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The COVID-19 crisis has demonstrated the myriad ways our healthcare system can respond to the challenge, and also how we fail to care for our most vulnerable patients.
In March 2020, as cases of COVID started to increase, I spoke with staff at the Family van, a mobile health clinic that provides preventative health services in some of Boston’s most underserved neighborhoods. They highlighted the difficulty of finding multilingual COVID information and how this made it difficult for non-English speaking patients to protect themselves. At the time, neither the CDC nor the state’s health department released COVID information in languages ​​other than English, Spanish and Chinese, leaving community health organizations to scramble to gather multilingual information at short notice.
Over a year later, this continues to be a problem. Many state governments provide limited information about the vaccine in languages ​​other than English, and some do not offer language support on their vaccine research websites. It’s no surprise that COVID infection rates are several times higher among non-English speakers, a worrying trend that reflects previous epidemics.
To date, much of the discussion about improving care for non-English speaking patients has focused on medical interpreters. It is important; patients who use interpreters receive more preventive care, experience fewer adverse events and have greater adherence to medications. However, COVID has taught us that just having an interpreter available at the point of care is not enough. There are many deeply rooted and historically applied barriers that prevent non-English speaking patients from receiving the care they need – barriers that start long before a patient shows up to the clinic and last long after their appointment – and it is time for a more comprehensive reform.
Recently, several programs have emerged to provide language-specific materials and care. This includes government-led efforts to translate awareness raising information into different languages, and community-led efforts such as the COVID-19 Health Literacy Project, an initiative I founded to translate COVID fact sheets into 40 languages.
Yet these efforts remain interim solutions. To ensure that non-English speakers are not sidelined again once this crisis has passed, we must remove the barriers they face not only in receiving medical care, but also in accessing and treating it. We need to rethink every part of a non-English speaking patient’s experience with the healthcare system — before, during and after an appointment.
Before patients even see a clinician, they need to be able to access health information in their native language. Hospitals and clinics can work with interpreter services to translate health information (eg, patient education materials, public service announcements). Our work with the COVID-19 Health Literacy Project also revealed that many bilingual providers are excited to help translate documents into their native language, so healthcare organizations can consider building a foundation. internal data of multilingual staff available to help as needed.
Public health agencies can also play an important role. For example, they could hire translators and make them available remotely and under contract to clinical and social service organizations in rural or low-income communities who often have a shortage of interpreters. This is also why we are transforming the COVID-19 Health Literacy Project into a new non-profit organization that provides free translation services to community organizations to translate health documents into the languages ​​spoken by their patients.
Efforts to translate health information need to be coupled with programs to ensure that this information actually reaches immigrant communities. The key is to bring culturally and linguistically appropriate services to the places where people live and work. The medium is also important; evidence suggests that non-English speakers prefer text messaging or in-person communication. A good example is New York City’s Fleet of Mobile Vaccination Vans, where bilingual staff help patients navigate each step of the COVID vaccination process in their own language.
When it comes to the appointment itself, healthcare organizations should strive to match patients with providers who speak their native language. Linguistic concordance is associated with fewer medical errors, better understanding of the condition and treatment plan, and increased satisfaction. Of course, this is not always possible and qualified interpreters should be used at all other times.
After an appointment or hospitalization, patients typically receive discharge instructions that detail their new medication regimen, home care instructions, and follow-up appointments. However, for non-English speaking patients, this document is rarely translated into their native language.
It was suggested to use machine translation tools (e.g. Google Translate) to automate the translation of output instructions, but this approach must go further. We must strive to turn discharge planning into a conversation that non-English speaking patients can truly participate in. For example, before discharge, clinicians can provide patients with their translated discharge instructions, review them verbally (in the presence of an interpreter), and allow patients time and space to ask questions.
For these changes to work at scale, they must be supported by policy reform. A good starting point is to reinstate the regulations on language provisions annulled by a recent HHS rule. Under the new rule, providers are no longer required to include notices on important communications informing patients of their right to receive language assistance. Additionally, not having a language access program is no longer a violation of regulatory compliance for many federally funded health care organizations. These changes are a step backwards and may lead healthcare organizations to deprioritize access to languages.
How can we pay for these initiatives? On the one hand, while the government distributes $ 1.32 billion in funding for community health centers under the CARES Act, they could demand that a certain proportion be spent on building the infrastructure necessary to support non-English speakers. Additionally, nonprofit hospitals could tap into their community benefit dollars – community-led services that nonprofit hospitals must provide to justify their tax-exempt status – to fund these programs.
It is obvious that our healthcare system is dropping patients with limited English proficiency, and now is the time to act, to move away from interim solutions and implement comprehensive changes that support non-English speakers across the continuum of health care.
This is an opinion and analysis article; the opinions expressed by the author or authors are not necessarily those of American scientist.
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