Transcript - Migration Policy Institute

Language Access in Pharmacies
Linda Weiss, PhD
The New York Academy of Medicine
Emily M. Ambizas, PharmD
St. John’s University, College of Pharmacy and Allied Health Professions
New York State Conference on
Increasing Language Access in Healthcare
April 2007
Presentation Focus

The availability of prescription medication instructions in
languages other than English, including:



Improving language access



Pharmacist provision of written prescription medication information
Counseling in languages other than English
Methods for providing multilingual medication information
Barriers to and facilitators of change
Will be discussing our recent research, as well as more general information
on language issues in a pharmacy context
Language Access in NYS Pharmacies: Legal
Considerations

As recipients of federal funds in payment for medications, pharmacies may be
subject to the requirements of Title VI of the 1964 Civil Rights Act.

Pharmacies may be required to provide language access services to comply
with the branding and counseling provisions governing pharmacy practice.
Branding: Medical labels or printed information must be rendered in a way that “is likely to be
read and understood by the ordinary individual under customary conditions of purchase and
use.”
Counseling: A pharmacist or pharmacy intern providing prescription services shall be required
to personally counsel each patient or person authorized to act on behalf of a patient.

Hospital-based pharmacies may be required to follow the directives of the
NYS Language Access and Patients Rights regulations adopted in September
2006

NYS pharmacies are required to print labels in English. They can print labels
in a second language as well.
New York City Demographics:
Foreign Born and LEP

Approximately 2.9 million immigrants live in NYC,
accounting for 36% of the City’s population

Currently, immigrants and their children account for nearly
2/3 of the NYC’s population.

More than 1 in 4 adults in NYC do not speak English at all
or do not speak it well.

Almost ½ of LEP New Yorkers live in homes where no one speaks
English well.
New York
City:
LEP by
Neighborhood
Current Practice in NYC:
Results from a Survey of Pharmacists




Conducted a telephone survey of 200 randomly selected pharmacies
from a list of all NYC pharmacies (2100+) provided by the Office of
Professions, NYS Education Department.
Interviews were conducted with a pharmacist on duty.
Survey included questions on:
 Frequency and language of LEP customers
 Languages spoken by pharmacy staff
 Ability to print translated medication labels and leaflets
 Frequency of translations
 Other policies and practices regarding multilingual medication
information
Interviews were conducted between February and August 2006 and
took about 5 minutes each to complete.
Pharmacist & Pharmacy Characteristics

Pharmacy Type





Independent
Chain
Hospital outpatient
Clinic
119
71
7
3
(59.5%)
(35.5%)
(3.5%)
(1.5%)
76
10
75
11
20
8
(38%)
(5%)
(38%)
(6%)
(10%)
(4%)
Pharmacist Birthplace






USA/Canada/Puerto Rico
Africa/Middle East
Asia & Pacific Islands
Caribbean/S. America
Europe
Missing
Limited English Proficient Pharmacy
Patients

Pharmacist Self-Report

Daily LEP, any language






Daily Spanish
Daily Chinese
Daily Russian
Less than daily LEP
No LEP customers
176 (88%)
156 (78%)
31 (16%)
27 (14%)
14 (7%)
10 (5%)
Percent LEP in pharmacy census tract



Mean
Median
Range
24.4%
22.3%
3.2% - 62.9%
Frequency of Translation of Written Materials

Sample with LEP customers daily (n = 176)





Daily translation
Weekly translation
< Weekly translation
Never translate
Don’t know/missing
63
22
39
44
8
(35.8%)
(12.5%)
(22.2%)
(25.0%)
(4.5%)
Bivariate
Associations
with Daily
Translation:
Pharmacies
with Daily
LEP
Customers
(n = 176)
Characteristics
Pharmacist gender
Male
Female
Missing
Pharmacist license date
2000-present
1990-1999
1980-1989
<1980
Missing
Pharmacist birthplace
USA/Canada
Africa/Middle East
Asia/Pacific Islands
Europe
South America/Caribbean
Missing
Pharmacist position
Owner
Manager
Staff
Other
Missing
Pharmacy type
Chain
Independent
Hospital outpatient/Clinic
Daily LEP patients at pharmacya
Any language
Spanish language
Chinese language
Russian language
LEP in census tract, mean % (range)
Any language
Spanish language
Other European language
Asian language
* p < .05 in logistic regression
** p < .01 in logistic regression
Pharmacies with
daily LEP patients
Odds of daily
translation
1.00
0.62
(0.32,1.19)
1.00
0.91
1.13
1.59
(0.40, 2.03)
(0.41, 3.09)
(0.63, 3.99)
1.00
0.71
2.70
1.25
0.36
(0.13,
(1.31,
(0.43,
(0.04,
1.00
0.56
0.52
--
(0.24, 1.32)
(0.21, 1.29)
--
1.00
7.06
6.43
(2.92, 17.05)**
(1.47, 28.05)*
1.00
0.64
1.76
0.39
(0.25, 1.63)
(.0.81, 3.86)
(0.15, 1.03)
1.05
1.08
0.93
1.01
(1.03,
(1.05,
(0.88,
(0.99,
3.84)
5.56)**
3.63)
3.16)
1.08)**
1.11)**
0.99)*
1.04)
Adjusted Odds for Daily Translation of
Medication Labels
Characteristic
Pharmacist birthplace
USA/Canada/Puerto Rico
Asia/Pacific Islands
South America/Caribbean
Africa/Middle East
Europe
Pharmacy type
Chain
Independent
Clinic/Outpatient hospital
Pharmacy neighborhood characteristics
LEP in pharmacy neighborhood, Spanish speaking
LEP in pharmacy neighborhood, other Eur. Language
LEP in pharmacy neighborhood, Asian language
*p <.05 in multivariate logistic regression
** p < 0.01 in mutivariate logistic regression
Adjusted Odds Ratio &
(Confidence Interval)
1.00
1.50
0.15
0.22
1.20
(0.64, 3.52)
(0.01, 1.97)
(0.03, 1.49)
(0.32, 4.39)
1.00
4.08
6.43
(1.55, 10.74)**
(1.27, 32.48)*
1.09
0.99
1.03
(1.05, 1.13)**
(0.92, 1.06)
(0.99, 1.06)
Pharmacy Capacity to Provide Medication
Information in Languages other than English
Spanish
n (%)
Translated labels & patient
information sheets
Main label
Patient information sheet
Warning label
Verbal information in
languages other than English
Yes
By pharmacist
By other staff
Telephone interpretation
Yes
No
143
103
149
(71.5%) 24
(51.5%)
9
Chinese
n (%)
(12.0%) 19
(4.5%)
8
Russian
n (%)
(9.5%)
(4.0%)
Any Language
n (%)
159
103
88
(79.5%)
(51.5%)
(44.0%)
(74.5%) 28
(14.0%) 24
(12.0%) 177
(88.5%)
44 (22.0%)
23 (11.5%)
17 (8.5%)
86 (43.0%)
117 (58.5%)
6 (3.0%)
10 (5.0%)
133 (66.5%)
27
172
(13.5%)
(86.0%)
Most pharmacies (75%) have dispensing software with translation capabilities. 2 respondents
said they developed their own translation software. 9 respondents said they handwrite the
translations.
Translated Medication Labels: Determining
Who Gets Them






