Access to Spanish prescription medication labels from New York City pharmacies

Background: Miscomprehension of medication instructions places patients at risk for medication errors and poor health outcomes. Limited English proficient (LEP) patients are at particular risk of miscomprehension, particularly if instructions are not provided in a language they understand. According to the 2000 Census, approximately 21 million people in the US are LEP. New York City (NYC), a key immigrant destination, is currently home to close to 1.8 million LEP residents, over half of whom are native Spanish speakers. The extent to which LEP patients have access to translated medication labels has not been carefully examined. Methods: We conducted a telephone survey of 200 pharmacies using a randomized list of all licensed pharmacies in NYC (n= 2,186). Pharmacies were considered ineligible if a working phone number could not be identified (n=44) or if they did not serve outpatients (n=20). Two hundred sixty-two eligible pharmacies were contacted to reach a preset goal of 200, for a response rate of 76.3%. The primary focus of the survey was translation capacity and practice. Anticipating that translation would be associated with multiple factors, the survey included questions on pharmacy, pharmacist and patient characteristics. Proportions LEP within each pharmacy's census tract were merged with the survey responses for inclusion in our final analytic data set. In this analysis, we focused on label translation practices and predictors at pharmacies that reported seeing Spanish/LEP patients on a daily basis. Results: Spanish-speaking LEP patients were seen daily at 78% of pharmacies. Seven percent of pharmacies reported less than daily and only 16% reported never having Spanish/LEP patients. Among pharmacies with daily Spanish/LEP patients, 79% could translate labels into Spanish, but just 37% did so on a daily basis. Pharmacy type (OR = 3.9, p < .05 for independent vs. chain) and concentration of Spanish/LEP in the pharmacy census tract (OR = 1.02, p < .001 for a 1% increase in Spanish/LEP) were associated with daily translation in multivariate analysis. Eighty percent of the pharmacies surveyed lacked systematic and objective methods for identifying and documenting linguistic needs and for informing patients of pharmacy language capabilities. Discussion: Spanish speaking patients do not have sufficient access to linguistically appropriate prescription medication labels, even when they utilize pharmacies with translation capability. Pharmacists should be proactive in addressing the language needs of their patients including implementation of systematic methods for identifying and documenting patient needs. Spanish signs should inform patients of translation capabilities.