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Language Barriers Plague Almost Half of U.S. Drug Stores

Too many pharmacies can't safely help non-English-speaking clients, study finds

MONDAY, Aug. 6, 2007 (HealthDay News) -- If the experience of a group of Milwaukee-area pharmacists is any indication, nearly half of America's pharmacies are unable to communicate with, or provide information to, non-English-speaking clients.

That means as many as 168 million of the 4 billion prescriptions written each year could be going to patients who aren't able to fully understand the information provided, putting them at risk of potentially harmful medication errors, a new study finds.

The findings, "should put some pressure on the medical profession and pharmacies that they really need to help patients understand how to take their medications," said one expert, Dr. Robert Schwartz, professor of family medicine and community health at the University of Miami Miller School of Medicine. He was not involved in the study.

The research, published in the August issue of Pediatrics, was led by Dr. Glenn Flores, professor of pediatrics and public health at the University of Texas Southwestern Medical Center at Dallas. His team surveyed 175 pharmacies in Milwaukee County, Wis., to determine what sorts of services they provide to non-English-language clients.

Of the 128 pharmacies that responded to the survey, 53 percent could mostly or always provide non-English-language prescription labels; 46 percent could mostly or always provide non-English-language information packets; and 36 percent could mostly or always communicate in a non-English-language. Community pharmacies were least likely to be able to communicate with non-English-speaking clients, while those using telephone interpreter services were most likely to be able to communicate.

Of those pharmacies that could provide written information in a foreign language, most (88 percent for prescription labels, 95 percent for information packets) used computer software to do so. Among pharmacies providing verbal communication in a foreign language, two-thirds used bilingual staff, a third used telephone interpreters, and about one out of nine used a family member or friend of the patient to do so.

Overall, 55 percent of respondents claimed to be satisfied or very satisfied with their ability to communicate with non-English-speaking clients.

The study shows that "there are major barriers right now [for non-English-speakers] to getting high quality care," Flores concluded.

The solution, he said, is for pharmacies to hire additional non-English-speaking staff; increase the quality and number of non-English languages available in their computer software; and increase the use of phone interpreter services.

"I'm impressed, because it brings a very important issue to the public's attention," said Schwartz. He believes the team might have found different results in a more ethnically diverse community, however. According to figures cited in the study, 16 percent of the population of Milwaukee County speak a language other than English at home, and 7 percent have limited English proficiency.

"If you did this in Miami, you would probably get a different result," said Schwartz. "There are many pharmacies in Miami where you can only speak Spanish. An English speaker in those pharmacies might have to ask for help with instructions, too."

Flores says the issue of language and accurate communication isn't on the radar of many of the nation's druggists. "I'm always negatively surprised when I go around the country, and pharmacists say they never thought about this," he said.

One pharmacy that clearly has given thought to this issue is Maimonides Medical Center in New York City, which serves a patient base speaking some 60 to 70 languages and dialects, according to president and CEO Pamela Brier, who also was not involved in the study.

The hospital's pharmacy services provide prescribing information (but not labels) in any of 10 core languages, including English, Spanish, Mandarin, Cantonese, Russian, Italian, Urdu, Arabic, French, and Polish, and has made it a point to hire staff fluent in these languages, Brier said. Telephone interpreter services and multilingual (non-pharmacy) staff help fill in the gaps. The women's clinic has seen an increase in Bangladeshi patients, for instance.

"It is a big, big problem in urban care," Brier says. "I don't get how you take care of people if you don't speak the language and understand the culture, it's just not possible."

Language barriers can have real medical consequences, Flores said. He noted the case of a child with iron-deficiency anemia who was hospitalized after her Spanish-speaking parents gave her a 12.5-fold overdose of her medicine, because they misunderstood the prescription label. It read "15 mg [milligrams] per 0.6 mL [milliliters], 1.2 mL daily." They interpreted that to mean, administer 15 mL.

One thing non-English-speaking patients can do to help themselves, Flores said, is ask their physicians to indicate on their prescriptions that the label and/or associated information be provided in a language the patient understands. Also, they should let the pharmacist know when they do not understand the information provided.

"I think that combination may help stimulate pharmacists to know this is an important issue. This is compromising patient safety, so let's do something about this," he said.

More information

For health information in Spanish (or any of 9 other languages), visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Glenn Flores, M.D., director, division of general pediatrics, and professor, pediatrics and public health, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas; Robert Schwartz, M.D., professor and chair, family medicine and community health, University of Miami Miller School of Medicine; Pamela Brier, president and CEO, Maimonides Medical Center, Brooklyn, N.Y.; August 2007, Pediatrics
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