Patient-Physician Language Concordance and Lifestyle Counseling among Spanish-Speaking Patients

OBJECTIVE: Patient-physician language discordance is associated with worse quality of healthcare for patients with limited English proficiency. As Latinos are less likely than non-Latino whites to eat a healthy diet and engage in regular physical activity, we sought to determine whether patient-physician language discordance was associated with decreased lifestyle counseling for diet, exercise, and smoking in a Spanish-speaking patient population.

METHODS: We performed a retrospective medical record review and identified 306 Spanish-speaking patients age 35-75 who utilized interpreter services between June 2001 to June 2006 in two Boston-based primary care practices. Our primary outcome was counseling on diet, exercise, and smoking among all patients, as recommended by the U.S. Preventive Services Task Force. Our main predictor of interest was patient-physician language concordance. In our multivariable modeling, we included age, sex, weight, insurance status, number of PCP visits, total number of primary care visits including urgent care, duration of patient-PCP relationship, and comorbidities.

RESULTS: The overall prevalence of counseling was 64.7% for diet, 55.6% for physical activity, and 60.8% for smoking practices. Patients with language-concordant physicians were more likely to be counseled on diet and physical activity compared to patients with language-discordant physicians. After multivariable adjustment, these differences in counseling persisted for diet [odds ratio (OR)=2.2, CI 1.3-3.7] and physical activity (OR=2.3, CI 1.4-3.8). There was no significant difference with regard to discussion of smoking (OR=1.3, CI 0.8-2.1). Clustering by provider and clinic site using generalized estimating equations did not significantly alter our results.

CONCLUSIONS: Spanish-speaking patients are more likely to discuss diet and exercise modification if they have a Spanish-speaking physician compared to those having a non-Spanish-speaking physician. Further research is needed to explore whether matching Spanish-speaking patients with Spanish-speaking providers may improve lifestyle counseling.