Disparities in access to linguistically appropriate prescription medication labels

Background: An essential component of quality care for limited English Proficient (LEP) patients is language access. Linguistically accessible medication information is particularly important, given the serious consequences of error and patient responsibility for managing often complex medication regimens on their own. Approximately 21 million people in the U.S. were LEP at the time of the 2000 census, representing a 50% increase since 1990. Little information is available on their access to medication instructions in languages they comprehend. Methods: We conducted (1) a random sample telephone survey of 200 NYC pharmacies, and (2) 2 focus group discussions and 58 interviews with LEP Chinese and Spanish speaking pharmacy patients. Pharmacies were identified through a listing of all licensed NYC pharmacies and were asked about translation capability and practice, as well as other pharmacy, pharmacist and patient characteristics. LEP pharmacy patients were identified through health and social service organizations where they worked or received services. Those participating in interviews were requested to bring in prescription bottles for current medications so that the language(s) of the labels could be recorded by the interviewer. Interview and focus group participants were asked about medication knowledge, experience and problems; sources and preferences regarding medical information; and factors affecting pharmacy choice. Results: Eighty-eight percent (n=176) of pharmacists surveyed reported that they had LEP patients on a daily basis. Among these 176 pharmacies, only 39% reported translating labels daily and 23% never translated labels. Spanish was the most common language for translation capabilities (72%) followed by Chinese (12%). However, just 19% of the bottles brought by Spanish interview participants had translated labels compared to 72% of the bottles brought by Chinese participants. Focus group participants reported similar disparities in access, with significantly more Chinese than Spanish participants having translated labels. All Chinese focus group participants were aware that Chinese labels were available at certain NYC pharmacies. In contrast just 50% of Spanish participants knew about the availability of Spanish labels. Discussion: Linguistically appropriate medication labels are not made available to all LEP patients. Pharmacists with the capacity to translate labels should post signs and make other efforts to ensure that patients know that they can request translated labels. Physicians, nurses, and other providers should inform and encourage their LEP patients to request translated labels and should be aware that LEP patients may need supplemental medication instructions if translated information is not available from pharmacies.