Can tell through interaction
Language in customer record
Customer requests translation
Indicated on the prescription
Sign in pharmacy
Word of mouth
108
20
66
14
15
21
(54.0%)
(10.0%)
(33.0%)
(7.0%)
(7.5%)
(10.5%)
Four pharmacists reported that translated labels are provided to all patients except those
requesting English only.
Understanding Medication Information:
Why it is important

Information may be complex, including:
 Dosing, frequency and duration



Implication of medication errors:


Reduced efficacy, side effects, drug resistance
The significance of prescription medications for treatment of illness:


Special instructions regarding food, liquids, and storage
Side effects
1.3 billion medications were prescribed or provided during medical visits in 2002
alone
Patients have day-to-day responsibility for medication management and
recognition of adverse events
Efforts Made to Provide Information in Multiple
Languages (more common)






Utilization of dispensing software with translation
capabilities
Handwritten translated instructions
Staffing with bilingual employees and/or language
study
Telephone interpreting using language lines
Telephone medication counseling by bilingual
pharmacists in other pharmacies
On-line medication and health information in multiple
languages (e.g. walgreensespanol.com)
Efforts Made to Provide Information in Multiple
Languages (less common & more costly)

In-stores kiosks with health information in multiple
languages

Video-based interpretation services


Direct video link between the patient and a remote
translator
“Talking” medication bottles with verbal
instructions
Barriers to Increased Language Access

Pharmacists concerned about translating into languages they don’t
understand – concerned about liability if there is an error

Inadequacies in translation software


Programs may only print one language at a time. May need to print two
labels to have English and a second language
Translations may be awkward, not grammatically correct

Demands on pharmacists’ time are already very high. Some feel there
is not time for translation

Shortage of qualified bilingual staff

Pharmacists attitudes and level of awareness
Planned Next Steps:
Improvement in language access at pharmacies through:




Continuing education classes for practicing pharmacists
Pilot interventions at selected pharmacies
Review of label translations for accuracy and reliability
Outreach to LEP populations
Next Step Objectives
Increased:




Availability and awareness of dispensing software with translation
capabilities
Availability and awareness of telephone interpreting services
Inclusion of patient language preference in the patient profile
Signage and proactive efforts to inform patients of available language
services
Decreased:

Use of “ad hoc” interpreters
Project Staff & Community Advisory Board
Members


















Emily Ambizas, St. John’s University, College of Pharmacy and Allied Health Professions
Elana Behar, The New York Academy of Medicine
Tamar Bauer, Nurse – Family Partnerships
Sebastian Bonner, The New York Academy of Medicine
Olveen Carrasquillo, Columbia University Department of Medicine
Francesca Gany, New York University School of Medicine
Adam Gurvich and Maysoun Freij, The New York Immigration Coalition
Holly Lee, Charles B. Wang Community Health Center
Robert A. Mangione, St. John’s University, College of Pharmacy and Allied Health Professions
Priti Patel., St. John’s University, College of Pharmacy and Allied Health Professions
Peri Rosenfeld, Visiting Nurse Services of New York
Elyse Rudolph, Literacy Assistance Center
Linda van Schaik, Bellevue Hospital Center
Lauren Schwartz, NYC Poison Control Center
Karen Scott Collins, NYC Health and Hospitals Corporation
Iman Sharif, Albert Einstein College of Medicine/Montefiore Medical Center
Linda Weiss, The New York Academy of Medicine
-----Kate Liebman, Program Officer, Altman Foundation
Contact information:
Linda Weiss, PhD
Senior Research Associate
The New York Academy of Medicine
[email protected], tel: 212-822-7298
Emily Ambizas, PharmD
Assistant Clinical Professor
St. John’s University, College of Pharmacy and Allied
Health Professions
[email protected], tel: 718-990-2753