Physician Efforts To Reduce Racial/Ethnic Disparities Are "Modest And Uneven"
WASHINGTON, DC—While many U. S. physicians identify language or cultural barriers as obstacles to providing high-quality patient care, physicians' efforts to overcome communication barriers are modest and uneven, according to a new national study released by the Center for Studying Health System Change (HSC).
Nearly half (48.6%) of all U.S. physicians in 2008 reported that difficulty communicating with patients because of language or cultural barriers was at least a minor problem affecting their ability to provide high-quality care, though less than 5 percent viewed it as a major problem, according to the study funded by the Robert Wood Johnson Foundation (RWJF).
Despite consensus in the medical community about steps physicians can take to address racial and ethnic disparities, physician adoption of several recommended practices to improve care for minority patients ranged from 7 percent reporting they have the capability to track patients' preferred language to 40 percent reporting they have received training in minority health issues to slightly more than half reporting their practices provide some interpreter services, the study found.
"Although disparities certainly stem from factors beyond the physician-patient encounter, the ability of physicians to communicate effectively with patients from diverse backgrounds is important to providing high-quality care," said HSC Senior Researcher James Reschovsky, Ph.D., coauthor of the study with HSC Health Research Analyst Ellyn R. Boukus, M.A.
Physicians were asked whether their practice provides interpreter services; whether their practice provides patient-education materials in languages other than English; whether they have received training in minority health issues; whether they receive reports containing patient demographic information, such as race or ethnicity; whether their practice has information technology (IT) to identify patients' preferred language; and whether they receive reports about the quality of care delivered to minority patients.
Based on HSC's nationally representative 2008 Health Tracking Physician Survey, the study findings are detailed in a new HSC Issue Brief—Modest and Uneven: Physician Efforts to Reduce Racial and Ethnic Disparities—available here. Funded by RWJF, the survey includes responses from more than 4,700 physicians, and the response rate was 62 percent.
Other key findings include:
While nearly 97 percent of physicians have at least some non-English speaking patients, only slightly more than half of physicians (56%) were in practices that provided interpreter services in 2008.
Among physicians in practices treating patients with any of four prevalent chronic conditions-asthma, diabetes, congestive heart failure and depression—72 percent in 2008 reported their practice provides patient—education materials for at least one of the four conditions. Yet, only 40 percent of physicians in these practices reported providing patient-education materials in languages other than English for at least one of the conditions.
Less than one in four physicians (23%) indicated they receive reports on patient demographics, such as race or ethnicity. Likewise, 22 percent of physicians indicated their practice has IT capable of reporting patients' preferred language, but only a third of these physicians (7%) routinely used this capability.
Nearly nine out of 10 physicians lacked a formal means to assess the quality of care provided to patients across racial and ethnic groups. Only 11.8 percent of physicians reported access to reports on the quality of care they provide stratified by patient race or ethnicity.
Physicians in practices with a greater share of minority patients were more likely to adopt each of the measures to address disparities. For example, almost twice as many physicians reported providing interpreter services in practices with a majority of minority patients, relative to those in low-minority practices-less than 10 percent minority patients (72.3% vs. 39.2%). Similarly, there were large differences in provision of patient-education materials in foreign languages (60% vs. 24%), routine use of IT to access patients' preferred languages (10.5% vs. 4.3%) and quality reporting by racial/ethnic group (16.8% vs. 8.2%).
Physicians in solo and group practices were less likely to adopt measures to address disparities than those in institutional practices, such as hospitals, health maintenance organizations (HMOs) and medical schools. For example, nearly 90 percent of physicians in group- or staff-model HMOs reported providing interpreter services, compared with 34 percent of physicians in solo or two-physician practices.
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation's changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded in part by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research.
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