Parker Melissa M, Fernández Alicia, Moffet Howard H, Grant Richard W, Torreblanca Antonia, Karter Andrew J
Division of Research, Kaiser Permanente, Oakland, California.
Division of General Internal Medicine, San Francisco General Hospital, San Francisco, California3Department of Medicine, University of California at San Francisco, San Francisco, California.
JAMA Intern Med. 2017 Mar 1;177(3):380-387. doi: 10.1001/jamainternmed.2016.8648.
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.
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.
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.
为美国越来越多英语水平有限（LEP）的糖尿病拉丁裔提供具有文化胜任力的护理具有挑战性。
评估从语言不匹配（仅会英语）的初级保健医生（PCP）转为语言匹配（会说西班牙语）的PCP或反之的LEP糖尿病拉丁裔患者危险因素控制的变化。
设计、设置和参与者：这项前后对比的差异研究选取了1605名成年糖尿病患者，他们自我认定为拉丁裔，首选语言为西班牙语，且在2007年1月1日至2013年12月31日期间更换了PCP。研究参与者是北加利福尼亚凯撒永久医疗保健系统（一个可获得双语PCP和/或专业口译服务的综合医疗保健服务系统）的成员。会说西班牙语和仅会英语的PCP通过自我报告或使用数据来确定。
更换PCP后患者与PCP语言匹配情况的变化。
血糖控制（糖化血红蛋白[HbA1c]<8%）、血糖控制不佳（HbA1c>9%）、低密度脂蛋白（LDL）控制（LDL<100mg/dL）和收缩压（SBP）控制（SBP<140mmHg）。
总体而言，本研究纳入了1605名LEP糖尿病拉丁裔成年人（平均[标准差]年龄为60.5[13.1]岁），与从一名语言不匹配的PCP转为另一名语言不匹配的PCP的患者相比，从语言不匹配的PCP转为匹配的PCP的患者在血糖和LDL控制方面有显著的净改善。经过调整并考虑长期趋势后，血糖控制的患病率增加了10%（95%CI，2%至17%；P = 0.01），血糖控制不佳的患病率降低了4%（95%CI，-10%至2%；P = 0.16），LDL控制的患病率增加了9%（95%CI，1%至17%；P = 0.03）。SBP控制方面未观察到显著变化。从匹配的PCP转为不匹配的PCP的LEP拉丁裔中，LDL控制的患病率增加了15%（95%CI，7%至24%；P<0.001）。任何一组在更换PCP后危险因素控制均未恶化。
我们观察到从语言不匹配的PCP转为匹配的PCP的LEP糖尿病拉丁裔患者在血糖控制方面有显著改善。促进语言匹配的护理可能是LEP拉丁裔糖尿病管理的一种策略。
