Improving communication between health-care professionals and patients with limited

English proficiency in the general practice setting

Melanie AttardA, Alexa McArthur

A,C, Dagmara Riitano

A, Edoardo Aromataris

A, Chris Bollen

B and

Alan PearsonA

AThe Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA

5005, Australia.

BAdelaide North East Division of General Practice, Level 1, Education Centre, Modbury Hospital,

Smart Road, Modbury, SA 5092, Australia.

CCorresponding author. Email: alexa.mcarthur@adelaide.edu.au

Better PracticeBetter PracticeBetter PracticeBetter PracticeEvidence-based information for health professionals

Recommendations• Collectingself-reporteddatafrompatientsoncountryoforigin,ethnicityandlanguageshouldbecarriedoutbypracticestaffbeforetheinitialconsultation.1(Grade A)

• Qualifiedmedicalinterpretersshouldbethecommunicationmediumofchoice.2,3(Grade A)

• Intheabsenceofaqualifiedmedicalinterpreter,andifthepresentingconditionisminor,friendsandrelativesmayinterpretifrequestedbythepatient.2,4(Grade B)

• Thegeneralpracticeshouldbesupportiveofstafftrainingaroundeffectiveandefficientuseofqualifiedmedicalinterpreters.5,6(Grade A)

• Ifpossible,recruitandretaingeneralpracticestaffwhoreflecttheculturaldiversityofthecommunityserved.7(Grade B)

• Culturalcompetencytrainingforallgeneralpracticestaff(bothclinicalandadministrative)ishighlyrecommended.1,2(Grade A)

ObjectivesThepurposeofthisBetterPracticeInformationSheetistopresentthebestavailableevidenceforpromotinginterventionsdesignedtoimprovecommunicationsbetweenhealthcareprofessionalsingeneralpracticeandpatientswithlimitedEnglishproficiency.

Why is this important?Healthcareprofessionalsingeneralpracticetreatpatientsfromadiverserangeofculturalandlinguisticbackgrounds,withasignificantproportionoftheAustralianpopulationspeakingaprimarylanguageotherthanEnglish.PeoplewithlimitedEnglishproficiency(LEP)arelesslikelytovisittheirclinicianandundergootherpreventativescreeningsandtests.8

Theyarealsolesslikelytoadheretomedicationregimesandfollow-upplans,havedecreasedunderstandingoftheirdiagnosis,andoveralllesssatisfactionwiththeircare.4Accesstohighqualitymedicalinterpreterservicesimprovesthequalityofcareforthesepatients.2,3Forthisreason,proactiveassessmentofpatientneedforaninterpretershouldoccuroneachencountertheyhavewiththepractice.

Languageassistancewillideallybeprovidedbyaprofessionallytrainedmedicalinterpreter,butcanalsocomefrommultilingualstaff,familyorfriends.4Byunderstandingthebenefitsthataninterpretingservicecanoffer,healthcareprofessionalscanhelpfacilitateculturallycompetentcare.9Thisisalsosupportedbyensuringstaffhavesufficientawarenessandunderstandingoftheneedsofpatientsfromdiverseculturalgroupsandwhatconstitutesaneffectiveculturallyappropriateservice.

Improving communication between healthcare professionals in general practice and patients

with limited English proficiency

Improving communication between healthcare professionals in general practice and patients with limited English proficiency

Better Practice 2012 | 1

Grades of RecommendationRecommendationsaregradedonthebasisofboththelevelofevidencethatunderpinsthemandfactorsrelatedtotheirimplementation.TheGradesofRecommendationusedherearebasedonthosedevelopedandcurrentlyinusebytheJoannaBriggsInstitute10:Grade AStrongsupportthatmeritsapplicationGrade BModeratesupportthatwarrantsconsiderationofapplicationGrade CNotsupported

Translating and Interpreting Service (TIS) National

Telephone: 131 450 (24hours,7days) - Immediate access to telephone service.

(DoctorsPriorityLinerequiresMedicareprovidernumber)

Web: www.immi.gov.au/tis - Pre-book a telephone service. Usetheonlineform. - Pre-book an on-site interpreter to attend appointment.

Bookonlineupto28daysinadvance.

Yes

Improving communication between healthcare professionals in general practice and patients with limited English proficiency

2 | Better Practice 2012

Culturallycompetentgeneralpractice• Practicestaffactivelyidentifypatientswith

limitedEnglishproficiency• Promotionofmultilingualhealthcareservice

(ifavailable)• Availabilityoftranslatedwrittenmaterialson

commonmedicalconditionsandprocedures• Activepromotionofinterpreterservicesvia

writtenmaterialsinpatients’primarylanguage

No

No

No

Generalpracticedevelopsculturalcompetencystrategy

Aninterpreterisnotrequired• Documentinconsultationnotes• Continuewithtreatment

Ifthepresentingconditionisminor,friendsandrelativesmayinterpretifrequestedbythepatient.

