1. Based on retrospective cohort data, limited English proficiency (LEP) Latino patients were more likely to be non-adherent to oral hypoglycemic medications and insulin as compared to English-speaking Latino patients and Caucasian patients.
2. Patient-physician language concordance was not associated with increased rates of adherence among LEP Latino patients, suggesting that other factors, such as cultural differences, may be important barriers to receiving appropriate care.
Evidence Rating Level: 2 (Good)
Study Rundown: Medication adherence is important in the management of chronic medical conditions like diabetes. Understanding barriers can help create solutions to address these issues. Differences in language proficiency may be a factor in decreased adherence amongst diabetic Latino patients. This retrospective cohort study aimed to determine the association between patient race/ethnicity, preferred language, and physician language concordance with patient-adherence to newly prescribed diabetes medications.
Limited English proficiency (LEP) Latino patients were more likely to be non-adherent to oral hypoglycemic medications and insulin compared with both English-speaking Latino patients and Caucasian patients. Additionally, English-speaking Latino patients were more likely to be non-adherent compared with Caucasian patients. The concordance of language between the patient and physician was not associated with adherence in LEP Latino patients. Strengths of this study included the use of validated electronic records to determine medication adherence (based on prescription filling). Limitations of this study included the use of administrative data, which may result in misclassification error with English-proficiency status. Also, adjustment for socioeconomic status was dependent on a contextual measure called the Neighborhood Deprivation Index, as opposed to individual-level socioeconomic indicators.
In-Depth [retrospective cohort study]: This retrospective cohort study was conducted using the Kaiser Permanente Northern California Diabetes registry from January 2006 to December 2012. The cohort included insured patients with type 2 diabetes who were English-speaking Caucasian, English-speaking Latino or LEP Latino patients with new prescriptions for diabetes medications. The exposures of interest were patient race/ethnicity, preferred language and physician self-reported Spanish-language fluency. The primary outcome of interest was primary non-adherence (never dispensed), early-stage non-persistence (dispensed only once), late-stage non-persistence (³2 dispenses, but discontinued within 24 months), and inadequate overall medication adherence (>20% time without sufficient medication supply during 24 months after initial prescription). Statistical analyses include bivariate analysis using Χ2 test, t tests and Wilcoxon rank sum tests. Multivariate and modified Poisson regression models were used to calculate adjusted relative risk (adjusted for: age, sex, socioeconomic status as defined by the Neighborhood Deprivation Index for both the patient and the physicians).
The study population was 30 838 (21 878 were Caucasian, 5755 English-speaking Latino patients, 3205 LEP Latino patients). Among LEP Latino patients, 50.2% had a language concordant physician. Overall non-adherence was statistically higher in LEP Latino patients as compared to English-speaking Latino patients and Caucasians. When adjusted for patient and physician characteristics this relationship persisted: LEP Latino patients were more likely to be non-adherent to oral hypoglycemic medications and insulin than both English-speaking Latino patients (RR from 1.11, 95% CI 1.06-1.15 to RR 1.17, 95% CI 1.02-1.34; p < 0.05), and Caucasian patients (RR from 1.23, 95% CI 1.19-1.27 to RR 1.30, 95% CI 1.23-1.39; p < 0.05). Patient-physician language concordance was not associated with rates of non-adherence among LEP Latino patients.
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