Patient-Physician Language Concordance and Use of Preventive Care Services Among Limited English Proficient Latinos and Asians

ObjectivesPatient-physician language concordance among limited English proficient (LEP) patients is associated with better outcomes for specific clinical conditions. Whether or not language concordance contributes to use of specific preventive care services is unclear.MethodsWe pooled data from the 2007 and 2009 California Health Interview Surveys to examine mammography, colorectal cancer (CRC) screening, and influenza vaccination use among self-identified LEP Latino and Asian (i.e., Chinese, Korean, and Vietnamese) immigrants. We defined language concordance by respondents reporting that their physician spoke their non-English language. Analyses were completed in 2013–2014.ResultsLanguage concordance did not appear to facilitate mammography use among Latinas (adjusted odds ratio [AOR] = 1.02, 95% confidence interval [CI] 0.72, 1.45). Among Asian women, we could not definitively exclude a negative association of language concordance with mammography (AOR=0.55, 95% CI 0.27, 1.09). Patient-physician language concordance was associated with lower odds of CRC screening among Asians but not Latinos (Asian AOR=0.50, 95% CI 0.29, 0.86; Latino AOR=0.85, 95% CI 0.56, 1.28). Influenza vaccination did not differ by physician language use among either Latinos or Asians.ConclusionsPatient-physician language concordance was not associated with higher use of mammography, CRC screening, or influenza vaccination. Language concordance was negatively associated with CRC screening among Asians for reasons that require further research. Future research should isolate the impact of language concordance on the use of preventive care services from health system factors.Language barriers in health care may reduce the quality of care received by limited English proficient (LEP) patients, serve as a hurdle to the receipt of preventive care services, and contribute to health disparities.^1–3 Patient-physician communication is enhanced by language concordance (i.e., when the physician is fluent in the patient''s non-English language). Language concordant care is associated with patient trust in physicians and greater satisfaction,^4,5 increased medication adherence,⁶ and higher rates of glycemic control among diabetic patients.⁷ In contrast, language barriers are not associated with other conditions, such as mortality or length of stay in patients with myocardial infarction.⁸Latinos and Asians are the fastest-growing racial/ethnic minority groups in the United States.⁹ Preventive care services use, such as mammography for breast cancer screening, colorectal cancer (CRC) screening, and influenza vaccination, are suboptimal in both populations.^10–16 Studies of the association between patient-physician language concordance and completion of preventive care practices report inconsistent findings. Prior work, while limited in scope, suggests that language concordance may be negatively associated with receipt of CRC screening and positively associated in some groups with mammography and influenza vaccination.^17–20 However, this work has been limited by sampling selection and by significant variation in key definitions such as LEP or language concordance itself.^18–20The California Health Interview Survey (CHIS) includes representative samples of major racial/ethnic minority groups and is conducted in multiple languages including English, Spanish, Mandarin, Cantonese, Korean, and Vietnamese. We used CHIS to examine the associations between patient report of patient-physician language concordance and patient report of use of mammography, CRC screening, and influenza vaccination among LEP Latino and Asian Americans in California.     

Recent US Case of Variant Creutzfeldt-Jakob Disease—Global Implications

Variant Creutzfeldt-Jakob disease (vCJD) is a rare, fatal prion disease resulting from transmission to humans of the infectious agent of bovine spongiform encephalopathy. We describe the clinical presentation of a recent case of vCJD in the United States and provide an update on diagnostic testing. The location of this patient’s exposure is less clear than those in the 3 previously reported US cases, but strong evidence indicates that exposure to contaminated beef occurred outside the United States more than a decade before illness onset. This case exemplifies the persistent risk for vCJD acquired in unsuspected geographic locations and highlights the need for continued global surveillance and awareness to prevent further dissemination of vCJD.     

Ventilation/perfusion (V/Q) scanning in contemporary patients with pulmonary embolism: utilization rates and predictors of use in a multinational study

Journal of Thrombosis and Thrombolysis - Ventilation/perfusion (V/Q) imaging and computed tomography pulmonary angiography (CTPA) are common tools for acute pulmonary embolism (PE) diagnosis....