Consultation

Bookaninterpreter• Standardisedprotocolforpracticestaffinitiating

booking• Usethesameinterpreteraspreviousconsultation

(documentedinnotes)• Consideruseofspeakerphoneorvideo

conferencing

Yes

Yes

Isaninterpreterrequired?• Generalpracticestaffshouldconsider: ‘Wouldthispatientbenefitfromhaving

aninterpreter?’

Informpatientofbenefitsofinterpreterservicesandask: ‘Wouldyoulikeaprofessional

medicalinterpreter?'

Wastheuseoftheinterpreterbeneficial?• Obtainpatientsatisfactionfeedback,ifpossible• Documentinconsultationnotesandconsiderusingthesame

interpreterinthefuture

Improving communication between healthcare professionals in general practice and patients with limited English proficiency

Improving communication between healthcare professionals in general practice and patients with limited English proficiency Better Practice 2012 | 3

1. Enhancing cultural competency within the general practice

•Practicestaffshouldactivelycollectself-reporteddatafrompatientsoncountryoforigin,ethnicityandlanguagebeforetheinitialconsultation.

•Patientpamphletsexplainingtheavailabilityandbenefitsoffreeinterpreterservicesshouldbeondisplayinthereceptionareaofthegeneralpracticeinavarietyoflanguages.

•Recruitandretaingeneralpracticestaffwhoreflecttheculturaldiversityofthecommunityserved.

•Provideculturalcompetencytrainingforstaff(bothclinicalandadministrative),aswellastrainingintheuseofinterpreters.

•AusefulresourcewhichaimstoincreaseculturalunderstandingforserviceprovidersisTheCulturalDictionary.11

2. Communications in patients' primary language

•Wherestaff(bothclinicalandadministrative)havehighproficiencyandarewillingtocommunicatewithpatientsinlanguagesotherthanEnglish,thismultilingualaspectoftheserviceshouldbeactivelyadvertised.

- Languagesspokenbyclinicstaffshouldbehighlightedinthereceptionarea,inleafletsusedtopromotetheserviceandontheClinicwebsite.

- Adviserelevantgroupsofthelanguagesspokenatyourclinic,including:

-MigrantResourceCentreofSAwww.mrcsa.com.au

-RoyalAustralianCollegeofGeneralPractitioners(RACGP)www.racgp.org.au

-Localconsulateshttp://protocol.dfat.gov.au/Consulate/list.rails

•Providetranslatedwrittenmaterialstopatients,wherepossible,butdonotpresumethatallpatientswillnecessarilybeliterateorabletoreadwrittenmaterialsintheirprimarylanguage.

- EnsurematerialsinlanguagesotherthanEnglishmostcommonlyspokenbyyourpatientsarereadilyavailable.

- AsourceoftranslatedwrittenmaterialsrecommendedbytheRACGP2istheHealthInsitewebsiteatwww.healthinsite.gov.au,whichprovideshelpfuleducationalmaterialforpatientsonarangeofclinicalconditionsinavarietyoflanguages.

3. Assessing the need for an interpreter• Trainreceptionstafftoassessforpatientneedforaninterpreterandtoadvisepatientsofinterpretingserviceoptionsavailable.ThisshouldcommencefromthemomentthepatientorfamilymemberfirstmakescontactwiththeClinic.

• EmpowerreceptionstaffbyensuringtheyareawarethatappropriateuseofinterpretersattheClinicrequiresthemtobeproactiveincoordinatingthis.

•Qualifiedmedicalinterpretersshouldbethefirstchoiceforinterpretingservices.

•Familymembersandfriendswillcommonlyactasinterpreters.Thisisacceptableifthepatientproblemisminor,andtheyspecificallyaskfortheirfamilymembertointerpret,however:- Considerthatfamilymembersareunlikelytoact

asneutralinterpreters.- Donotallowfamilymemberstospeakforthe

patientiftheyareactingasinterpreters.- Theuseofchildrenasinterpretersisnot

encouraged.- Itcanbedifficulttodiscussmedicalandother

sensitiveinformationwhenfamilymembersareusedasinterpreters.

4. Accessing interpreter services• HaveastandardprotocolinplaceineachClinicforbookinginterpreters.Thiswillhighlight:

- Exactlywhichlanguage/dialect/culturalgroupisrequired(donotassumepatientalwayswantsinterpreterintheirprimarylanguage)

- Wheregendermaybeimportantduetocultural/familyfactors,trytomatchgenderofpatient,GPandinterpreterwithaimtoavoidhavingfamilymembersactasinterpreter.

- Ifthepatienthaspreviouslyusedaninterpreter,bookthesameoneiftheencounterwassatisfactorysothatanongoingrelationshipcanbedeveloped.

- Nameofinterpreterused(andcontactdetails)shouldbedocumentedintheconsultationnotestofacilitatebookingthesameinterpreter.

