Does glycemic control improve for limited–English proficiency (LEP) Latinos with diabetes who switch from English-only to Spanish-speaking primary care physicians (PCPs)?
In this pre-post comparative study of 1605 LEP Latino patients with diabetes who switched PCPs, it was found that there was a significant 10% increase in the proportion of patients with glycemic control among those who switched from an English-only to a Spanish-speaking PCP compared with those who switched from one English-only PCP to another.
Facilitating language-concordant care may be an effective strategy for diabetes management among LEP Latinos with diabetes.
Providing culturally competent care to the growing number of limited–English proficiency (LEP) Latinos with diabetes in the United States is challenging.
To evaluate changes in risk factor control among LEP Latinos with diabetes who switched from language-discordant (English-only) primary care physicians (PCPs) to language-concordant (Spanish-speaking) PCPs or vice versa.
Design, Setting, and Participants
This pre-post, difference-in-differences study selected 1605 adult patients with diabetes who self-identified as Latino, whose preferred language was Spanish, and who switched PCPs between January 1, 2007, and December 31, 2013. Study participants were members of the Kaiser Permanente Northern California health care system (an integrated health care delivery system with access to bilingual PCPs and/or professional interpreter services). Spanish-speaking and English-only PCPs were identified by self-report or utilization data.
Change in patient-PCP language concordance after switching PCPs.
Main Outcomes and Measures
Glycemic control (glycated hemoglobin [HbA1c] < 8%), poor glycemic control (HbA1c > 9%), low-density-lipoprotein (LDL) control (LDL < 100 mg/dL), and systolic blood pressure (SBP) control (SBP < 140 mm Hg).
Overall, 1605 LEP Latino adults with diabetes (mean [SD] age, 60.5 [13.1] years) were included in this study, and there was a significant net improvement in glycemic and LDL control among patients who switched from language-discordant PCPs to concordant PCPs relative to those who switched from one discordant PCP to another discordant PCP. After adjustment and accounting for secular trends, the prevalence of glycemic control increased by 10% (95% CI, 2% to 17%; P = .01), poor glycemic control decreased by 4% (95% CI, −10% to 2%; P = .16) and LDL control increased by 9% (95% CI, 1% to 17%; P = .03). No significant changes were observed in SBP control. Prevalence of LDL control increased 15% (95% CI, 7% to 24%; P < .001) among LEP Latinos who switched from concordant to discordant PCPs. Risk factor control did not worsen following a PCP switch in any group.
Conclusions and Relevance
We observed significant improvements in glycemic control among LEP Latino patients with diabetes who switched from language-discordant to concordant PCPs. Facilitating language-concordant care may be a strategy for diabetes management among LEP Latinos.
Parker MM, Fernández A, Moffet HH, Grant RW, Torreblanca A, Karter AJ. Association of Patient-Physician Language Concordance and Glycemic Control for Limited–English Proficiency Latinos With Type 2 Diabetes. JAMA Intern Med. Published online January 23, 2017. doi:10.1001/jamainternmed.2016.8648