Improving Quality of Care for Spanish-Speaking Patients in a Dermatology Clinic

From the 2022 HVPA National Conference

Brett McLarney PhD (Lewis Katz School of Medicine at Temple University), Theresa Tran B.S. (Lewis Katz School of Medicine at Temple University), Christina Lopez MD, Afton Metkowski MD, Sylvia Hsu MD, Kraftin Schreyer MD, Dharmini Shah Pandya MD

Background

Temple University Hospital (TUHS) serves as a safety-net hospital for the 462,455 patients in the Greater North Philadelphia area. Approximately 30% of these patients identify as Hispanic. In efforts to increase accessibility to dermatologic care, the TUH dermatology clinic offers walk-in clinic hours and sees a high volume of patients – routinely exceeding 100 patients in a single afternoon. Many patients require Spanish language interpreting services. While in-person and remote interpretational services are available, in practice, these services are limited by the time required to use, unclear audio-visual, and occasional dropped calls.

Objective

The objective of this project is to assist the TUH Dermatology Department in improving patient satisfaction and health outcomes for Spanish-speaking patients without compromising the clinic’s high-volume and ‘walk-ins-welcome’ policy. Our intervention focuses on providing after-visit educational materials, translated into Spanish, to Spanish-speaking patients seen in the clinic.

Methods

Independent observations for clinical process and flow were utilized to construct a process and flow diagram. Baseline data on the Spanish-speaking patient clinic experience, satisfaction, and understanding was gathered by means of after-visit, patient-completed surveys (n = 29).

Results

The average after-visit satisfaction rating 4.7 on a 5-point Likert scale; average patient rating of the quality of interpretational services offered was 4.6. Of the 29 patients, 22 (76%) utilized an official interpreter during the visit; 1 (3%) reported difficult understanding the diagnosis and/or treatment during their current visit; 7 (24%) experienced difficulty understanding diagnosis and/or treatment of their condition in the past; 29 (100%) reported wanting to be provided with information, written in Spanish, regarding their diagnosis and treatment. Implementation of the translated educational handouts is in progress.

Conclusion

Currently, Spanish-speaking patients report high satisfaction with visits at our clinic. However, interpretational services, understanding of the diagnosis and/or treatment, and structural barriers are areas that can be improved. Strikingly, despite the majority of patients reporting understanding the relevant medical information for their conditions, all patients indicated wanting education materials regarding their conditions provided in their native language. One explanation for this discrepancy is that patients overreport their understanding on surveys compared to reality. There may also be concern among patients for missing crucial pieces of information regarding their conditions at future visits despite a current level of good understanding.

Clinical Implications

Minimizing healthcare disparities is a top priority for providers. As such, recognizing the additional barriers to care experienced by Spanish-speaking patients and employing interventions to decrease these barriers is paramount to achieving an equitable healthcare environment. Data collected in this project has motivated our clinic to work with professional translating services to provide written educational materials regarding common dermatologic conditions, such as atopic dermatitis and alopecia, to Spanish-speaking patients in their native language. We will utilize handouts to provide supplemental information to patients with their after-visit-summaries. The next step is to conduct a pilot trial and survey patients regarding intervention satisfaction and diagnosis and treatment understanding. Statistical analysis will be applied to compare current baseline data with post-implementation data. If proven satisfactory, we will increase our information bank and expand to other languages spoken at the TUH dermatology clinic including Russian, Chinese, and Vietnamese.

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