Language Concordance as a Determinant of Patient Compliance and Emergency Room Use in Patients with Asthma

TLDR

The study tests whether physicians speaking the same language as Spanish‑speaking asthma patients improves medication adherence, office visit attendance, and reduces emergency department use. Chart review of 96 Spanish‑speaking asthma patients—65 treated by seven bilingual physicians and 31 by 23 non‑bilingual physicians—was conducted. Patients with language‑discordant physicians were more likely to miss medication, appointments, and ER visits, with higher rate ratios in extended follow‑up, confirming that language concordance is linked to better compliance and cost‑effective ambulatory care.

Abstract

To test the hypothesis that the ability of physicians to speak the same language as asthmatic patients promotes patient compliance and the use of scheduled office appointments in preference to emergency services, the charts of 96 Spanish-speaking patients with asthma were reviewed. Of these patients, 65 were cared for by seven Spanish-speaking bilingual physicians and 31 were cared for by 23 non-Spanish speaking physicians. Compared with patients with language concordant physicians, patients with language discordant physicians were only slightly more likely to omit medication, to miss office appointments, and to make at least one emergency room visit. Subgroup analysis showed that, with extended follow-up, patients cared for by a language discordant physician were more likely to omit medication (rate ratio: 3.24; P=0.08), more likely to miss office appointments (rate ratio: 3.06; P=0.01), and were slightly more likely to make an emergency room visit (rate ratio: 2.07; P=0.12) than patients with language concordant physicians. Cox regression analyses taking account of differences in follow-up time, age, gender, pay-status, and severity of disease confirmed these findings. These data suggest that patient compliance and more cost-effective use of ambulatory care services may be associated with the ability of physicians to speak the same language as their patients.