Quality of reproductive health services to limited English proficient patients

Patients with limited English proficiency (LEP) frequently receive health care services of suboptimal quality. This may be particularly detrimental in reproductive health care services where education and counseling play a prominent role to ensure contraceptive use. A medical record review of 1,641 reproductive health visits of LEP clients was conducted to explore whether the use of interpreters (language-discordant, LDI) negatively impacts the provision of quality reproductive health care when compared with clients seen by a bilingual provider (language concordant, LC). Chi-square tests and logistic regression analyses were conducted on a number of quality of care indicators to measure differences in these two groups. LDI visits were significantly less likely than LC visits to contain documentation of the provision of at least one education and counseling service (63% vs. 87%, p<0.001). This difference in the frequency of service provision is observed among all major categories of counseling services, including contraceptive method use/ options, STI/ HIV prevention, and other reproductive and non-reproductive health counseling. Among women, LDI visits were significantly less likely than LC visits to have documentation of STI risk assessment (57% vs. 65%, p<0.05). Female clients in LDI and LC visits were about equally likely to be tested for chlamydia and to receive a pregnancy test, when not clinically indicated. Results of the multivariate analysis followed the results of the bivariate analysis but showed an interaction effect for STI counseling. Quality improvement activities need to target family planning providers who have to use interpreters when serving LEP clients.