Community pharmacists’ use of language access services

One of my pet interests is health literacy and its far-reaching impact on quality and access to healthcare.  The issues surrounding it can almost be insidious in nature.  Despite this, health literacy is typically only given superficial coverage in traditional training programs. 

Here in South Florida we have an especially diverse patient population with a higher than average percentage of those with limited English proficiency (LEP).  It’s pretty intuitive, but LEP patients are (unfortunately) more likely to encounter barriers to health care and are associated with poorer outcomes than non-LEP patients. 

In part to address this, there was actually an Executive Order mandating “meaningful access” be given to LEP persons for Federally-funded activities (what, you didn’t think ‘meaningful use/access’ was limited to EHRs and the like?).  Consequently, hospitals, clinics, etc. began incorporating translators and other language access services (LAS) as SOP (at least on paper) due to their receipt of Federal funding/payments.  However, a funny thing happened on the way to implementation in community pharmacies – much as those pharmacies and the healthcare professionals that staff them are treated differently than similar entities/professionals in our system of health care…this mandate has been treated more as a voluntary compliance issue.  What, if any, impact has this had on reimbursement or outcomes?  The jury is still out.  However, as a first step to methodically examine this issue, we conducted a national survey of availability and use of LAS in community pharmacies; the initial results of which have recently been published in the Journal of the American Pharmacists Association (JAPhA).

Pharmacist responses to the survey ranged from descriptions of widely advertised and seamlessly integrated interpretation (verbal) and translation (written) LAS services to the (rarely observed) attitude of ‘if they’re in our country they should speak English’.  Overall, we identified issues regarding awareness (e.g., about half of pharmacies with LAS capacities did not report making them known to patients), use of LAS (e.g., about 40% said they “never” used interpretation/translation tools), and workflow/time (e.g., a quarter of respondents said they simply lacked time to use LAS).  Alternately, there were encouraging signs as pharmacies that did apprise patients of LAS availability used a variety of methods including in-store direct notification, signage, flyers, and targeted mailings.  Additionally, more LAS products are becoming available such as Elsevier’s MEDcounselor Languages module, which advertises SIG translation and patient education materials in 14 languages.  Another gem that area pharmacists have started using (albeit moreso in AmCare clinic settings) is the free MediBabble iPhone app.  My understanding is that a future update will (ahem) include pharmacists in the introductions section. 

Unfortunately, our article “Community pharmacists’ use of language-access services in the United States” is behind a subscription wall, but I would be happy to answer any questions that I can.

@kevinclauson

Disclosure: A couple years ago we received a grant from one of the quadrillion companies Elsevier operates for an unrelated research study.  Inclusion of their product in this post is mostly due to timing (I just received an email about it), and should probably not be construed as a conflict of interest except for the most Mel Gibsonian of conspiracy theorists.  Separately, this JAPhA LAS study was funded by a NSU President’s Grant.  Going forward we are planning to study the LAS disconnect further, as well as possible solutions that may include tools such as automated LAS kiosks in pharmacies and online functionality as well as LAS availability notification via social media; funding source(s) TBD.

 

Source: Feichtl MM, Clauson KA, Alkhateeb FM, Jamass DS, Polen HH. Community pharmacists’ use of language-access services in the United States. J Am Pharm Assoc. 2011;51(3):368-72.

Pharmacist use of social media

The most recent hat tip for alerting me that one of my articles was published goes to @redheadedpharm, who also has one of the most thoughtful pharmacist authored blogs out there IMHO.  I should note that by drawing my attention to the article, TRP does not endorse the contents nor see eye-to-eye with me regarding pharmacists, pharmacy, or social media.  And that’s ok. I have to think no rational person just wants an echo chamber.  In fact, I may revisit the whole ‘landscape of pharmacist blogs’ in a future post if I can figure out a way to do so that doesn’t involve generating the hate e-mail and widespread snark that the AJHP article did.* 

In any event, I did want to share that the article I assisted Drs. Alkhateeb and Latif with is titled Pharmacist use of social media and was published in the International Journal of Pharmacy Practice.  As you can see to the left, this is a Short Communication and essentially provides a snapshot of social media use by pharmacists in West Virginia.  The most frequently used applications in this group of surveyed pharmacists included: YouTube (74%), Wikipedia (72%), Facebook (50%), and blogs (26%). Twitter (12%) and LinkedIn (12%) were also used by the respondents.  In a sense, it was a confirmatory study in that it verified some things we thought we knew about pharmacists and social media.  Some of the findings (e.g., 50% use of Facebook) were a little surprising.  Use of Facebook, in particular was examined a little more in-depth; only 15.8% indicated they used it for any professional purpose.  Usage patterns largely reflected those of non-healthcare professionals…these pharmacists used Facebook to keep in touch with colleagues, chat, upload pictures, etc. 

@kevinclauson

*It’s interesting how ‘hate e-mail’ can be a touchstone for publication topics.  The pharmacists blog study generated a dubious top 5 level volume of hate e-mail.  It was among the best written hate e-mail (which was oddly encouraging), but didn’t come close to the level produced after our Wikipedia paper came out.  To be fair, the sheer number of Wikipedia users and the widespread coverage** it received probably contributed to its you-are-as-bad-as-the-scientists-doing-research-on-puppies outrage. 

**Curious fact, of all the interviews I’ve done about our research over the years (e.g., New York Times, Wall Street Journal, CNN, BBC, NPR, New Scientist, etc.) the most hardcore fact-checkers were from Good Housekeeping and Fitness Magazine. Seriously.

Issues with translating prescription information into other languages in pharmacies

(Click image above to view larger version)

There was a recent news item taken from an article in Pediatrics examining what happens when computerized language assistance services (LAS) are imperfect.  It focused on the erroneous translation of prescription information from English to Spanish in pharmacies in New York and possible consequences.  That was similar to an aspect of our LAS research we highlighted in an interview in The Oncology Pharmacist several months ago.  We are examining related problems as well, including low- and high-tech solutions to varying issues with LAS (e.g. automated LAS kiosks, natural language processing, pictographs).  In December 2009, we presented a poster of the results of a national survey of the use of language assistance services (sometimes called language access services) in community pharmacies.  One of the major concerns in using LAS cited by pharmacists (52.1%) in our study was about mistakes made with translations (written) and interpretations (verbal).  Their concerns appear to be at least somewhat justified based on the results of the Pediatric study.  This is a contributing factor as to why almost half (49.8%) of pharmacists in our survey who have LAS fail to notify their patients of its availability.

@kevinclauson