Abstract
BackgroundCommunication between patients with limited English proficiency (LEP) and telephone triage services has not been previously explored. The purpose of this study was to determine the utilization characteristics of a primary care triage call center by patients with LEP.MethodsThis was a retrospective cohort study of the utilization of a computer-aided, nurse-led telephone triage system by English proficiency status of patients empaneled to a large primary care practice network in the Midwest United States. Interpreter Services (IS) need was used as a proxy for LEP.ResultsCall volumes between the 587 adult patients with LEP and an age-frequency matched cohort of English-Proficient (EP) patients were similar. Calls from patients with LEP were longer and more often made by a surrogate. Patients with LEP received recommendations for higher acuity care more frequently (49.4% versus 39.0%; P < 0.0004), and disagreed with recommendations more frequently (30.1% versus 20.9%; P = 0.0004). These associations remained after adjustment for comorbidities. Patients with LEP were also less likely to follow recommendations (60.9% versus 69.4%; P = 0.0029), even after adjusting for confounders (adjusted odds ratio [AOR] = 0.65; 95% confidence interval [CI], 0.49, 0.85; P < 0.001).ConclusionPatients with LEP who utilized a computer-aided, nurse-led telephone triage system were more likely to receive recommendations for higher acuity care compared to EP patients. They were also less likely to agree with, or follow, recommendations given. Additional research is needed to better understand how telephone triage can better serve patients with LEP.
Highlights
Communication between patients with limited English proficiency (LEP) and telephone triage services has not been previously explored
Call characteristics and nurse recommendation Compared to calls from non-Interpreter Services (IS) patients, those from IS patients were of longer duration in minutes; Median (Q1, Q2): 13.9 (9.2, 21.1) versus 12.2 (7.9, 18.2); P = 0.0002, and were more often made by a surrogate, n (%): 203 (34.6%) versus 35 (6.0%); P < 0.0001 (Table 2)
In this study of a computer-aided nurse-led telephone triage system in a primary care network, we found similar proportions of callers making one or repeat calls between patients who required IS and those who did not
Summary
Communication between patients with limited English proficiency (LEP) and telephone triage services has not been previously explored. In the primary care setting, these triage call centers are typically staffed by nurses who use computer- assisted decision-making tools to provide care recommendations to callers and manage patient consultation requests [2] This consultation management has been shown to effectively manage patient access to providers while reducing workload and maintaining costs [3,4,5,6]. Disparities in utilization of telephone triage have been demonstrated among non-native language speakers in countries outside the U.S Non-native Swedish speakers utilized a national phone triage service less frequently compared to native speakers, while non-native Norwegian speakers reported less trust in recommendation/advise given to them by nurses through telephone triage [18, 19] To help mitigate these barriers, healthcare systems typically contract with professional medical interpreters and telephonic or video interpretation services. Interpreter use reduces, but does not eliminate health disparities among patients with LEP, partly due to the type of interpreter used and the quality of interpretation services [20, 21]
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