Translating evidence on medical interpreters into practice: identifying and addressing language needs in primary care
Murphy, Jessica Elizabeth
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BACKGROUND: Professional interpreters improve care for limited English proficient patients but are underused. Study Design: Mixed methods study evaluating effectiveness and implementation of a rooming protocol to screen patients for language needs and call interpreters OBJECTIVE: Examine barriers and facilitators to protocol implementation and effectiveness to increase interpreter use METHODS: Provider surveys explored baseline and post-implementation attitudes. Simple and multiple logistic regression analyses examined the impact of practicing in the pilot clinics versus comparison clinics on post-implementation responses. Medical Assistants and providers were interviewed regarding barriers and facilitators to implementation. Interview analysis used modified grounded theory. Trends in the number of telephone interpreter calls were examined to determine protocol effectiveness. RESULTS: Context themes included having established teams and workflows; transitioning to a new interpreter vendor; and challenges incorporating the workflow, including providers’ tardiness and clinic understaffing. Evidence themes included beliefs that the protocol improved the patient experience but otherwise mixed responses; preferring live interpreters; and limited buy-in to language screening. Facilitation themes included Medical Assistants needing more support. Providers in the pilot clinics versus comparison clinics had significantly higher odds of positive responses on post-implementation survey questions regarding satisfaction with care (OR 5.3) and communication (OR 6.7). Implementation did not increase the number of telephone interpreter calls in the pilot clinics. CONCLUSION: Ineffectiveness of the protocol was likely due to inconsistent implementation. The protocol may improve patient care but context limited implementation success. The limited buy-in to language screening raises questions about how to better identify patient language needs.