Online Program

"There is a gap”: A qualitative study of patient experiences in a linguistically diverse safety-net primary care setting

Tuesday, November 3, 2015

Rachel Berkowitz, MPH, Highland Hospital Department of Medicine, Oakland, CA
Lyn Berry, MD, Highland Hospital Department of Medicine, Oakland, CA
Maryan Cohen, Highland Hospital Department of Medicine, Oakland, CA
Leonardo Magdaleno, Alameda Health System, Oakland, CA
Nai Saeturn, Alameda Health System, Oakland, CA
Gabriella Bartos, MD, Highland Hospital Department of Medicine, Oakland, CA
Irene H. Yen, PhD, Department of Medicine, UCSF, San Francisco, CA
INTRODUCTION: Conversion to a patient-centered medical home (PCMH) has the potential to improve patient experience and primary care quality. Within an urban safety net Adult Medicine Clinic (AMC), an urban safety-net setting, these desired outcomes are complicated by both the diversity of the patient community and the continuity implications of a residency program. To create a truly patient-centered environment within such a complex healthcare setting, direct engagement with patient voice and experience beyond survey-based satisfaction measures is crucial, though not often done.

METHODS: To more holistically explore the patient experience, the authors initiated a qualitative study, interviewing 19 patients who spoke English, Spanish, or Mien about what makes their experiences in the clinic positive or negative. These three groups represented the most commonly spoken or interpreted languages in the AMC. The authors—a team of physicians, researchers, interpreters, and a patient—collaboratively analyzed the transcripts and notes to identify key themes of patient experience.

FINDINGS: Some themes were identified across language groups. The unique challenges of physician discontinuity due to residency training resulted in frustration with physicians not knowing one’s history, while the expectation of healthcare system failures—a sense that “it’s just [the Hospital]”—was tied to the reality of seeking care at a public facility. Other themes were specific to the non-English speakers. Spanish and Mien speakers both described the potential negative influences of interpreter-filtered conversations on the provider-patient relationship as well as quality of care. As one Spanish-speaking patient said:“The appointments…[are] only fifteen minutes long and then you waste a lot of time when you…are telling the interpreter what the doctor is asking you…you lose some of the natural flow of conversation between a patient and provider.” Mien speakers in particular identified a sense of being forgotten and unable to self-advocate as a result of the language barrier, in part due to speaking a language that is not spoken amongst healthcare providers or staff in the AMC.

DISCUSSION: Findings demonstrate important crosscutting issues to be addressed as well as the added impact of language differences on clinical relationships and healthcare system navigation. The challenges faced by all patients within the AMC are compounded by the realities of seeking care in a different language. Soliciting the perspectives of a diverse community of patients is vital for nuanced considerations of needs and challenges within primary care training clinics to create a medical home for a linguistically diverse patient population.

Learning Areas:

Diversity and culture
Provision of health care to the public

Learning Objectives:
Describe the impact of language difference on quality and experience of primary care Analyze the importance of incorporating holistic and in-depth lessons on the unique needs of diverse patient communities in primary care training

Keyword(s): Cultural Competency, Public Hospitals

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I received my BA in Cultural Anthropology and my MPH in Community Health and Development, focusing on qualitative research methods and conducting original qualitative research during both degrees. After having worked as a PCMH monitoring and evaluation intern for 6 months with the Highland Hospital Adult Medicine Clinic, I conducted all 19 patient interviews described in this presentation, in partnership with interpreters. I then served as the primary thematic analyst on the interviews.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.