A Patient Compliance And Literacy Problem
Or A Failure In The Healthcare System?

Introduction

Despite federal mandates to translate prescriptions,¹ the technical capacity to do so, and the rather obvious clinical need for prescription information in the language of non-English speaking patients , many pharmacies in New York City do not provide translated labels,according to an April 27, 2007 presentation by Linda Weiss, PhD, at the annual meeting of the Society for General Internal Medicine held in Toronto, Ontario, Canada.

As Dr. Weiss notes:

Study Parameters and Results

Of the 2186 New York City pharmacies licensed in 2006, 200 pharmacies were surveyed.

“Health literacy is the strongest predictor of a person’s health status,” Ann Zweber, RPh, director of assessment and senior instructor of pharmacy practice at Oregon State University in Corvallis, told Medscape in response to a request for independent commentary. She was not involved with this study.

“If patients do not understand their medical condition and how to manage it, including how to use their medications, they are more likely to suffer from poor health outcomes,” Dr. Zweber said.

Translation Capacities

Even those pharmacists who provided translated printed information did so only when they happened to notice a patient having difficulty with English (54%) or if specifically asked (33%). Less than 20% of the pharmacies surveyed had protocols to systematically identify patients who need might need translated labels; less than 10% had signs indicating that translated materials were available.

Commentary

First, I recommend reading the article, which also includes speculation about the reasons pharmacies appear less likely than other healthcare providers to offer translated information, thoughts about informal strategies by some pharmacies to provide patients information in their own language, and services being developed to provide more sophisticated and specialized translation services.

Although, as the authors note, the research has limitations,² its revelation that a large proportion of a randomly selected sampling of pharmacies lacked a systematic means of providing clinical information to a patient in his or her own language is astounding. My contention, in fact, is that this problem transcends issues of patient compliance and patient literacy.

Conceptualizing a patient as noncompliant because of a failure to following instructions provided in a language that patient doesn’t comprehend may meet some technical definition of compliance but certainly has little in common, for example, with a patient who unilaterally changes a medication dose because of side-effects or another who never has a prescription filled because of distrust of doctors.

Similarly, a recent immigrant who speaks only Spanish may somehow be described as functionally illiterate in an environment dominated by users of the English language, but describing the problem in terms of “health illiteracy” risks misrepresenting the problem as a deficit on the part of the patient when, given the rather easy availability of translation software, the primary responsibility rests upon the pharmacies.

As one of those doctors who are reflexively resistant to government “interference,” I have fastidiously looked to - well, to anyone else but government solve problems in the healthcare system. In this case, however, I am foursquare in favor of an approach that first addresses enforcement of the altogether reasonable regulations that all healthcare providers, including pharmacies, provide materials translated into an language understood by the patients served.³

Source: Pharmacies May Not Always Translate Prescription Labels for Non-English Speaking Patients Laurie Barclay, MD Medscape Medical News 2007.


Footnotes

1. All healthcare providers receiving federal funds are, by legislation, required to offer language services to limited English proficient patients [back]
2. E.g., the data were collected “through a relatively brief telephone survey (shorter than 5 minutes), preventing probing any item in detail; and reliance on self-report, which most likely biases the findings toward overestimation of pharmacy translation practices.” [back]
3. Yes, the regulations must be practical. Not every pharmacy in southwest Missouri can provide labels written in an obscure dialect spoken only by the last 83 members of an isolated tribe living on a tributary of the Amazon. That kind of exception, however, should not be confused with a New York pharmacy not offering prescription levels in Spanish. [back]

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