Medication safety and limited English proficiency: A continuing education curriculum for practicing pharmacists

Language access is a key component of quality health care for limited English proficient (LEP) patients. The impact of language barriers on medication use is particularly important, given the complexity of instructions and the serious implications of error. Pharmacies, despite their essential role in the dissemination of medication instructions, have been slow to incorporate language access services, such as translated medication labels and use of trained interpreters, into their service delivery systems. We developed a continuing education (CE) course to introduce practicing pharmacists to this issue and to offer solutions that proactively improve services for LEP patients. The three hour course, offered through St. John's College of Pharmacy, focused on cultural competence, immigrant demographics, English proficiency, medication safety, legal issues, and methods for overcoming language barriers. Participants (n = 27) at two sessions were given pre- and post-tests to measure knowledge and perceptions and to gain insight into their past experience with LEP patients. One-third of the course participants were immigrants and 29% spoke a language other than English at home. Half of the participants reported that greater than 25% of their patients were LEP. The most common patient languages were Spanish, Russian, and Chinese. Changes from pre- to post-test suggest increased knowledge and a shift in attitudes. On the pre-test, 77% felt “immigrants should know English;” compared to 63% on the post-test. There was an increase of 30 percentage points in those who felt healthcare should be available to all persons regardless of immigration status and in those reporting that they should improve language services in their practice. Half of the participants said they anticipated making changes to their language services within two months. Unfortunately, telephonic interpreting, considered to be among the simplest and most effective interventions, was considered too costly by many participants. Preliminary results suggest that the CE course was effective in increasing knowledge and raising awareness around this critical issue. However, interventions that are feasible from the perspective of cost, technological compatibility, and reliability remain limited. As population shifts and increasing advocacy efforts make language access in pharmacies essential, courses such as this may help pharmacists work together to develop innovative solutions to provide the best care to their patients, regardless of language.