representative of all Latinos in the United States. Furthermore, the study participants had a high rate of insurance coverage and were mostly women, which also limits the generalizability of our findings. Because our results are based on a cross-sectional survey, we cannot infer cause and effect between interpreter use and receipt of medication information. Patient reports are not focused on a particular experience during one specific doctor or pharmacy visit but on what generally occurred over several visits during the last 6 months. They are also subject to recall bias, although social desirability to underestimate communication barriers may lead to an overestimate of the amount of information participants received. We did not have objective measures of whether patients used interpreters such as those from administrative data or direct observations.
For this analysis, we did not have detailed or systematic clinic-level measures of structure. It is possible that different patterns of services by study site contribute to the results. For example, clinics that have more bilingual staff or providers may provide better medication counseling. This would support, however, the premise that improving structure results in better quality of doctor-patient communication. Future studies should examine the associations between structural variables and medication information giving.
Finally, we did not have information about interpreter types (professional, family member, medical staff) in our analysis. Studies have documented decreased satisfaction with care and the risks of using ad hoc interpreters compared with professional interpreters.17,37
We, however, postulate that our findings reflect typical community-based medical care, since most outpatient community practices do not have professional or trained interpreters.
Our findings have important policy implications for areas that are experiencing an increase in Spanish-speaking populations. Despite federal regulations38
requiring access to appropriate language services, physicians in communities with small but growing Latino populations report more language barriers compared with physicians practicing in major Latino population centers.39
Policies should address linguistic barriers not only by increasing and standardizing interpreter services but also through comprehensive efforts, such as requiring health professionals to participate in tailored CME about the importance of linguistically appropriate care40,41
; and improving community access to adult education in areas with growing numbers or high concentrations of people with LEP. Furthermore, efforts to reduce language barriers around medication prescribing for LEP patients should focus on increasing the number health professionals who are fluent in non-English languages.
Future areas of investigation could include novel uses of technology such as web-based translators in pharmacies. Patients could use multimedia in a private booth and receive new prescription medication information in their preferred language. Pharmacies should incorporate computer software that accurately provides translated medication-related written information in the desired foreign language.32
Similar technology could be incorporated into physician electronic-prescribing systems so that important drug information is automatically printed in the designated language when a new medicine is prescribed. The use of multimedia and portable or handheld electronic devices may have promise, but they should be combined with counseling from providers or staff. The redesign of primary care into a team-based setup42
may provide opportunities for team members such as dual-role staff interpreters to provide new medication prescription counseling.
This study demonstrates that interpreter use increases the amount of information that Spanish-speaking Latinos receive when they are prescribed a new medication. Among studies that looked at communication between patients and providers around medication prescribing, this study is unique as it examines reports of care from Spanish-speaking Latinos at multiple sites and accounts for medication advising provided by both physicians and pharmacists. This study supports the case for the liberal provision of interpreters to all patients who need or request one during any type of clinical encounter.