Patient-physician language concordance linked to improved glycemic control

1. For Latino patients with limited-English proficiency (LEP), changing from language-discordant to language-concordant primary care physician was associated with improved rates of glycemic and low-density-lipoprotein (LDL) control.

2. Most patients who switched physicians underwent improvement in glycemic, cholesterol, and blood pressure control regardless of language status.

Evidence Rating Level: 2 (Good)       

Study Rundown: In the United States, many of the 50 million Latinos may have limited English proficiency (LEP), which adds barriers to communication and care. In previous studies, LEP Latinos with diabetes have improved rates of anti-glycemic medication adherence and glycemic control when receiving care from a language-concordant primary care physician (PCP). The current study is an observation of LEP Latino diabetic patients undergoing PCP change to examine differences in glycemic, cholesterol, and blood pressure control based on patient-physician language concordance/discordance.

In the study cohort of LEP Latinos who underwent a change in PCP, language was listed as a reason for 30% of those who switched from discordant to concordant pairings. Overall, most patients after a PCP switch had improvements in glycemic, cholesterol, and blood pressure control. However, improvement in glycemic control was more substantial amongst the group of patients who changed from a language-discordant to language-concordant PCP. The same was seen in improvement of LDL. The strength of the study included appropriate pre- and post-change data, and the reasons for PCP changes. The main limitations of the study were the relatively short follow up period, and the lack of data about the extent of language comprehension for each patient.

Click to read the study, published today in JAMA Internal Medicine

Relevant Reading: Language Concordance, Interpersonal Care, and Diabetes Self-Care in Rural Latino Patients

In-Depth [retrospective cohort]: This study included patients from the Kaiser Permanente Northern California Diabetes Registry who self-identified as Latino with a preferred language as Spanish and switched PCPs at least once during the study period of 2007 to 2013. Patients were included if they were empaneled with pre- and post-switch physicians for 12 months, and had continuous membership, drug benefits, and physician language data available. PCPs were identified as Spanish speaking either through self-identification or through billing codes for bilingual physicians. Outcomes included good glycemic control (HbA1c <8%), poor glycemic control (HbA1c >9%), LDL control (<100 mg/dL), and systolic blood pressure control (<140 mm Hg).

A total of 1605 LEP Latinos were included in the study. Patients who switched from language-discordant to language-concordant PCPs cited language as the reason more often (30% vs. 9%). All groups (discordant to discordant, discordant to concordant, concordant to concordant, concordant to discordant) experienced improved glycemic control after switching. LEP Latinos undergoing discordant to concordant switch had the greatest improvement with 10% (p = 0.01) net increase in good glycemic control; while concordant to discordant pairings had no significant improvement in control. Control of LDL was improved for both discordant to concordant (9% increased, 95%CI 1-17%) and concordant to discordant (15%, 95%CI 7-24%) pairings.

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