Despite the frequent need for language assistance services (LAS) at community pharmacies and the widespread availability of such services, LAS are underused by community pharmacists, results of a recent survey show.
"Patients who are not proficient in English and who do not know that LAS are available at their pharmacy will not be able to understand the purpose, dosage, and possible side effects of their medications," said Kevin Clauson, PharmD, associate professor of pharmacy practice at Nova Southeastern University in Palm Beach Gardens, Florida. "Sadly, patients are at increased risk of poor outcomes if they are not proficient in English and don’t have prescription information in their own language."
Clauson and his co-investigators analyzed responses to questionnaires completed by 296 chain and independent community pharmacists nationwide.
According to US census figures, a language other than English is spoken in 19.7% of homes in the United States. Of those speaking a language other than English at home, 8.6% have limited English proficiency (Census 2000: Language Use. www.census.gov/population/www/socdemo/lang_use.html).
"My colleagues and I were increasingly concerned about possible inaccuracies on some of the prescriptions we were dispensing," Clauson explained. "For example, some of the native Spanish speakers and Russian speakers were saying that the translations did not exactly match what was being inputted into the system."
LAS include interpreters as well as translated written materials, such as a medication package insert.
The results show that although LAS are available in up to 73.8% of pharmacies nationwide, 49.8% of pharmacists who worked at a pharmacy where such services were available acknowledged that they do not notify their patients about the availability of such services.
Not surprisingly, Spanish was the language most often requested for verbal interpretation or translation nationwide. French, Vietnamese, Chinese, and Russian were also commonly requested.
More than half of pharmacists who did not use LAS said their hesitation stemmed from concern about inaccuracies in translation/interpretation. Nearly one third said that the provision of LAS was too time-consuming. "This is undoubtedly a workflow issue that should be easy to address," Clauson said.
To improve the workflow, pharmacies may want to consider reexamining the "duties" performed by pharmacy personnel at each workstation. Focus groups may also help identify ways to reduce the time it takes to process prescriptions and make more efficient use of personnel.
About one fourth of respondents cited concern about legal issues. "Pharmacists said they were worried that they would be liable if the prescription label was printed in a language they did not know and included inaccurate translations," he explained. Pharmacists said that LAS were most often needed at prescription drop-offs (56.2%), during counseling (39.2%), and when prescriptions were picked up (36.1%).
"The takeaway message is that LAS are available, but they are currently being used suboptimally," Clauson observed. "And we believe that making sure that patients are aware of such services can help improve outcomes in this particularly at-risk population with limited English proficiency." For example, posting notices in conspicuous areas that inform patients about the availability of interpreters and how to contact an interpreter may be helpful, he said.
Finally, he noted that interventions may need to take into account cultural barriers. "Some patients who come from cultures where they are taught not to question authority figures because it’s perceived as disrespectful may simply nod in agreement when the pharmacist explains how to use a medication," he said. "However, they may not understand, and they then go home and draw up 5 tablespoons of cough syrup for their child instead of 5 mL, which is a preventable error."
Clauson mentioned a case where a pharmacist tried to explain to the Spanish-speaking parents of a 10-month-old girl how to give the prescribed dose of an iron supplement by showing them the dropper and vial. The pharmacist did not speak Spanish, and an interpreter was not used. Although the parents nodded that they understood the pharmacist’s directions, instead of using the dropper, they gave a tablespoon of iron to the infant. As a result, the child received a 12.5-fold overdose and had to be hospitalized (Morbidity and Mortality Rounds on the Web. April 2006).