• Itisrecommendedthatthetelephoneinterpreterservicebeusedonspeakerphonesothatallpartiescanhearalldialogue.

• Providevideoconferencingoptionwherepreferableforallparties.

“The procedures described here must only be used by people who have appropriate expertise in the field to which the procedure relates. The applicability of any information must be established before relying on it. While care has been taken to ensure this Better Practice Information Sheet summarises available research and focus group input, any loss, damage, cost, expense or liability suffered or incurred as a result of reliance on these procedures (whether arising in contract, negligence or otherwise) is, to the extent permitted by law, excluded”.

• TheJoannaBriggsInstitute TheUniversityofAdelaide

NorthTerrace,SouthAustralia,5000

www.joannabriggs.edu.au ph:+61883134880 fax:+61883134881 email:jbi@adelaide.edu.au• PublishedbytheJoanna

BriggsInstitute© 2012

ThisBetterPracticeInformationSheetpresentsthebestavailableevidenceonthistopic.Implicationsforpracticearemadewithanexpectationthathealthprofessionalswillutilise thisevidencewithconsiderationoftheircontext,theirclient’spreferenceandtheir clinicaljudgement.

Evidence-based Practiceevidence, context,client preference

judgement

Information SourceThisBetterPracticeInformationSheethasbeenderivedfromanextensiveevidencesummaryandfocusgroupsconductedwithgeneralpractitionersandpracticenursesinMarch2012,withintheAdelaideNorthEastDivisionofGeneralPractice,SouthAustralia.12

AcknowledgementsThisBetterPracticeInformationSheetwasdevelopedbyaresearchteamattheJoannaBriggsInstituteaspartofajointprojectwiththeAdelaideNorthEastDivisionofGeneralPractice.12TheprojectwasfundedbyNorthernCommunitiesHealthFoundationInc.,Adelaide.

References1. FloresG,NguiE.Racial/ethnic

disparitiesandpatientsafety.PediatrClinNorthAm.2006Dec;53(6):1197-215.

2. TheRoyalAustralianCollegeofGeneralPractitioners.Standardsforgeneralpractice:4thedition.2010.

3. Garcia-CastilloD,FettersMD.Qualityinmedicaltranslations:areview.JHealthCarePoorUnderserved.2007Feb;18(1):74-84.

4. KarlinerLS,JacobsEA,ChenAH,MuthaS.DoprofessionalinterpretersimproveclinicalcareforpatientswithlimitedEnglishproficiency?Asystematicreviewoftheliterature.HealthServRes.2007Apr;42(2):727-54.

5. RamirezD,EngelKG,TangTS.Languageinterpreterutilizationintheemergencydepartmentsetting:aclinicalreview.JHealthCarePoorUnderserved.2008May;19(2):352-62.

6. GrayB,HilderJ,DonaldsonH.WhydowenotusetrainedinterpretersforallpatientswithlimitedEnglishproficiency?Isthereaplaceforusingfamilymembers?AustJPrimHealth.2011;17(3):240-9.

7. AndersonLM,ScrimshawSC,FulliloveMT,FieldingJE,NormandJ.Culturallycompetenthealthcaresystems.Asystematicreview.AmJPrevMed.2003Apr;24(3Suppl):68-79.

8. FloresG.Theimpactofmedicalinterpreterservicesonthequalityofhealthcare:asystematicreview.MedCareResRev.2005;62(3):255-299.

9. Dysart-GaleD.Cliniciansandmedicalinterpreters:negotiatingculturallyappropriatecareforpatientswithlimitedEnglishability.FamCommunityHealth.2007;30(3):237-46.

10.TheJoannaBriggsInstitute(AU).GradesofRecommendation[Internet].Adelaide(Australia):JoannaBriggsInstitute;2006[updated2012Feb19;cited2012Apr13].Availablefrom:http://www.joannabriggs.edu.au/Grades%20of%20Recommendation

11.MigrantResourceCentreofCanberra&Queanbeyan(AU).TheCulturalDictionary[Internet].ACTGovernmentCommunityServices(Australia);2003[cited2012Apr13]Availablefrom:http://www.dhcs.act.gov.au/__data/assets/pdf_file/0017/5282/Cultural_Dictionary.pdf

12.McArthurA,AttardM,RiitanoD,WilliamsM,AromatarisE,BollenC,PearsonA.ImprovingcommunicationbetweenhealthcareprofessionalsingeneralpracticeandpatientswithlimitedEnglishproficiency.Adelaide:TheJoannaBriggsInstitute,UniversityofAdelaide(Australia);2012May.

Improving communication between healthcare professionals in general practice and patients with limited English proficiency

4 | Better Practice 2012

Excellent resources from the Centre for Culture, Ethnicity & Health

TipSheetsavailablefordownloadinclude:• assessingtheneedforaninterpreter• arranginganinterpreter• workingwithinterpreters

www.ceh.org.au/mghp/problem_gambling_resources/mghp-using-interpreters.aspx