Speaking a Second Language Has Countless Benefits in the Pharmacy Setting

Having bilingual skills in the pharmacy setting can reduce poor communication caused by language discordance—which occurs when a patient’s primary spoken language is not the same as what is primarily spoken in a health care system¹—and improve patient outcomes, according to Robert Mueller, PharmD, BCPS, an associate professor at Concordia University in Milwaukee, Wisconsin.²

Image credit: melita | stock.adobe.com

In the United States, being able to communicate in Spanish could be particularly beneficial because it is the second most common language spoken in US households after English, according to 2019 census data.³

“Patients come from a variety of diverse cultural, linguistic, religious, educational, and socioeconomic backgrounds,” Mueller said in a news release.² “And yet, pharmacists need to be able to provide adequate care to all patients.”

In 2021, Hispanic and Spanish-speaking patients made up approximately 62% of the limited English proficiency (LEP) population in the United States, according to KFF. Those in the LEP population are less likely to have health insurance, more likely to be individuals of color, and more likely to face other health care disparities driven by racial or ethnic inequalities.⁴

Hispanic patients are also at increased risk of developing diabetes and diabetes-related complications, which can require the care of a pharmacist. In one study, investigators wanted to see whether pharmaceutical care that was provided in a language other than English could improve diabetes outcomes. The cohort included patients who received care at a federally qualified health center and largely preferred using the Spanish language.⁵

Investigators collected disease-related data (ie, hemoglobin A_1c [HbA1_c]), ethnicity, and primary language preference from each patient’s initial pharmacy visit, and their research showed that care that was given by a Spanish-speaking clinical pharmacist significantly improved blood pressure outcomes, although there was not a statistically significant improvement in HbA_1c.⁵

There are other ways that language barriers can impact patient health. For instance, in an article in Nurse Journal, the author highlights a systematic review looking at the effects of language barriers. In this review, 35% of patients who did not speak the local language were confused about how their medication worked. Additionally, 65% of patients who lived in a country that did not speak their primary language experienced a barrier to care; 20% of these patients did not even try to get care out of fear of not being able to understand the provider.⁶

Barriers to care can also have direct negative effects on patient health. When the pharmacist is not able to effectively communicate with the patient, the patient has an increased risk of medication errors or experiencing adverse events.¹

Data from the systematic review highlighted in Nurse Journal showed that approximately 16% of patients with language discordance had an adverse reaction to their medication because the communication barrier led to improper use^.6 Furthermore, language barriers can affect patient satisfaction and adherence to pharmacist recommendations, Mueller says.²

However, pharmacists can do several things to address language barriers with patients, regardless of their primary language. For instance, pharmacies can hire a trained interpreter to translate at the practice.² Pharmacies and other health care organizations can also implement a technology-based interpretation service or another type of language-access program to reduce barriers. Practices can also implement multicultural trainings—which can teach providers other relevant skills to use when interacting with LEP patients, and non-English phrases or cultural norms related to health care—and provide bilingual medical documents. Finally, practices can collaborate with community organizations that supply educational resources to health care systems.⁶

“Addressing language discordance in pharmacy settings is essential to providing equitable health care services and ensuring patient safety,” Mueller concluded.²

References

1. Muir RT, Kapoor A, Cayley ML, et al. Language discordance as a marker of disparities in cerebrovascular risk and stroke outcomes: A amulti-center Canadian study. Cerebral Circulation - Cognition and BehaviorCereb Circ Cogn Behav. 2023;4:100163. doi: 10.1016/j.cccb.2023.100163.

2. Mueller, R. Importance of Llanguage Sskills as a Ppharmacist. Concordia University Wisconsin. August 25, 2023. Accessed January 9, 2024. https://blog.cuw.edu/language-skills-pharmacist-2163-3/

3. Dietrich S, Hernandez E. Nearly 68 Mmillion Ppeople Sspoke a Llanguage Oother Tthan English at Hhome in 2019. Census Bureau. December 6, 2022. Accessed January 9, 2024. https://www.census.gov/library/stories/2022/12/languages-we-speak-in-united-states.html

4. Haldar S, Pillai, D, Artiga, S, Pillai, D, Haldar S. Overview of Hhealth Ccoverage and Ccare for Iindividuals with Llimited English Pproficiency (LEP). KFF. July 7, 2023. Accessed January 9, 2024. https://www.kff.org/racial-equity-and-health-policy/issue-brief/overview-of-health-coverage-and-care-for-individuals-with-limited-english-proficiency

5. Chavez B, Kosirog, E, Brunner JM. Impact of a bilingual pharmacy diabetes service in a federally qualified health center. Ann Pharmacother. 2018;52(12):1218-1223. doi: 10.1177/1060028018781852

6. Deering, M. Addressing Llanguage Bbarriers in Healthcare. Nurse Journal. News Release. September 29, 2023. Accessed January 9, 2024. https://nursejournal.org/articles/language-barriers-in-healthcare/