Patient Experiences in a Linguistically Diverse Safety Net Primary Care Setting: Qualitative Study.

Rachel L Berkowitz,Irene H Yen,Lyn Berry,Nimeka Phillip

doi:10.2196/jopm.9229

Abstract

BackgroundThe patient-centered medical home model intends to improve patient experience and primary care quality. Within an urban safety net setting in Northern California, United States, these desired outcomes are complicated by both the diversity of the patient community and the care continuity implications of a residency program.ObjectiveThe objective of our study was to understand the patient experience beyond standardized satisfaction measures.MethodsWe conducted a qualitative study, interviewing 19 patients from the clinic (English-, Spanish-, or Mien-speaking patients).ResultsSome themes, such as the desire to feel confident in their doctor, emerged across language groups, pointing to institutional challenges. Other themes, such as distrust in care being provided, were tied distinctly to speaking a language different from one’s provider. Still other themes, such as a sense of powerlessness, were related to cultural differences and to speaking a language (Mien) not spoken by staff.ConclusionsFindings illuminate the need to understand cultural behaviors and interactional styles in a diverse patient population to create a high-quality medical home.

Highlights

I don’t know because I don’t understand English, and whatever I tell the interpreter, he is relaying the information in English, and relaying what the doctor says back to me
There is a gap. [Mien-speaking patient]. This comment was shared by a Mien-speaking patient at the Lakeview Hospital Adult Medicine Clinic (LHAMC, located in an urban setting in Northern California, USA; we have changed the name of the hospital to protect the privacy of the patients) and provides a window into one of the challenges experienced by non-English-speaking patients within a multilingual, multicultural urban safety net setting
We focused on 3 patient language groups: English-speaking, Spanish-speaking, and Mien-speaking patients

Summary

Introduction

I don’t know because I don’t understand English, and whatever I tell the interpreter, he is relaying the information in English, and relaying what the doctor says back to me. Patient-centered care is an increasingly promoted approach for improving quality of, access to, and satisfaction with health care, for primary care [1,2]. To fully implement patient-centered care, we must partner with patients and understand how to strengthen their experiences and outcomes [3]. Many factors shape the way patients perceive quality of care. In urban safety net clinics, understanding those experiences can be challenging. The patient-centered medical home model intends to improve patient experience and primary care quality. Within an urban safety net setting in Northern California, United States, these desired outcomes are complicated by both the diversity of the patient community and the care continuity implications of a residency program

Methods

Results

Conclusion