Introduction

Language barriers have negative impacts on health outcomes among patients with limited English proficiency^1-3. There is limited data regarding common prescribing practices, including variable translation methods and pharmacy communication. Furthermore, there is no standardization of best practices regarding the provision of non-English language (NEL) medication instructions or labels. To identify unmet linguistic needs, this survey assesses frequency and methods of current prescriber practices for translated medication instructions (TMI).

Methods

An ~5-minute, online anonymous survey was disseminated to prescribers within the Michigan Medicine healthcare system. Questions addressed prescribing practices, translation methods, and prescriber communication with pharmacies. Patients with non-English language preference (PNELP) are defined as anyone who speaks English less than “very well” and/or prefers a NEL. Participants were offered a chance to enter a drawing for ten $100 gift cards.

Results

Of 477 recipients, 155 completed the survey. Based on preliminary findings, 74% reported that they, a team member, or a certified interpreter provide TMI, while 50% use a non-certified translator (e.g. family member), and 40% expect the pharmacy to provide TMI. Among those who provide written TMI, 67% of prescribers use a certified translator, 38% use computer-generated translation, 36% access a trusted website, 28% involve other staff, and 15% translate themselves. Among respondents who expect pharmacies to provide written TMI, respondents have the following expectations: the pharmacy independently identifies PNELP (44%), the pharmacy provides TMI upon request (39%), and patients know to request TMI from the pharmacy (19%). Respondents most commonly endorsed the following language concordance barriers: time constraints for written translation (68%), inadequate resources (63%), asynchronous care interpreter access (51%), use of non-Latin alphabet or diacritical marks (41%), uncertainty about the pharmacy’s ability to provide TMI (81%), and lack of clarity on best practices (60%). Only 8% of prescribers advise PNELP to request TMI from pharmacies, and 70% “disagree” or “strongly disagree” that they feel confident PNELP receive accurate written TMI.

Conclusions

Our findings highlight numerous and prevalent language concordance barriers, confusion surrounding the pharmacy's role in medication translation, and the lack of standardized practices for TMI.

References

1. U.S. Census Bureau. Selected Social Characteristics in the United States. US Census Bur. 2021;Latest ACS 5-Year Estimates Data Profiles/Social Characteristics. https://data.census.gov/table/ACSDP5Y2021.DP02?d=ACS+5-Year+Estimates+Data+Profiles

2. Wilson E, Chen AH, Grumbach K, et al. Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med. 2005;20(9):800-806. doi:10.1111/j.1525-1497.2005.0174.x

3. Moreno G, Tarn DM, Morales LS. Impact of interpreters on the receipt of new prescription medication information among Spanish-speaking Latinos. Med Care. 2009;47(12):1201-1208. doi:10.1097/mlr.0b013e3181adcc1b