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Studies explore reasons for Latino Health Care disparities

Newswise — According to a pair of recent studies Limited English Proficiency (LEP) is a key barrier to accessing primary health care services for U.S. Hispanics, while new data show a growing discrepancy in mental health services delivered to the Latino community.

Both are presented in the November issue of Medical Care, published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

The new studies "emphasize the importance of language access achieved through system change," comments Dr. Eliseo J. Pérez-Stable of University of California, San Francisco, in an accompanying editorial. "Individual clinicians have a responsibility to care for LEP patients in the best possible way. Health systems and policy makers have a responsibility to provide the means by which to achieve this."

A survey study led by Dr. Jennifer S. Haas of Brigham and Women's Hospital and Harvard Medical School evaluated the effects of LEP on key measures of the quality of primary health care delivered to 1,792 Latinos. All of the subjects had current health insurance, thus eliminating lack of insurance as a health care barrier.

About 40 percent of the study subjects described their English as "poor or fair." Latinos in this LEP group scored lower on three of four health care quality measures. Compared to those whose English was "good to excellent," the LEP subjects were twice as likely to have no regular source of health care or to lack continuity of care.

Latinos with LEP also had more problems with long waits in the waiting room and with getting medical information or advice by telephone. English proficiency did not affect the ability to get medical appointments over the phone. "These results suggest that interventions to address LEP may be important to improving the quality of primary care for this rapidly growing population," Dr. Haas and colleagues write.

In the second study, Dr. Carlos Blanco of Columbia University and colleagues used nationally representative survey data to compare trends in mental health care for U.S. Hispanics versus non-Hispanics. On most measures of mental health care, Hispanics showed no change from 1993-96 to 2000-02.

In contrast, mental health services provided to non-Hispanic patients increased substantially during the same period. For example, the percentage of doctor's office visits resulting in diagnosis of a mental disorder remained at about five percent for Hispanic patients. For non-Hispanic patients, the same measure increased from six to nine percent.

There was a sharp difference in prescriptions for drugs used to treat mental disorders (psychotropic medications). The rate of such prescriptions decreased slightly for Hispanic patients (from about ten to nine percent), compared to a significant increase for non-Hispanics (from ten to 12.5 percent). Psychotherapy and psychiatrist visits also decreased for Hispanic patients, but increased for non-Hispanics. The "growing ethnic disparity" in mental health care "may be related to a mismatch between the large growth of the Hispanic population and the health care system's ability to adapt to this growth," Dr. Blanco and colleagues write.

Limited English proficiency appears to be an important contributor to the recognized health care disparities among Latino populations, according to Dr. Pérez-Stable. The findings raise tough questions for the health care system: Should LEP patients be seen only by doctors and nurses who are proficient in that language? Should new policies be established to ensure that professionally trained interpreters are available?

Both solutions would face challenges in addressing the widening gap in mental health care. Dr. Pérez-Stable concludes, "Effective communication between the patient and the clinician is a central component in defining access to health care, and may be critically important for research about health disparities."