Report: Physicians' efforts to reduce racial, ethnic inequalities modest

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While many U.S. physicians identify language or cultural barriers as obstacles to providing high-quality patient care, physicians' efforts to overcome communication barriers are modest and uneven, according to a report released by the Center for Studying Health System Change (HSC).

James Reschovsky, PhD, HSC senior researcher, and Ellyn R. Boukus, MA, HSC health research analyst, found that 48.6 percent of all U.S. physicians in 2008 reported that difficulty communicating with patients because of language or cultural barriers was at least a minor problem affecting their ability to provide high-quality care, although less than 5 percent viewed it as a major problem.

Funded by the Robert Wood Johnson Foundation, the survey included responses from more than 4,700 physicians who were asked whether their practice provides interpreter services and patient-education materials in languages other than English and whether they have received training in minority health issues, reports containing patient demographic information and reports about the quality of care delivered to minority patients.

Despite consensus in the medical community about steps physicians can take to address racial and ethnic disparities, physician adoption of practices to improve care for minority patients ranged from 7 percent reporting they have the capability to track patients' preferred language to 40 percent reporting they have received training in minority health issues to slightly more than half reporting their practices provide some interpreter services, the study found.

The HSC report also found that:

  • While nearly 97 percent of physicians have at least some non-English speaking patients, only 56 percent were in practices that provided interpreter services in 2008.
  • Among physicians in practices treating patients with asthma, diabetes, congestive heart failure or depression, only 40 percent of physicians in these practices reported providing patient-education materials in languages other than English for at least one of the conditions.
  • 23 percent indicated they receive reports on patient demographics, such as race or ethnicity. Likewise, 22 percent of physicians indicated their practice has IT capable of reporting patients' preferred language, but only a third of these physicians (7 percent) routinely used this capability.
  • Nearly nine out of 10 physicians lacked a formal means to assess the quality of care provided to patients across racial and ethnic groups. Only 11.8 percent of physicians reported access to reports on the quality of care they provide stratified by patient race or ethnicity.
  • Physicians in practices with a greater share of minority patients were more likely to adopt each of the measures to address disparities. For example, almost twice as many physicians reported providing interpreter services in practices with a majority of minority patients, relative to those whose practices included less than 10 percent minority patients (72.3 vs. 39.2 percent).
  • Physicians in solo and group practices were less likely to adopt measures to address disparities than those in institutional practices, such as hospitals, health maintenance organizations (HMOs) and medical schools. Nearly 90 percent of physicians in group- or staff-model HMOs reported providing interpreter services, compared with 34 percent of physicians in solo or two-physician practices.